主动脉夹层术后患者出院时心理体验的质性研究

Qualitative Study on Psychological Experience of Patients Discharged after Aortic Dissection Surgery

目的 深入了解主动脉夹层术后患者出院时的心理体验,为医护人员制订针对性的心理干预策略提供参考。方法 运用描述性现象学研究方法,通过目的性抽样选取2021年4-6月收治于武汉市某三级甲等综合医院行主动脉夹层手术治疗后即将出院的20例患者,对其进行面对面半结构式深度访谈,依据Colaizzi 7步分析法进行资料归纳分析并提炼主题。结果 共提炼出5个主题:正性心理体验的激发(乐观与坦然、眷恋与期待、信任与感谢);负性心理体验的困扰(恐惧与害怕、焦虑与抑郁、愧疚与无奈、无力感与不确定);人生重大转折的心理应对(珍惜生命、向下比较、转移重心);居家自我管理意识的唤起(反思自省能力增强、自我照顾认知提升);多维度社会支持的渴望(医护人员支持、家庭支持、同伴支持)。结论 主动脉夹层术后患者出院时心理体验具有正性体验与负性体验共存的特点,部分患者会出现创伤后成长,能够反思自省,有一定的自我照顾认知,但同时存在多方面的心理支持需求。医护人员应同时关注患者的正性与负性心理体验,采取规范、系统的心理干预,促进正性体验的产生与负性体验的转化,鼓励患者树立战胜疾病的信心,协助患者在逆境中成长,提供针对性的自我管理教育,建立良好的社会支持系统,增强患者心理健康水平。

Objective To understand the psychological experience of patients discharged after aortic dissection surgery,providing a reference for healthcare providers in developing targeted psychological intervention strategies.MethodsDescriptive phenomenological approach was used to select 20 patients who were about to be discharged after aortic dissection surgery in a Grade Ⅲ-A general hospital in Wuhan from April to June 2021 by purposive sampling.The patients received face-to-face semi-structured in-depth interviews,and the obtained data were summarized and analyzed to extract themes by using Colaizzi’s sevenstep analysis method.ResultsA total of 5 themes were extracted as follows:the stimulation of positive psychological experience (optimism and calm;attachment and expectation;trust and gratitude);the distress of negative psychological experience (fear and terror;anxiety and depression;guilt and helplessness;powerlessness and uncertainty);the psychological coping strategies for major turning points in life (life cherishing;downward comparison;shift of emphasis);the aroused awareness of home-based self-management(enhanced reflection and introspection;improved self-care cognition);the desire for multidimensional social support (healthcare provider support;family support;peer support).ConclusionPatients discharged after aortic dissection surgery have both positive and negative psychological experiences.Some of them will have post-traumatic growth,reflection and introspection ability and certain self-care cognition,while having a variety of needs for psychological support.Healthcare providers should pay attention to the positive and negative psychological experiences of patients,take standard and systematic psychological intervention,promote the generation of positive experience and the transformation of negative experience,encourage patients to build up the confidence to overcome their diseases,help them grow up in adversity,provide targeted selfmanagement education,establish a good social support system,and enhance the mental health level of patients.