重危患者家属需求评估的研究
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摘要
背景：重症监护使危急重病的抢救成功率明显提高，增强了对衰竭器官的支持和保护能力，许多重危患者在严密监护与精心治疗下，度过了生命中最危险时刻，走向康复。研究表明，亲人重病给家属造成的巨大压力可以直接影响家属健康，轻者表现为神经内分泌功能失调，出现全身不适、体重下降、疲乏、倦怠、疼痛、失眠、肠胃功能紊乱等症状，严重者甚至发生抑郁症。家属的健康状况又与患者的康复密切相关，家属的情绪状态可以帮助患者获得医疗手段以外的、精神上的安慰与寄托，有助于增强患者战胜疾病的信心，利于康复。反之家属的不良情绪和行为会给患者带来消极影响。现代护理概念强调人的整体性，人不是孤立的个体，家庭是个体最重要的社会支持力量，患者与家属互相影响。所以，满足患者家属需求可以帮助家属维持身心健康，更为深远的意义是利于患者康复，回归社会。
70年代起国外学者开始重视满足患者家属需求的问题，在大量调查研究的基础上，1979年Molter NC主编的重危患者家属需求量表(CCFND问世。80年代重危患者家属需求成为国外护理的研究热点，至今方兴未艾。1991年Leske对CCFNI进行修订，使之更为完善，因其表达规范，评分量化，在国内外广泛应用。CCFNI作为一个具体的评估家属需求的工具，为ICU成员有的放矢地满足特殊人群的需求、改进ICU管理模式、提高患者及家属的满意度，提出了积极有效的方法。
Backgrounds
Intensive care makes obvious increasing in rescue achievement ratio of critical deseases and enhance the ability to support and protect failure organs. Many critical patients recovered from illness gradually because of intensive care. Critical care has been firstly focused on the impacts of a life-threatening illness on patient. Limited attention and care has been paid to critical patients' family members, whose needs have been ignored or inaccurately perceived by intensive care unit (ICU) medical staff. Lots of study show critical illness and subsequent hospitalization are a kind of stress for critical patients' family members, that may be a direct influence to family members' health. Furthermore, there is a close correlation between health condition of family members and convalescence of patients . So to meet needs of critical patients' family members can relieve the stress of family members and retain their physical and mental health, accordingly benefit patient's recovery.
Last 30 years, the needs of families of critically ill patients have been addressed in several research studies in Western ICU institutions. Based on lots of early studies, the first edition of the Critical Care Family Needs Inventory (CCFNI) was established by Molter (1979).Then critical care family needs became to research hot spot until today in west counties. CCFNI was revised by Leske(1991) and be used wildly
70年代起国外学者开始重视满足患者家属需求的问题，在大量调查研究的基础上，1979年Molter NC主编的重危患者家属需求量表(CCFND问世。80年代重危患者家属需求成为国外护理的研究热点，至今方兴未艾。1991年Leske对CCFNI进行修订，使之更为完善，因其表达规范，评分量化，在国内外广泛应用。CCFNI作为一个具体的评估家属需求的工具，为ICU成员有的放矢地满足特殊人群的需求、改进ICU管理模式、提高患者及家属的满意度，提出了积极有效的方法。
Backgrounds
Intensive care makes obvious increasing in rescue achievement ratio of critical deseases and enhance the ability to support and protect failure organs. Many critical patients recovered from illness gradually because of intensive care. Critical care has been firstly focused on the impacts of a life-threatening illness on patient. Limited attention and care has been paid to critical patients' family members, whose needs have been ignored or inaccurately perceived by intensive care unit (ICU) medical staff. Lots of study show critical illness and subsequent hospitalization are a kind of stress for critical patients' family members, that may be a direct influence to family members' health. Furthermore, there is a close correlation between health condition of family members and convalescence of patients . So to meet needs of critical patients' family members can relieve the stress of family members and retain their physical and mental health, accordingly benefit patient's recovery.
Last 30 years, the needs of families of critically ill patients have been addressed in several research studies in Western ICU institutions. Based on lots of early studies, the first edition of the Critical Care Family Needs Inventory (CCFNI) was established by Molter (1979).Then critical care family needs became to research hot spot until today in west counties. CCFNI was revised by Leske(1991) and be used wildly
引文
[1] 殷磊主编．护理学基础．北京：人民卫生出版社．2003．6．
[2] Breu C, Dracup K. Helping the spouses of critically ill patients. Am J Nurs 1978; 78:50-53
[3] Hampe SO. Needs of the grieving spouse in a hospital setting. Nuts Res 1975; 24:113-120
[4] Molter NC. Families are not visitors in the critical care unit. Dimens Crit Care Nuts 1994; 13: 2-3.
