袁秀群,范 穎

(上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院急診,上海200127)

·論 著·

急診護(hù)士對(duì)于心肺復(fù)蘇時(shí)患者家屬在場(chǎng)的態(tài)度調(diào)查

袁秀群,范 穎

(上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院急診,上海200127)

目的 調(diào)查急診護(hù)理人員在進(jìn)行心肺復(fù)蘇時(shí),對(duì)于患者家屬在場(chǎng)情況(family presence,FP)的認(rèn)可度,以期為制定相關(guān)法律、政策準(zhǔn)許FP提供依據(jù)。方法 2013年4－6月,便利抽樣法選擇在上海仁濟(jì)醫(yī)院和瑞金醫(yī)院急診工作超過1年的55名護(hù)士作為研究對(duì)象,采用Fullbrook調(diào)查問卷對(duì)急診護(hù)士進(jìn)行FP態(tài)度調(diào)查。結(jié)果 在48份有效問卷中,女性調(diào)查對(duì)象占多數(shù),共42名,占87.5%;學(xué)歷以大專和本科為主,分別占54.2%和31.3%;職稱以護(hù)師為主,共26名,占54.2%;參與調(diào)查的基本都是臨床一線的護(hù)士和搶救護(hù)士,分別占45.8%和41.7%。在參與本調(diào)查的48名急診護(hù)理人員中,有40名護(hù)理人員經(jīng)歷過FP,占83.3%;有8名護(hù)理人員未經(jīng)歷過FP,占16.7%。79.2%的護(hù)士認(rèn)為“親眼目睹心肺復(fù)蘇的過程對(duì)患者家屬也是一種心靈創(chuàng)傷”,僅8.3%的護(hù)士認(rèn)為“心肺復(fù)蘇時(shí),患者家屬或者朋友在場(chǎng)對(duì)患者有益”。70.9%的護(hù)士并不支持制定相關(guān)法律條文同意FP。大多數(shù)參與調(diào)查的護(hù)士均認(rèn)為讓患者家屬親眼目睹整個(gè)心肺復(fù)蘇的過程可能會(huì)對(duì)患者家屬造成一定的心理壓力,同時(shí)對(duì)參與搶救的醫(yī)護(hù)人員產(chǎn)生一定的干擾。結(jié)論 大部分的急診護(hù)理人員對(duì)FP持反對(duì)態(tài)度,認(rèn)為FP對(duì)護(hù)理人員和患者均會(huì)產(chǎn)生負(fù)面影響。

急診護(hù)士;態(tài)度;家屬在場(chǎng);心肺復(fù)蘇

[Nurs J Chin PLA,2014,31(13):1-4]

隨著患者對(duì)自己權(quán)利保護(hù)意識(shí)的逐漸增強(qiáng),醫(yī)護(hù)人員為患者實(shí)施心肺復(fù)蘇時(shí),其家屬在旁的現(xiàn)象越來越多,并對(duì)急診搶救工作帶來一定的干擾,成為急診亟待解決的問題。根據(jù)相關(guān)定義,患者家屬在場(chǎng)情況(family presence,FP)是指對(duì)患者進(jìn)行侵入性操作或心肺復(fù)蘇時(shí),家屬陪在其身邊,并給予視覺及身體接觸上的支持[1]。2000年,美國(guó)心臟協(xié)會(huì)(American Heart Association,AHA)[2]、美國(guó)急救護(hù)士協(xié)會(huì)(Emergency Nurses Association,ENA)[3]等世界多家知名醫(yī)療機(jī)構(gòu)和組織支持并實(shí)施FP。國(guó)內(nèi)、外研究[4-7]表明,醫(yī)護(hù)人員對(duì)于心肺復(fù)蘇時(shí)FP的態(tài)度截然不同。支持FP的醫(yī)護(hù)人員認(rèn)為,心肺復(fù)蘇時(shí)患者家屬在場(chǎng)是他們應(yīng)有的權(quán)利[4-5];而反對(duì)FP的醫(yī)護(hù)人員認(rèn)為,心肺復(fù)蘇時(shí)患者家屬的言論、情緒等可能會(huì)對(duì)醫(yī)護(hù)人員產(chǎn)生強(qiáng)烈的干擾并帶來巨大的心理壓力[6-7]。在搶救過程中,醫(yī)護(hù)人員通常會(huì)要求患者家屬在外等候,而患者家屬支持FP者較多,他們認(rèn)為在親人有生命危險(xiǎn)時(shí)能陪伴在旁,可為患者提供最有力的心理支持。目前,國(guó)內(nèi)并沒有明確的針對(duì)心肺復(fù)蘇時(shí)患者家屬能否在場(chǎng)的法律條文和相關(guān)政策法規(guī)。因此,本研究旨在了解急診護(hù)理人員有關(guān)FP的態(tài)度,以期為相關(guān)管理機(jī)構(gòu)針對(duì)此矛盾現(xiàn)狀制定和完善相應(yīng)的政策、法規(guī)提供現(xiàn)實(shí)依據(jù)。

