以家庭為中心重症病人家屬的護理照護

Family-Centered Care for Families of Patients in Critically Ill Condition

10.29494/LN.201603_17(1).0001

唐鈺婷(Yu-Ting Tang)；康豑云(Chih-Yun Kang)；蔣立琦(Li-Chi Chiang)

重症 ； 加護病房 ； 家屬 ； 以家庭為中心 ； Critical ； Intensive care unit (ICU) ； family ； family-centric care (FCC)

領導護理

17卷1期（2016 / 03 / 01）

2 - 13

繁體中文

加護病房是不對外開放的重症照護病房，接受加護病房治療的重症病人病情多屬危及生命的狀況，因此被限制在外的重症病人家屬會因為所愛的家人宣告病危感到沉重壓力，也因此有較為特殊的照護需要。但加護病房的醫護人員常忽略只在會客時間出現的家屬也是需要照護的，因此當家屬自己無法妥善處理壓力源，需求也未被滿足時，會逐漸累積成負面的情緒。而這負面的情緒不但會影響病人，讓病人心理不安；也會降低家屬協助病人做治療決策的能力，影響病人的權益。甚至容易造成家屬與醫護人員的衝突，讓醫病關係緊張。因此本文整理加護病房家屬的壓力源、需求以及對心理的影響，並且依據家屬的壓力源與需求，建議可提供的護理措施，讓在高壓環境工作的護理人員，能照顧好病人與家屬的身心，同時也讓病人家屬不再是護理人員的壓力源，達到三贏的局面。

Intensive care units (ICU) are designed for critically ill patients to receive intensive treatments and care for their life-threatening conditions, during which their families are not allowed to visit and stay with patients. The families of critically ill patients often feel heavily stressed when the loved one is announced to be in a critical condition; therefore, they have special care needs during this critical situation. However, ICU medical and nursing staff often ignore the families' care needs although they only appear during patient visiting hours. When families themselves are unable to properly handle their stress sources, and their care needs are not well taken care of, their stress will gradually progress into negative emotions. The negative emotions of families not only affect patients' psychological comfort but also lower the families' decision making ability for patients' treatments, affecting the patients' rights. Moreover, stressed emotions of family members easily cause mutual conflicts and create tense doctorpatient relationships. This article discusses ICU patient families' stressors and needs and their negative impacts on their psychological wellbeing. Some recommended family-centered care (FCC) measures can be applied to ICU patients and their families to meet their care needs for physical and psychological wellbeing. ICU nurses should be expected to take good care of their patients and families without seeing patients' families as a stress source, achieving a win -win situation among patients, families, and nursing staff.

