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河北省三级医院ICU护士死亡焦虑现状调查及干预研究

发布时间:2018-08-18 11:39
【摘要】:目的:随着社会的不断发展、现代生活节奏越来越快,心理压力在普通人群中都有所提升。众所周知,生死交替是人类进化的必然阶段,是每个人都必须要经历和承受的。ICU是医院危急重症患者的集中地,每天都上演着生离死别。我国学者目前大部分心理状况的研究集中在重症患者及家属,较少对直接参与临终关怀的医护人员给予关注,这类医护人员在重症患者救治的过程中发挥着举足轻重的作用。当ICU护士出现相关不良心理应激或者死亡焦虑的反应时,给患者及其家属的心理慰藉和社会精神支持等方面带来负面作用。常年奋战在ICU一线的护士作为人民健康的保健护航者,其死亡焦虑水平理应引起更广泛的社会关注。本次调查研究主要为了了解河北省三级医院ICU护理人员死亡焦虑现状,探讨护理人员死亡焦虑的相关影响因素,针对可控性因素实施相应对策,为今后有效降低ICU护士的死亡焦虑感提供数据支持。方法:从2016年3月至2016年12月,采用便利抽样法,抽取河北省三级医院ICU护士作为研究对象,使用中文版五级死亡焦虑量表,调查三级医院ICU护士死亡焦虑现状。共发放调查问卷450份,回收409份,有效回收率为90.89%。本调查研究分为两部分内容:第一,纳入护理人员的一般状况包括性别、年龄、民族、婚姻状况、学历、护龄、职称、宗教信仰、工作科室等;第二,把护士是否接受过死亡教育或亲历死亡事件纳入到调查范畴。以35分认为调查人群处于高死亡焦虑状态。采用SPSS22.0数据包对所得结果进行分析,计数资料间的对比采用卡方检验、计量资料采用方差分析和t检验进行分析;涉及到两两比较的数据采用SNK-q检验进行对比;死亡焦虑的影响因素分析采用多元条件Logistic回归方法;培训前后死亡焦虑得分情况对比采用配对t检验。结果:1ICU护士死亡焦虑评分(45.16±6.07)普遍得分较高,386人(94.38%)表现出较高死亡焦虑水平。其中女性护士存在死亡焦虑比例达95.3%,高于男性护士的86.4%,差异有统计学意义,P0.05。2ICU护士一般情况与死亡焦虑评分的对比情况如下:年龄≤25岁的护士死亡焦虑评分为38.74±5.66,明显低于25岁的护士得分水平47.32±4.45,t=-15.761,p0.001;icu男性护士的死亡焦虑评分为43.43±7.97明显低于女性护士的45.37±5.78,t=-2.006,p=0.046;护士初始学历是中专、大专和本科水平的护士死亡焦虑评分分别为46.63±6.02、45.78±5.24和42.53±7.44,三者对比有统计学差异,f=12.230,p0.001,学历越高死亡焦虑评分越低;职称水平分别为护士、护师、主管护师和副主任护师及以上的护士死亡焦虑评分分别为43.81±5.36、44.73±6.03、46.16±5.46和40.57±4.86,四者对比有统计学差异,f=3.259,p=0.033,主管护师的死亡焦虑水平高于护师和护士,但是副主任护师及以上的高死亡焦虑评分最低;不同婚姻状况、最高学历、用工形式以及是否为科室带教老师、科室带组组长和工作年限等对护士死亡焦虑评分情况无影响,差异没有统计学意义,p0.05。3是否接受过死亡教育及事件对死亡焦虑评分影响情况参加过死亡教育或临终关怀的培训或学习的护士死亡焦虑评分为42.37±6.92,明显低于未参加过死亡教育或临终关怀的培训或学习的护士46.01±5.52,差异有统计学意义,t=-5.293,p0.001;参与患者或亲人的临终处置的护士死亡焦虑评分为44.52±6.63,明显低于未参与患者或亲人的临终处置的45.62±5.59,差异有统计学意义,t=-2.017,p=0.045;是否目睹过严重事故或威胁生命事件对死亡焦虑评分的情况无影响,差异没有统计学意义,p0.05。4将23例不存在死亡焦虑的护士作为研究对象,按照1:2比例进行科室、性别、家庭环境进行匹配,追溯其填写的调查问卷,采用条件logistic回归研究死亡焦虑评分的影响因素。研究表明有参与亲人临终处置的经历和曾经系统参加临终关怀相关培训工作是死亡焦虑的“保护因素”。5采用就近原则的方法,在河北省胸科医院组织对45名icu护士(之前均未参加过类似培训或者教育经历)进行死亡焦虑培训工作,观察培训前、培训中、培训后死亡焦虑评分的变化情况。培训前我院icu护士死亡焦虑评分为45.36±5.93,培训过程中调查发现icu护士死亡焦虑评分降低至44.68±5.62,培训结束后icu护士死亡焦虑评分降低至42.35±6.15。结论:1三级医院ICU护士死亡焦虑评分普遍得分较高,94.38%表现出较高死亡焦虑水平,并且存在性别差异,其中女性护士死亡焦虑水平高于男性护士。2 ICU护士死亡焦虑评分在年龄、初始学历、职称水平上存在差异,年龄≤25岁的护士死亡焦虑评分明显低于25岁的护士得分水平;初始学历越高死亡焦虑评分情况相应越低;职称水平升高,死亡焦虑评分情况相应升高。3参加过死亡教育或临终关怀的培训或学习以及参与患者或亲人的临终处置的护士死亡焦虑评分低于没有上述经历的护士。4条件Logistic回归研究死亡焦虑评分的影响因素,结果表明年龄≤25岁、有参与亲人临终处置的经历和曾经系统参加临终关怀相关培训工作有助于降低ICU护士死亡焦虑水平。5组织ICU护士开展的死亡焦虑系统培训工作行之有效,在参加过培训后,死亡焦虑水平降低效果显著。
[Abstract]:Objective: With the continuous development of society, the pace of modern life is getting faster and faster, and psychological pressure is rising in the general population. As we all know, life-death alternation is the inevitable stage of human evolution, which everyone must experience and accept. ICU is the concentration of critically ill patients in hospitals. Life-death parting takes place every day. At present, most of the researches on psychological status focus on the critically ill patients and their family members, and few of them pay attention to the medical staff directly involved in hospice care. These medical staff play an important role in the treatment of critically ill patients. Psychological comfort and social and spiritual support from family members have brought about negative effects. Nurses working hard all the year round in ICU as health care escorts of the people should arouse wider social concern about their level of death anxiety. Methods: From March 2016 to December 2016, ICU nurses in Hebei tertiary hospitals were selected by convenience sampling method, and the Chinese version of the fifth level of death anxiety was used. A total of 450 questionnaires were sent out and 409 of them were recovered with an effective recovery rate of 90.89%. The study was divided into two parts. First, the general conditions of nurses included gender, age, nationality, marital status, educational background, nursing age, professional title, religious belief, and work room, etc. The results were analyzed by SPSS22.0 data package. The comparison of the counting data was analyzed by Chi-square test, and the measurement data was analyzed by ANOVA and T-test. The data were compared by SNK-q test; the influencing factors of death anxiety were analyzed by multivariate conditional logistic regression method; and the scores of death anxiety