1 對(duì)象與方法

1.1 研究對(duì)象 2013年4－6月,便利抽樣法選擇在上海仁濟(jì)醫(yī)院和瑞金醫(yī)院急診工作超過1年的55名護(hù)理人員作為此次調(diào)查對(duì)象。其中男6名(10.9%)、女49名(49.1%);年齡20～40歲,平均(28.9±6.7)歲;工作年限1～15年,平均(5.4±3.7)年。所有調(diào)查對(duì)象均知曉本研究目的,并自愿參加此次研究,調(diào)查量表已報(bào)院倫理委員會(huì)批準(zhǔn)。

1.2 方法

1.2.1 研究工具 本研究采用醫(yī)護(hù)人員對(duì)心肺復(fù)蘇期間家屬在場(chǎng)態(tài)度調(diào)查問卷進(jìn)行調(diào)查。該問卷包括3個(gè)部分:第一部分為被調(diào)查者的基本資料,包括性別、年齡、學(xué)歷、職稱和急診工作時(shí)間。第二部分僅1項(xiàng),即是否有心肺復(fù)蘇時(shí)FP經(jīng)歷。第三部分以Fullbrook的問卷[8]為主體,運(yùn)用Brislin翻譯法對(duì)英文版的量表進(jìn)行翻譯、回譯和文化調(diào)適,并結(jié)合國(guó)內(nèi)相關(guān)研究[9-10]后形成的,用于調(diào)查護(hù)理人員對(duì)心肺復(fù)蘇期間FP的態(tài)度,該部分分為3個(gè)維度共17個(gè)條目,每個(gè)條目設(shè)“同意”、“中立”、“不同意”3個(gè)選項(xiàng)。被調(diào)查的護(hù)士根據(jù)列出情況勾出最符合實(shí)際自己立場(chǎng)的選項(xiàng)。該問卷有良好的信、效度[11]。

1.2.2 資料收集 問卷由研究者統(tǒng)一發(fā)放,向受調(diào)查者統(tǒng)一講解研究目的,填寫問卷要求后,由其自行填寫。填寫完畢后,統(tǒng)一回收。共發(fā)放調(diào)查問卷55份,回收52份,回收率為94.6%?；厥蘸螽?dāng)場(chǎng)核對(duì),有遺漏的補(bǔ)填,其中有效問卷共48份,問卷的有效回收率為92.3%。

1.3 統(tǒng)計(jì)學(xué)處理 采用SPSS 20.0統(tǒng)計(jì)軟件,計(jì)數(shù)資料采用頻數(shù)、百分?jǐn)?shù)的形式表示,計(jì)量資料采用表示,并采用描述性統(tǒng)計(jì)。

2 結(jié)果

2.1 調(diào)查對(duì)象的一般情況 在48份有效問卷中,女性調(diào)查對(duì)象占多數(shù),共42名,占87.5%;學(xué)歷以大專和本科為主,分別占54.2%和31.3%。職稱以護(hù)師為主,共26名,占54.2%;參與調(diào)查的基本都是臨床一線的護(hù)士和搶救護(hù)士,分別占45.8%和41.7%。其余情況詳見表1。

表1 被調(diào)查護(hù)士的基本情況(N＝48)

2.2 護(hù)理人員經(jīng)歷FP的情況 在參與本調(diào)查的48名急診護(hù)理人員中,有40名護(hù)理人員經(jīng)歷過FP,占83.3%;有8名護(hù)理人員未經(jīng)歷過FP,占16.7%。