1. Al-Mutair, A. S.,Plummer, V.,O'Brien, A.,Clerehan, R.(2013).Family needs and involvement in the intensive care unit: a literature review.Journal of Clinical Nursing,22(13-14),1805-1817.
2. Angus, D. C.,Barnato, A. E.,Linde-Zwirble, W. T.,Weissfeld, L. A.,Watson, R. S.,Rickert, T.,Rubenfeld, G. D.(2004).Use of intensive care at the end of life in the United States: an epidemiologic study.Critical Care Medicine,32(3),638-643.
3. Auerbach, S. M.,Kiesler, D. J.,Wartella, J.,Rausch, S.,Ward, K. R.,Ivatury, R.(2005).Optimism, satisfaction with needs met, interpersonal perceptions of the healthcare team, and emotional distress in patients' family members during critical care hospitalization.American Journal of Critical Care,14(3),202-210.
4. Azoulay, E. M. D.,Chevret, S. M. D. P.,Leleu, G. M. D.,Pochard, F. M. D.,Barboteu, M. M. D.,Adrie, C. M. D.,Schlemmer, B. M. D.(2000).Half the families of intensive care unit patients experience inadequate communication with physicians.Critical Care Medicine,28(8),3044-3049.
5. Azoulay, E.,Pochard, F.,Chevret, S.,Arich, C.,Brivet, F.,Brun, F.,Schlemmer, B.(2003).Family participation in care to the critically ill: opinions of families and staff.Intensive Care Medicine,29(9),1498-1504.
6. Azoulay, E.,Pochard, F.,Chevret, S.,Jourdain, M.,Bornstain, C.,Wernet, A.,Lemaire, F(2002).Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial.American Journal of Respiratory and Critical Care Medicine,165(4),438-442.
7. Bokinskie, J. C.(1992).Family conferences: a method to diminish transfer anxiety.Journal of Neuroscience Nursing,24(3),129-133.
8. Cappellini, E.,Bambi, S.,Lucchini, A.,Milanesio, E.(2014).Open intensive care units: a global challenge for patients, relatives, and critical care teams.Dimensions of Critical Care Nursing,33(4),181-193.
9. Chan, K. S.,Twinn, S.(2007).An analysis of the stressors and coping strategies of Chinese adults with a partner admitted to an intensive care unit in Hong Kong: an e xploratory study.Journal of Clinical Nursing,16(1),185-193.
10. Chien, W. T.,Chiu, Y. L.,Lam, L. W.,Ip, W. Y.(2006).Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study.International Journal of Nursing Studies,43(1),39-50.
11. Chiu, Y. L.,Chien, W. T.,Lam, L. W.(2004).Effectiveness of a needs-based education programme for families with a critically ill relative in an intensive care unit.Journal of Clinical Nursing,13(5),655-656.
12. Ciufo, D.,Hader, R.,Holly, C.(2011).A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centred care.International Journal of Evidence - Based Healthcare,9(4),362-387.
13. Curry, S.(1995).Identifying family needs and stresses in the intensive care unit.British Journal of Nursing,4(1),15-19.
14. Davidson, J. E.,Powers, K.,Hedayat, K. M.,Tieszen, M.,Kon, A. A.,Shepard, E.,Armstrong, D.(2007).Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005.Critical Care Medicine,35(2),605-622.
15. Ferri, M.,Zygun, D. A.,Harrison, A.,Stelfox, H. T.(2015).Evidence-based design in an intensive care unit: end-user perceptions.BMC Anesthesiol,15,57.
16. Fumis, R. R.,Deheinzelin, D.(2009).Family members of critically ill cancer patients: assessing the symptoms of anxiety and depression.Intensive Care Medicine,35(5),899-902.
17. Lautrette, A.,Darmon, M.,Megarbane, B.,Joly, L. M.,Chevret, S.,Adrie, C.,Azoulay, E.(2007).A communication strategy and brochure for relatives of patients dying in the ICU.New England Journal of Medicine,356(5),469-478.
18. Lazarus, R. S.(1966).Psychological Stress and the Coping Process.New York:McGraw-Hill.
19. Lilly, C. M.,De Meo, D. L.,Sonna, L. A.,Haley, K. J.,Massaro, A. F.,Wallace, R. F.,Cody, S.(2000).An intensive communication intervention for the critically ill.The A merican Journal of Medicine,109(6),469-475.
20. McAdam, J. L.,Dracup, K. A.,White, D. B.,Fontaine, D. K.,Puntillo, K. A.(2010).Symptom experiences of family members of intensive care unit patients at high risk for dying.Criticl Care Medicine,38(4),1078-1085.
