“家属”照护策略在隔离病房的2019冠状病毒病患者中的应用

Application of“family member-like”care strategies among COVID-19 patients in an isolation ward

目的:2019冠状病毒病(coronavirus disease 2019,COVID-19)暴发后,为了有效控制疫情,中国采取了严格的隔离措施,确诊患者需收治在负压隔离病房,疑似患者必须隔离。在隔离期间,患者不仅面临多种困难,如适应环境、担心疾病的预后、对治疗缺乏信心等,还经历着与家人分离、与医务人员有距离感的痛苦,这些问题都可能导致患者产生孤独、焦虑、抑郁、失眠和绝望等一系列心理不适。因此,为了减少患者的负面情绪,“家属”照护策略应运而生。本研究旨在探讨“家属”照护策略能否提高隔离病房患者的心理弹性,改善其抑郁、焦虑、压力症状。方法:采用类实验设计评价对隔离病房成人COVID-19患者实施的“家属”照护策略的效果。2020年2月9日至3月20日期间在华中科技大学同济医学院武汉协和医院西院区湘雅病房住院的COVID-19患者被纳入本研究。医疗服务提供者自愿成为患者的家属,从患者入院到出院为其提供一对一、全程的家属式的照护。采用Connor-Davidson心理弹性量表简化版(CD-RISC-10)和抑郁-焦虑-压力量表中文版(DASS-21)对患者入院时、入院2周后和出院时的心理弹性和抑郁、焦虑、压力情况进行评估。结果:此问卷的应答率为100%。在60名患者中,39名(65.0%)为男性,21名(35%)为女性,住院时间为(27.5±3.5)d。60例患者均痊愈出院,无1例死亡和发生严重的并发症。CDRISC-10总分入院时为8.83±6.86,入院后2周为29.13±5.42,出院时为33.87±6.14,后2次评分较入院时均明显增加(F=404.564,P<0.001);多变量重复测量方差分析表明患者在韧性(F=360.839,P<0.001)、力量(F=368.217,P<0.001)和乐观(F=328.456,P<0.001)方面的评分有显著提高。入院时DASS-21总分为49.27±11.30,入院后2周为30.77±16.71,出院时为4.17±11.03,后2次评分较入院时均明显下降(F=270.536,P<0.001);多变量重复测量方差分析表明患者在抑郁(F=211.938,P<0.001)、焦虑(F=285.592,P<0.001)和压力(F=287.478,P<0.001)方面的评分有显著下降。结论:“家属”照护策略提升了COVID-19患者的心理弹性,改善了其抑郁、焦虑、压力症状,是一种针对COVID-19患者的有效管理方法。在传染病等突发公共卫生事件中,“家属”照护策略应该被纳入急救管理的措施中,以此来提高患者照护质量。

Objective:To control the pandemic of coronavirus disease 2019(COVID-19)effectively,strict isolation measures have been taken in China.Suspected patients must be isolated,and the confirmed patients specifically are isolated in negative-pressure isolation rooms.During the isolation,patients face difficulty in adapting to their surrounding environment,worry about the prognosis of the disease,lack confidence in treatment,separate from their families,and have a sense of distance from medical staff.Isolated patients may possess the feelings of negativity,including loneliness,anxiety,depression,insomnia,and despair.Hence,to reduce the risk of adverse psychological outcomes,“family member-like”care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic.This study aims to examine whether using“family member-like”care strategies can improve psychological resilience and reduce depression,anxiety,and stress symptoms among patients with COVID-19 in an isolation ward.Methods:A quasi-experimental design was used to evaluate the“family member-like”care strategies for adult patients with COVID-19 in an isolation ward.COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan,Hubei province,were included in this study from February 9 to March 20,2020.Healthcare providers who volunteered as family members were assigned to patients.They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge.Connor-Davidson Resilience Scale-10(CD-RISC-10)and Depression Anxiety Stress Scale-21(DASS-21)were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission,2 weeks after admission,and at their discharge from the hospital.Results:The questionnaire response rate of the“family member-like”strategies was 100%.Of the 60 patients,39(65.0%)were male,and 21(35%)were female.The hospital stay was(27.5±3.5)days.All the 60 patients were cured and discharged without any death and serious complications.The total scores for CD-RISC were 8.83±6.86 at admission,29.13±5.42 at 2 weeks after admission,and 33.87±6.14 at discharge,which were significantly improved at the 2 follow-ups(F=404.564,P<0.001).Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity(F=360.839,P<0.001),strength(F=368.217,P<0.001),and optimism(F=328.456,P<0.001)at the 2 follow-ups.The total scores of DASS-21 were 49.27±11.30 at admission,30.77±16.71 at 2 weeks after admission,and 4.17±11.03 at discharge,and the scores were significantly decreased at the 2 follow-ups(F=270.536,P<0.001).Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression(F=211.938,P<0.001),anxiety(F=285.592,P<0.001),and stress(F=287.478,P<0.001)at the 2 follow-ups.Conclusion:“Family member-like”strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients.It might be an effective care method for COVID-19 patients.It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.