2.3 護(hù)士對(duì)心肺復(fù)蘇時(shí)FP的態(tài)度 79.2%的護(hù)士認(rèn)為“親眼目睹心肺復(fù)蘇的過程對(duì)患者家屬也是一種心靈創(chuàng)傷”,僅8.3%的護(hù)士認(rèn)為“心肺復(fù)蘇時(shí),患者家屬或者朋友在場(chǎng)對(duì)患者有益”。70.9%的護(hù)士并不支持制定相關(guān)法律條文同意FP。大多數(shù)參與調(diào)查的護(hù)士均認(rèn)為讓患者家屬親眼目睹整個(gè)心肺復(fù)蘇的過程可能會(huì)對(duì)患者家屬造成一定的心理壓力,同時(shí)對(duì)參與搶救的醫(yī)護(hù)人員產(chǎn)生一定的干擾。詳細(xì)情況參見表2。

3 討論

3.1 急診護(hù)理人員FP的經(jīng)歷 在參與此次調(diào)查的急診護(hù)理人員中,83.3%的護(hù)理人員經(jīng)歷過心肺復(fù)蘇時(shí)FP,高于其他國(guó)家[12]。在中國(guó)“萬事孝為先”的文化背景下,當(dāng)患者遭遇生命威脅要進(jìn)行心肺復(fù)蘇時(shí),家屬往往擔(dān)心搶救效果而要求在搶救現(xiàn)場(chǎng)。但是由于急診患者病情嚴(yán)重,患者家屬心情焦急,會(huì)使參與搶救的醫(yī)生及護(hù)理人員產(chǎn)生巨大的工作壓力。急診的繁雜工作環(huán)境也造成了經(jīng)歷過FP的護(hù)理人員對(duì)FP產(chǎn)生抵觸情緒。因此,在現(xiàn)有的醫(yī)療環(huán)境下,護(hù)理人員缺乏獨(dú)自判斷是否允許患者家屬在場(chǎng)的標(biāo)準(zhǔn)和權(quán)限,故在面對(duì)全球范圍內(nèi)依舊頗具爭(zhēng)議的復(fù)蘇期間的FP問題,護(hù)理人員更希望醫(yī)療機(jī)構(gòu)能制定出明確的法律、法規(guī)。

表2 護(hù)士對(duì)心肺復(fù)蘇時(shí)FP的態(tài)度[N＝47,n(%)]

3.2 急診護(hù)士對(duì)心肺復(fù)蘇時(shí)FP持反對(duì)態(tài)度 本研究表明,僅有8.3%的急診護(hù)理人員認(rèn)為心肺復(fù)蘇時(shí)FP對(duì)患者、家屬和朋友有利,這也部分解釋了急診高達(dá)70.9%的護(hù)理人員對(duì)FP的實(shí)施持反對(duì)態(tài)度的原因。這和近幾年國(guó)內(nèi)、外不少調(diào)查[13-16]結(jié)果相似。有研究[17]指出,對(duì)于FP,雖然歐美國(guó)家已經(jīng)實(shí)施多年,但是依然有63%的醫(yī)護(hù)人員不支持。目前,國(guó)內(nèi)對(duì)FP的研究才剛剛起步,但是國(guó)內(nèi)急診醫(yī)護(hù)工作者對(duì)FP的抵觸情緒比較大。在參與調(diào)查的護(hù)理人員中,反對(duì)FP的原因之一是家屬會(huì)對(duì)醫(yī)護(hù)人員搶救產(chǎn)生干擾,會(huì)增加參與搶救的醫(yī)護(hù)人員無形的心理壓力[18-20]。心肺復(fù)蘇時(shí),FP會(huì)影響醫(yī)護(hù)人員實(shí)施有效搶救,并且患者家屬對(duì)心肺復(fù)蘇過程和操作規(guī)范的不了解也會(huì)增加產(chǎn)生醫(yī)療糾紛的風(fēng)險(xiǎn)。不可否認(rèn),在心肺復(fù)蘇時(shí),患者家屬的情緒、語言甚至過激行為在搶救室這個(gè)狹小的空間里只會(huì)分散醫(yī)護(hù)人員的搶救注意力,對(duì)整個(gè)搶救過程帶來負(fù)面影響。比如由于缺乏心理準(zhǔn)備,患者家屬常情緒激動(dòng)、或者拒絕接受患者臨床死亡等,這些均會(huì)對(duì)醫(yī)護(hù)人員造成負(fù)面影響。有研究[21]指出,由于家屬的干擾無法按照正常流程進(jìn)行心肺復(fù)蘇操作,從而影響了整體心肺復(fù)蘇的成功率,甚至增加了患者感染的危險(xiǎn)。所以,目前大多數(shù)醫(yī)院規(guī)定,心肺復(fù)蘇時(shí)患者家屬還是在搶救室外等候。

