四肢创伤性骨折患者术后早期功能锻炼心理体验与需求的质性研究

Qualitative study on psychological experience and needs of early functional exercise in patients with traumatic fracture of limbs after operation

目的:深入挖掘四肢创伤性骨折患者术后早期功能锻炼过程中的心理体验及需求。方法:采用现象学研究方法,对18例手术后4周内的四肢创伤性骨折患者进行半结构式深入访谈,并采用Colaizzi资料分析法对访谈资料进行分析、归纳,提炼主题。结果:提炼出5个早期功能锻炼心理体验的主题:创伤后的心理应激反应、对早期功能锻炼必要性的质疑和安全性的担忧、疼痛—恐惧—回避及视“疼痛”为危险信号、感受不到功能锻炼即时可见效果的挫折感和沮丧感、对功能重建的渴望和信心不足并存;提炼出5个早期功能锻炼需求的主题:信息支持的需求、被动辅助锻炼的需求、缓解锻炼疼痛的需求、康复成功经验分享的需求以及疼痛共情的需求。结论:创伤事件对患者心理冲击较大,存在多种心理应激反应。对早期功能锻炼存在认识误区,锻炼过程疼痛感明显,负性情感较为突出,希望得到身心等多方面的支持与帮助。应多渠道满足患者的身心需求,促进患者坚持规律的早期功能锻炼,以助后期功能的顺利恢复。

Objective:To deeply explore the psychological experience and the needs of patients with traumatic fracture of limbs in the process of early functional exercise after operation.Methods:Using phenomenological research methods,a semi-structured in-depth interview was conducted in 18 patients with traumatic fractures of the limbs within 4 weeks after surgery.Colaizzi data analysis method was used to analyze,summarize,and refine the themes.Results:Five psychological experience themes were extracted:post-traumatic stress reaction,doubts about the necessity and the safety of early functional exercise,pain-fear-avoidance and seeing"pain"as a danger signal,frustration and depression of not feeling the immediate effect of functional exercise,and the coexistence of desire and lack of confidence in functional reconstruction.The needs of exercise were refined into five themes:the need for information support,the need for passive assisted exercise,the need for relieving exercise pain,the need for the successful experience of rehabilitation and the need for pain empathy.Conclusion:Traumatic events had a great psychological impact on patients,leading to a variety of psychological stress reactions.There were misunderstandings about early functional exercise among patients.The pain was obvious in the process of exercise,negative emotions were prominent.They hoped to get physical and mental support and assistance in many ways.The physical and mental needs of patients should be met through multiple channels to promote patients to adhere to regular early functional exercise for better recovery of expected functions.