[5] Bouman CC. Identifying priority concerns of families of ICU patients. DCCN. 1984; 3(5):313-319.
[6] Daley L The perceived immediate needs of families with relatives in the intensive care setting. Heart and Lung. 1984; 13(3):231-237.
[7] Lynn-McHale BJ, Bellinger J. Perceived satisfaction levels of family members of critical care patients and accuracy of nurses' perceptions. Heart and Lung. 1988; 17(4):447-453.
[8] Molder NC. Needs of relatives of critically ill patients: a descriptive study. Heart and Lung, 1979,8(2)332-339.
[9] Leske JS. Needs of relatives of critical care patients: a follow up. Heart Lung 1986; 15: 189-193.
[10] Johnson D, Wilson M, Cavanangh B, et al.. Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 1998; 26:266-271
[11] Daley L The perceived immediate needs of family with relatives in the intensive care setting. Heart Lung 1984; 13:231-237
[12] Harvey M. Volunteers in the critical care waiting room. Anaheim, CA: Society of Critical Care Medicine; 1993. p. 79-80.
[13] Lynn-McHale DJ, Bellinger A. Need satisfaction levels of family members of critical care patients and accuracy of nurses' perceptions. Heart Lung 1988; 17:447-453
[14] Leske JS. Needs of relatives of critically ill patients : a follow-up. Heart and Lung ,1986,15 (2) : 189-193.
[15] Henneman EA, McKenzie JB, Dewa CS. An evaluation for meeting the information needs of families of critically ill patients. Am J Crit Care 1992; 1: 85-93.
[16] Medland JJ, Ferrans CE. Effectiveness of a structured communication program for family members of patients in an ICU. Am J Crit Care 1998; 7: 24-29.
[17] Chesla CA, Stannard D. Breakdown in the nursing care of families in the ICU. Am J Crit Care 1997; 6:64-71
[18] Miracle VA. A Closing Word: Critical Care Visitation. Dimensions of Critical Care Nursing.2003, 22(1):47-48.
[19] Wong F .The needs of families of critically ill patients in a Chinese community. Hong Kong Nursing Journal,1995,69,25-29.
[20] Chin YL, Chien WT, Lam LW. Effectiveness of a needs-based education uprogramme for families with a critically ill relative in an intensive care unit. Journal of Clinical Nursing, 2004, 13(5):655-656.
[21] Lee IY, Chien WT, Mackenzie AE.Needs of families with a relative in a critical care unit in HongKong.Journal of clinical nursing,2000,9(1):46-54.
[22] Lee IY, Mackenzie AE, Chien WT.Needs of Chinese families with a relative in a critical care unit. Journal of clinical nursing,1999,8(6):762-763.
[23] 李琦，阎成美，李蓉．重型脑外伤患者家属心理状况调查分析．解放军护理杂志，2000，17(1)：1-3．
[24] 韦晓君，徐燕敏，余焱．ICU患者家属对限制陪护的心理反应及护理对策．南方护理学报．2002，9(4)：53-55．
[25] 张晓静，郭爱敏，高凤莉．ICU患者家属心理需求的调查分析及对策．现代护理，2002，12(8)：936-937．
[26] 王文茹，高睿，李小妹，等．ICU患者亲属家庭需要的调查研究．中华护理杂志，2002，37(5)：339-341
[27] Leung KW, Chien WT, Mackenzie AE.Needs of Chinese families of critically ill patients. Western Journal of Nursing Research,2000,22(7):826-840.
[28] Brislin rw .The wording and translation of research instrument.In: Lonner WJ, Berry JW, eds.Field methods in cross-cultural research. Hong Kong :Sage Publications,1986,231-245.
[29] 方积乾主编．生存质量测定方法及应用．北京：北京医科大学出版社，2000．1．
[30] 方积乾主编．医学统计学与电脑试验．上海：上海科学技术出版社，2000．10
[31] 颜虹主编．医学统计学．北京：人民卫生出版社．2005．1．
[32] Cullen L, Titler M, Drahozal R.Family and pet visitation in the critical care unit-protocols for practice.Critical Care Nurse,2003, 23(10):62-67.
[33] 尤黎明．老年社区照护概述．国外医学．护理学分册．2005，24(11)：727-730．
[34] 刘秀芳．从日本老年介护事业看中国护工管理与发展．护士进修杂志．2005,20(7)：596-598．
[35] 周富玲．临终关怀与护理进展．中国实用护理杂志．2004，20(3)：53-54．
[36] Afessa B, Green B, Delke I,et al.Systemic Inflammatory Response Syndrom, Organ Failure, and Outcome in Critically Ill Obstetric Patients Treated in an ICU.Chest,2001,120 (4):1271-1277.