before and after training were compared by paired t test. Results: 1 The death anxiety score of ICU nurses was generally higher, 386 (94.38%) showed higher level of death anxiety. The proportion of nurses with death anxiety was 95.3%, which was higher than 86.4% of male nurses. The difference was statistically significant (P 0.05.2). The score of death anxiety of nurses was 43.43+7.97, which was significantly lower than that of female nurses (45.37+5.78, t=-2.006, p=0.046); the score of death anxiety of nurses with initial education was 46.63+6.02, 45.78+5.24 and 42.53+7.44, respectively, and the difference was statistically significant (f=12.230, p0.001). The scores of death anxiety of nurses with professional titles were 43.81 (+5.36), 44.73 (+6.03), 46.16 (+5.46) and 40.57 (+4.86), respectively. There was statistical difference between the four groups, f = 3.259, P = 0.033. The level of death anxiety of nurses in charge was higher than that of nurses and nurses in charge, but the level of death anxiety of nurses in charge and above was higher than that of nurses in charge. The scores of high death anxiety were the lowest; different marital status, the highest educational background, the type of employment and whether or not to be a teaching teacher, the head of the Department and the length of work had no influence on the scores of death anxiety, the difference was not statistically significant, p0.05.3 whether or not to receive death education and events had participated in the impact of death anxiety scores. The score of death anxiety of nurses trained or trained in death education or hospice care was 42.37 + 6.92, which was significantly lower than that of nurses trained or trained in death education or hospice care (46.01 + 5.52). The difference was statistically significant (t = - 5.293, P 0.001); the score of death anxiety of nurses involved in hospice care of patients or relatives was 44.52 + 6.63. It was significantly lower than that of the patients or relatives who had not participated in the hospice treatment, the difference was statistically significant, t = - 2.017, P = 0.045; whether or not witnessed serious accidents or life-threatening events had no effect on the score of death anxiety, the difference was not statistically significant, p0.05.4 23 nurses without death anxiety as the study object, according to the 1:2 ratio. Case matched with department, gender, family environment, retrospective questionnaire and conditional logistic regression were used to study the influencing factors of death anxiety score. Methods Forty-five ICU nurses (who had not participated in similar training or educational experience before) were trained in Hebei Thoracic Hospital to observe the changes of the scores of death anxiety before and after training. The death anxiety score of U nurses was reduced to 44.68+5.62, and the death anxiety score of ICU nurses was reduced to 42.35+6.15 after training. Conclusion: The death anxiety score of ICU nurses in Grade 1 tertiary hospitals was generally higher, 94.38% of them showed higher level of death anxiety, and there were gender differences, among them, the death anxiety level of female nurses was higher than that of male nurses. The scores of U nurses'death anxiety were significantly lower than those of 25-year-old nurses. The higher the initial educational background, the lower the score of death anxiety; the higher the professional title, the higher the score of death anxiety. 3. Nurses who participated in the training or learning of care and hospice treatment of patients or relatives had lower scores of death anxiety than those who did not. 4 conditional logistic regression was used to study the influencing factors of death anxiety score. The results showed that the age of nurses who participated in hospice treatment of relatives was less than 25 years old. It is helpful to reduce the level of death anxiety of ICU nurses. 5 It is effective to organize the training of death anxiety system for ICU nurses. After participating in the training, the level of death anxiety decreased significantly.
【学位授予单位】:河北医科大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R47

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