21. McAdam, J. L.,Puntillo, K.(2009).Symptoms experienced by family members of patients in intensive care units.American Journal of Critical Care,18(3),200-209.
22. Medland, J. J.,Ferrans, C. E.(1998).Effectiveness of a structured communication program for family members of patients in an ICU.America Journal of Critical Care,7(1),24-29.
23. Mitchell, M. L.,Courtney, M.(2004).Reducing family members' anxiety and uncertainty in illness around transfer from intensive care: an intervention study.Intensive and Critical Care Nursing,20(4),223-231.
24. Mitchell, M. L.,Courtney, M.,Coyer, F.(2003).Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care.Nurs Health Sci,5(3),207-217.
25. Paparrigopoulos, T.,Melissaki, A.,Efthymiou, A.,Tsekou, H.,Vadala, C.,Kribeni, G.,Soldatos, C.(2006).Short-term psychological impact on family members of intensive care unit patients.Journal of Psychosomatic Research,61(5),719-722.
26. Perez-San Gregorio, M. A.,Blanco-Picabia, A.,Murillo-Cabezas, F.,Dominguez-Roldan, J. M.,Sanchez, B.,Nunez-Roldan, A.(1992).Psychological problems in the family members of gravely traumatised patients admitted into an intensive care unit.Intensive Care Medicine,18(5),278-281.
27. Plaszewska-Zywko, L.,Gazda, D.(2012).Emotional reactions and needs of family members of ICU patients.Anaesthesiology Intensive Therapy,44(3),145-149.
28. Pochard, F.,Azoulay, E.,Chevret, S.,Lemaire, F.,Hubert, P.,Canoui, P.,Schlemmer, B.(2001).Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity.Critical Care Medicine,29(10),1893-1897.
29. Reider, J. A.(1994).Anxiety during critical illness of a family member.Dimension Critical Care Nursing,13(5),272-279.
30. Rukholm, E.,Bailey, P.,Coutu-Wakulczyk, G.,Bailey, W. B.(1991).Needs and anxiety levels in relatives of intensive care unit patients.Journal of Advanced Nursing,16(8),920-928.
31. Sullivan, D. R.,Liu, X.,Corwin, D. S.,Verceles, A. C.,McCurdy, M. T.,Pate, D. A.,Netzer, G.(2012).Learned helplessness among families and surrogate decision- makers of patients admitted to medical, surgical, and trauma ICUs.Chest,142(6),1440-1446.
32. Tel, H.,Tel, H.(2006).The effect of individualized education on the transfer anxiety of patients with myocardial infarction and their families.Heart & Lung,35(2),101-107.
33. Trochelman, K.,Albert, N.,Spence, J.,Murray, T.,Slifcak, E.(2012).Patients and their families weigh in on evidence-based hospital design.Crit Care Nurse,32(1),1-10.
34. Van Horn, E.,Tesh, A.(2000).The effect of critical care hospitalization on family members: stress and responses.Dimens Crit Care Nurs,19(4),40-49.
35. Verhaeghe, S.,Defloor, T.,V an Z uuren, F.,D uijnstee, M.,Grypdonck, M.(2005).The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature.Journal of Clinical Nursing,14(4),501-509.
36. Whitcomb, J. J.,Roy, D.,Blackman, V. S.(2010).Evidence-based practice in a military intensive care unit family visitation.Nursing Research,59(1 Suppl),32-39.
37. White, D. B.,Engelberg, R. A.,Wenrich, M. D.,Lo, B.,Curtis, J. R.(2007).Prognostication during physician-family discussions about limiting life support in intensive care units.Critical Care Medicine,35(2),442-448.
38. Williams, C. M.(2005).The identification of family members' contribution to patients' care in the intensive care unit: a naturalistic inquiry.Nursing in Critical Care,10(1),6-14.
39. 王秀珍(1999)。加護病房病人家屬霹荃及其護理。護理雜誌，46(2)，67-71。
40. 林雅華,鄭惠娟,謝采霞,劉晉雯,蘇麗智(2011)。成人加護病房病患家屬壓力感受與護理人員知覺之比較。護理暨健康照護研究，7(3)，243-251。
41. 高玉音,黃瓊玉,黃珊,李文欽,陳文魁(2013)。重症病人家庭決策者焦慮及睡眠障礙之相關因素探討。護理暨健康照護研究，9(1)，53-64。
42. 陳玉枝(2003)。加護病房醫療品質影響因素之探討。榮總護理，20(2)，171-183。
43. 劉慧玲,林雪娥,李蓉,高錦慧(2004)。家屬需求與護理人員感受家屬需求及其滿意度之調查研究：以某醫學中心心臟血管外科加護中心為例。榮總護理，21(1)，10-20。
44. 衛生福利部（2012）．歷年醫院概要（表九）歷年醫院住院人次數按床別分．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2758

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