[37] Leske JS.Comparison of family stresses,strengths,and outcomes after trauma and surgery. AACN Clinical Issues. 2003 , 14(1):33-41.
[38] Hardicre J.Meeting the needs of families of patients in intensive care units.Nursing Times,2003,99(27):26-27.
[39] Hardicre J. Nurses' experiences of caring for the relatives of patients in ICU. Nursing Times,2003,99(29):34-37.
[40] Mitchell M.L Courtney M, Coyer F. Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care. Nursing and Health Sciences, 2003, 5(3): 207-217.
[41] Wison JH.The family education:a professional resource for families.Journal of Psychosocial Nursing,1999,37(6):22-28.
[42] Wilkinson P. A qualitative study to establish the self-perceived needs of family members of patients in a general ICU. Intensive Crit Care Nurs 1995; 11:77-86
[43] Hickey M. What are the needs of families of critically ill patients? A review of the literature since 1976. Heart Lung 1990; 19:401-415
[44] Redley B,LeVasseur SA,Peters G,et al.Families'needs in emergency departments:instrument development.Journal of Advanced Nursing,2003,43(6):606-615.
[45] Redley B,Christine Beanland.Revising the critical care family needs inventory for the emergency department. Journal of Advanced Nursing,2004,45(1):95-104.
[46] 赵继军，席惠君，苑锦清．重症监护病房家属探视的可行性与必要性．解放军护理杂志．2001，18(6)：21-22．
[47] Mary E, Susn R,Colleen G, et al.Nurse-coached intervention for the families of patients in critical care units.Critical Care Nurse,2000,20(3):40-48.
[48] McCoy J.The role of critical care nurses in organ donation:a case study.Critical Care Nurse,2000,19(2)48-59.
[49] 庞洁．ICU患者家属护理的评估．国外医学．护理学分册．1997，16(6)：267．
[50] Leske JS. Needs of adult family members after critical care: Prescription for interventions. Crit C Nurs Clin NAmer. 1992; 4(4): 587-596.
[2] Breu C, Dracup K. Helping the spouses of critically ill patients. Am J Nurs 1978; 78:50-53
[3] Hampe SO. Needs of the grieving spouse in a hospital setting. Nuts Res 1975; 24:113-120
[4] Molter NC. Families are not visitors in the critical care unit. Dimens Crit Care Nuts 1994; 13: 2-3.
[5] Bouman CC. Identifying priority concerns of families of ICU patients. DCCN. 1984; 3(5):313-319.
[6] Daley L The perceived immediate needs of families with relatives in the intensive care setting. Heart and Lung. 1984; 13(3):231-237.
[7] Lynn-McHale BJ, Bellinger J. Perceived satisfaction levels of family members of critical care patients and accuracy of nurses' perceptions. Heart and Lung. 1988; 17(4):447-453.
[8] Molder NC. Needs of relatives of critically ill patients: a descriptive study. Heart and Lung, 1979,8(2)332-339.
[9] Leske JS. Needs of relatives of critical care patients: a follow up. Heart Lung 1986; 15: 189-193.
[10] Johnson D, Wilson M, Cavanangh B, et al.. Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 1998; 26:266-271
[11] Daley L The perceived immediate needs of family with relatives in the intensive care setting. Heart Lung 1984; 13:231-237
[12] Harvey M. Volunteers in the critical care waiting room. Anaheim, CA: Society of Critical Care Medicine; 1993. p. 79-80.
[13] Lynn-McHale DJ, Bellinger A. Need satisfaction levels of family members of critical care patients and accuracy of nurses' perceptions. Heart Lung 1988; 17:447-453
[14] Leske JS. Needs of relatives of critically ill patients : a follow-up. Heart and Lung ,1986,15 (2) : 189-193.
[15] Henneman EA, McKenzie JB, Dewa CS. An evaluation for meeting the information needs of families of critically ill patients. Am J Crit Care 1992; 1: 85-93.
[16] Medland JJ, Ferrans CE. Effectiveness of a structured communication program for family members of patients in an ICU. Am J Crit Care 1998; 7: 24-29.
[17] Chesla CA, Stannard D. Breakdown in the nursing care of families in the ICU. Am J Crit Care 1997; 6:64-71
[18] Miracle VA. A Closing Word: Critical Care Visitation. Dimensions of Critical Care Nursing.2003, 22(1):47-48.
[19] Wong F .The needs of families of critically ill patients in a Chinese community. Hong Kong Nursing Journal,1995,69,25-29.