3.3 心肺復(fù)蘇時(shí)FP對(duì)患者家屬的影響 本調(diào)查中,79.2%的醫(yī)護(hù)人員認(rèn)為,心肺復(fù)蘇時(shí)FP對(duì)患者家屬無益,只會(huì)帶來心理創(chuàng)傷。目睹整個(gè)心肺復(fù)蘇的過程對(duì)家屬來說是一個(gè)強(qiáng)大的應(yīng)激,家屬會(huì)對(duì)此產(chǎn)生巨大的心理陰影。在急診搶救過程中,超快的工作節(jié)奏、多個(gè)復(fù)雜、精密搶救儀器的使用,使護(hù)理人員沒有多余的時(shí)間和精力給予患者家屬心理支持和關(guān)懷,這與何滿紅等[6]的調(diào)查結(jié)果相似,即患者家屬目睹心肺復(fù)蘇過程后,由于對(duì)復(fù)蘇過程的不了解,加之無法承受巨大的心理壓力,會(huì)留下長(zhǎng)期心理創(chuàng)傷,這也是護(hù)理人員在心肺復(fù)蘇時(shí)反對(duì)FP的另一大原因。本研究結(jié)果顯示,僅有29.2%的護(hù)理人員認(rèn)為自己有能力做好患者家屬專業(yè)的心理指導(dǎo)。

3.4 本研究的局限性 本次研究?jī)H局限在上海2所醫(yī)院,不足以代表整個(gè)上海乃至全國(guó)。

4 小結(jié)

急診護(hù)理人員對(duì)FP持不支持的態(tài)度,普遍認(rèn)為FP不利于醫(yī)護(hù)人員搶救的展開,對(duì)醫(yī)護(hù)人員和患者家屬都會(huì)有較負(fù)面的影響[22-23]。FP在急診的應(yīng)用反而有可能會(huì)增加潛在的醫(yī)患矛盾,增加醫(yī)療風(fēng)險(xiǎn)。要想在國(guó)內(nèi)實(shí)施FP,除了對(duì)醫(yī)護(hù)人員進(jìn)行培訓(xùn),構(gòu)建和諧的醫(yī)患關(guān)系、增加醫(yī)患間的信任和配合外,相關(guān)法律支持[24]也是必不可少的。

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(本文編輯:郁曉路)

Emergency Nurses’Attitudes Towards Family Presence during Cardiopulmonary Resuscitation

Yuan Xiuqun,Fan Ying(Department of Emergency,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

Fan Ying,E-mail:fanying＠renji.com

Objective To identify emergency nurses’attitudes towards family presence(FP)during cardiopulmonary resuscitation in order to provide evdience for a written policy allowing FP.Methods By convenience sampling,a total number of 55 emergency nurses with at least one year experience were selected and their attitudes towards family presence during resuscitation were investigated by using Fullbrook questionnaire.Results Of total 48 respondents,87.5%are female nurses;bachlor and college degrees are the majority which occupies 54.2%and 31.3%respectively,and 54.2%respondents totally 26 are nurse practitioners.Most respondents are clinical nurses and professional nureses which accounted 45.8%and 41.7% respectively.Of all the 48 respondents,40 respondents(83.3%)have the experience of FP and the other 8 respondents(16.7%)were not.79.2%respondents claimed that“witnessing resuscitation is a traumatic experience for the family members”,and only 8.3%respondents agreed“the presence of family members or friends during CPR would benefit the patients.70.9%respondents are not in favor of a written policy which gives the family members the option to attend CPR.Most respondents have common on the opinion that the witness of resusucitation may have a psychological stress on family members,and cause emotional disturbs among the resuscitation team members.Conclusion Majority of emergency nurse staffs are against FP because of the negative effects on both nursing staffs and family members.

emergency nurse;attitudes;family presence;cardiopulmonary resuscitation

10.3969/j.issn.1008-9993.2014.13.001

R472.2

A

1008-9993(2014)13-0001-04

2013-04-26

2013-10-10

袁秀群,本科,護(hù)師,主要從事急診危重患者的搶救及護(hù)理工作

范穎,E-mail:fanying＠renji.com