[20] Chin YL, Chien WT, Lam LW. Effectiveness of a needs-based education uprogramme for families with a critically ill relative in an intensive care unit. Journal of Clinical Nursing, 2004, 13(5):655-656.
[21] Lee IY, Chien WT, Mackenzie AE.Needs of families with a relative in a critical care unit in HongKong.Journal of clinical nursing,2000,9(1):46-54.
[22] Lee IY, Mackenzie AE, Chien WT.Needs of Chinese families with a relative in a critical care unit. Journal of clinical nursing,1999,8(6):762-763.
[23] 李琦，阎成美，李蓉．重型脑外伤患者家属心理状况调查分析．解放军护理杂志，2000，17(1)：1-3．
[24] 韦晓君，徐燕敏，余焱．ICU患者家属对限制陪护的心理反应及护理对策．南方护理学报．2002，9(4)：53-55．
[25] 张晓静，郭爱敏，高凤莉．ICU患者家属心理需求的调查分析及对策．现代护理，2002，12(8)：936-937．
[26] 王文茹，高睿，李小妹，等．ICU患者亲属家庭需要的调查研究．中华护理杂志，2002，37(5)：339-341
[27] Leung KW, Chien WT, Mackenzie AE.Needs of Chinese families of critically ill patients. Western Journal of Nursing Research,2000,22(7):826-840.
[28] Brislin rw .The wording and translation of research instrument.In: Lonner WJ, Berry JW, eds.Field methods in cross-cultural research. Hong Kong :Sage Publications,1986,231-245.
[29] 方积乾主编．生存质量测定方法及应用．北京：北京医科大学出版社，2000．1．
[30] 方积乾主编．医学统计学与电脑试验．上海：上海科学技术出版社，2000．10
[31] 颜虹主编．医学统计学．北京：人民卫生出版社．2005．1．
[32] Cullen L, Titler M, Drahozal R.Family and pet visitation in the critical care unit-protocols for practice.Critical Care Nurse,2003, 23(10):62-67.
[33] 尤黎明．老年社区照护概述．国外医学．护理学分册．2005，24(11)：727-730．
[34] 刘秀芳．从日本老年介护事业看中国护工管理与发展．护士进修杂志．2005,20(7)：596-598．
[35] 周富玲．临终关怀与护理进展．中国实用护理杂志．2004，20(3)：53-54．
[36] Afessa B, Green B, Delke I,et al.Systemic Inflammatory Response Syndrom, Organ Failure, and Outcome in Critically Ill Obstetric Patients Treated in an ICU.Chest,2001,120 (4):1271-1277.
[37] Leske JS.Comparison of family stresses,strengths,and outcomes after trauma and surgery. AACN Clinical Issues. 2003 , 14(1):33-41.
[38] Hardicre J.Meeting the needs of families of patients in intensive care units.Nursing Times,2003,99(27):26-27.
[39] Hardicre J. Nurses' experiences of caring for the relatives of patients in ICU. Nursing Times,2003,99(29):34-37.
[40] Mitchell M.L Courtney M, Coyer F. Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care. Nursing and Health Sciences, 2003, 5(3): 207-217.
[41] Wison JH.The family education:a professional resource for families.Journal of Psychosocial Nursing,1999,37(6):22-28.
[42] Wilkinson P. A qualitative study to establish the self-perceived needs of family members of patients in a general ICU. Intensive Crit Care Nurs 1995; 11:77-86
[43] Hickey M. What are the needs of families of critically ill patients? A review of the literature since 1976. Heart Lung 1990; 19:401-415
[44] Redley B,LeVasseur SA,Peters G,et al.Families'needs in emergency departments:instrument development.Journal of Advanced Nursing,2003,43(6):606-615.
[45] Redley B,Christine Beanland.Revising the critical care family needs inventory for the emergency department. Journal of Advanced Nursing,2004,45(1):95-104.
[46] 赵继军，席惠君，苑锦清．重症监护病房家属探视的可行性与必要性．解放军护理杂志．2001，18(6)：21-22．
[47] Mary E, Susn R,Colleen G, et al.Nurse-coached intervention for the families of patients in critical care units.Critical Care Nurse,2000,20(3):40-48.
[48] McCoy J.The role of critical care nurses in organ donation:a case study.Critical Care Nurse,2000,19(2)48-59.
[49] 庞洁．ICU患者家属护理的评估．国外医学．护理学分册．1997，16(6)：267．
[50] Leske JS. Needs of adult family members after critical care: Prescription for interventions. Crit C Nurs Clin NAmer. 1992; 4(4): 587-596.