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Volume 46 Issue 4
Jun.  2021
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Article Navigation >  Journal of Bengbu Medical College  > 2021,  46 > 4: (543-546)  

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Analysis of related factors affecting the readiness of primary caregivers in ICU transferred patients

  • Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China

  • Received Date: 2019-12-08
    Accepted Date: 2020-06-16
  • ObjectiveTo analyze the related factors affecting the readiness of primary caregivers in ICU transferred patients.MethodsPrimary caregivers in ICU transferred patients were selected as the study subjects.According to the score using care preparedness scale (CPS), the primary caregivers of ICU transferred patients were divided into the CPS ≤ 16 group and the CPS>16 group.The basic information of the two groups, including gender, age, education, family income, care experience, the degree of understanding the patient's disease knowledge, the relationship with the patient and the patient's health condition such as the activities of daily living scale living (ADL)score, simplified Fugl-Meyer motor function score, mini-mental state examination (MMSE)score were compared.Multivariate logistic regression was used to analyze the related factors affecting the readiness of primary caregivers in ICU transferred patients.ResultsAmong the 120 caregivers of ICU transferred patients, 55 patients had the CPS scores less than or equal to 16 points(CPS ≤ 16) and 65 patients had the CPS scores greater than 16 points (CPS>16).There was no significant difference in gender, family income, and relationship between patients in the two groups(P>0.05).The age in CPS ≤ 16 group was significantly higher than that in CPS>16 group(P < 0.01).The education level, care experience and the degree of understanding the patients' disease knowledge in CPS ≤ 16 group were significantly lower than those in CPS>16 group (P < 0.05 and P < 0.01).The ADL score, simplified Fugl-Meyer motor function score, and MMSE score of patients with CPS ≤ 16 were significantly lower than those with CPS> 16(P < 0.01).After multivariate logistic regression analysis, the age of the primary caregiver, the education level of the primary caregiver, the understanding of the primary caregiver's knowledge of the patient's disease, the patient's ADL score, the patient's simplified Fugl-Meyer motor function score and the patient's MMSE score were the risk factors of readiness of primary caregivers in ICU transferred patients (P < 0.05 to P < 0.01).There was no correlation between the care experience of primary caregivers and the readiness of primary caregivers of ICU transferredred patients(P>0.05).ConclusionsThe age, education level, the degree of understanding the patient's disease knowledge of the primary caregiver, and the health condition of the patients are the related factors that affect the readiness of primary caregiver of ICU transferredred patients, which can be based on by targeted interventions in clinic.
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    [2] 邸英莲, 张翠娣, 李书. 基于自我表露理论的团体干预模式对脑卒中病人主要照顾者负担的影响[J]. 中华现代护理杂志, 2019, 25(2): 184. doi: 10.3760/cma.j.issn.1674-2907.2019.02.012
    [3] 路静静, 成巧梅. 恶性肿瘤病人主要照顾者的影响因素及护理干预的研究现状[J]. 护士进修杂志, 2017, 32(8): 702.
    [4] MAZANEC SR, REICHLIN D, GITTLEMAN H, et al. Perceived needs, preparedness, and emotional distress of male caregivers of postsurgical women with gynecologic cancer[J]. Oncol Nurs Forum, 2018, 45(2): 197. doi: 10.1188/18.ONF.197-205
    [5] 陈婧, 石艳, 郑洁, 等. 认知行为干预对ICU转出病人家属迁移应激及照顾者负担的影响[J]. 中国医药导报, 2019, 16(22): 185.
    [6] 刘娟娟, 刘姗, 蒋丽琼, 等. 脑卒中病人主要照顾者准备度现状及影响因素分析[J]. 中国护理管理, 2018, 18(1): 52. doi: 10.3969/j.issn.1672-1756.2018.01.014
    [7] 杨冬菊, 蒋晓莲. 维持性血液透析病人主要照顾者的照顾负担研究[J]. 中国血液净化, 2017, 16(12): 838.
    [8] YEH HY. Managing uncertainty by adopting a hybrid way of knowing: investigating the mangle-ish approach of ICU patients' caregivers[J]. Ment Health Relig Cult, 2017, 20(1): 1. doi: 10.1080/13674676.2017.1313826
    [9] 高豆青, 单岩, 张琳, 等. 终末期肾脏病病人与主要照顾者疾病不确定感的相关性研究[J]. 重庆医学, 2017, 46(8): 1145. doi: 10.3969/j.issn.1671-8348.2017.08.048
    [10] ZHOU S, WANG JN, WANG J, et al. Relocation stress and its influencing factors of the families of patients transferred from ICU[J]. Chin J Nurs, 2017, 52(8): 911.
    [11] 孟刘晶, 周嫣, 徐励, 等. 首发脑卒中病人主要照顾者阶段性需求满足现况分析[J]. 中华现代护理杂志, 2018, 24(35): 4229. doi: 10.3760/cma.j.issn.1674-2907.2018.35.003
    [12] 叶芒芒, 丁银蓉. 社区高龄脑梗死病人介入治疗后主要照顾者的家庭功能与抑郁情绪的关系研究[J]. 中国康复, 2019, 34(7): 378.
    [13] SHAO C, GU L, MEI Y, et al. Analysis of the risk factors of cognitive impairment in post-intensive care syndrome patient[J]. 2017, 29(8): 716.
    [14] 王晓华, 孟伟康, 梁晓慧, 等. 微信平台的延续护理对老年脑卒中主要照顾者心理及照顾能力的影响[J]. 河北医药, 2019, 41(13): 2059. doi: 10.3969/j.issn.1002-7386.2019.13.034
    [15] 唐青峰, 张国琴. 恶性肿瘤病人主要照顾者心理弹性在社会支持与应对方式间的中介效应[J]. 现代预防医学, 2017, 44(24): 4478.
    [16] 李培越, 秦红艳, 王晓艳, 等. ICU幸存者ICU后综合征对主要照顾者负担水平的影响[J]. 中国实用护理杂志, 2018, 34(32): 2535. doi: 10.3760/cma.j.issn.1672-7088.2018.32.014
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Analysis of related factors affecting the readiness of primary caregivers in ICU transferred patients

  • Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
  • Received Date: 2019-12-08
  • Accepted Date: 2020-06-16
  • Available Online: 2021-04-15

Abstract: ObjectiveTo analyze the related factors affecting the readiness of primary caregivers in ICU transferred patients.MethodsPrimary caregivers in ICU transferred patients were selected as the study subjects.According to the score using care preparedness scale (CPS), the primary caregivers of ICU transferred patients were divided into the CPS ≤ 16 group and the CPS>16 group.The basic information of the two groups, including gender, age, education, family income, care experience, the degree of understanding the patient's disease knowledge, the relationship with the patient and the patient's health condition such as the activities of daily living scale living (ADL)score, simplified Fugl-Meyer motor function score, mini-mental state examination (MMSE)score were compared.Multivariate logistic regression was used to analyze the related factors affecting the readiness of primary caregivers in ICU transferred patients.ResultsAmong the 120 caregivers of ICU transferred patients, 55 patients had the CPS scores less than or equal to 16 points(CPS ≤ 16) and 65 patients had the CPS scores greater than 16 points (CPS>16).There was no significant difference in gender, family income, and relationship between patients in the two groups(P>0.05).The age in CPS ≤ 16 group was significantly higher than that in CPS>16 group(P < 0.01).The education level, care experience and the degree of understanding the patients' disease knowledge in CPS ≤ 16 group were significantly lower than those in CPS>16 group (P < 0.05 and P < 0.01).The ADL score, simplified Fugl-Meyer motor function score, and MMSE score of patients with CPS ≤ 16 were significantly lower than those with CPS> 16(P < 0.01).After multivariate logistic regression analysis, the age of the primary caregiver, the education level of the primary caregiver, the understanding of the primary caregiver's knowledge of the patient's disease, the patient's ADL score, the patient's simplified Fugl-Meyer motor function score and the patient's MMSE score were the risk factors of readiness of primary caregivers in ICU transferred patients (P < 0.05 to P < 0.01).There was no correlation between the care experience of primary caregivers and the readiness of primary caregivers of ICU transferredred patients(P>0.05).ConclusionsThe age, education level, the degree of understanding the patient's disease knowledge of the primary caregiver, and the health condition of the patients are the related factors that affect the readiness of primary caregiver of ICU transferredred patients, which can be based on by targeted interventions in clinic.

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  • 现代化监护及抢救设备的持续完善和重症医学的不断发展，使得危重症病人的抢救成功率越来越高，ICU转出率也随之增长，而病人转至普通病房后，仍要对血压、电解质、心功能等进行观察，日常生活也需他人提供帮助[1-2]。作为ICU转出病人的主要照顾者，其准备度过低，不仅会增加病人的住院时间及费用、病情恶化的风险，也会加重自身与病人的身心压力，产生焦虑、烦躁等不良情绪[3]。主要照顾者准备度越高，病人生理及心理需求越能得到满足，躯体和神经功能恢复也相对主要照顾者准备度低的病人更快[4]。陈婧等[5]的研究表明，对ICU转出病人家属进行认知行为干预，可显著降低家属的迁移应急水平及负担，从而使家属尽快适应普通病房内的照料工作。但目前关于ICU转出病人主要照顾者准备度的影响因素还没有明确定论。因此，本研究对影响ICU转出病人主要照顾者准备度的相关因素进行分析，为促进ICU转出病人健康的提供理论依据。

1.   对象与方法

    1.1.   研究对象

  • 选择2018年6月至2019年11月120例ICU转出病人主要照顾者作为研究对象。(1)纳入标准：经本院伦理委员会审核批准，病人及主要照顾者均签署知情同意书；均符合ICU转出指征[6]，即血流动学稳定、已渡过疾病急性发作期、无需机械通气及不需要其他特殊生理监测仪器等；日常生活能力评定量表(ADL)[7]≤60分；主要照顾者≥18岁、照顾病人总时间≥6 h/d或照顾病人的时间最长，且仅有一个照顾对象。(2)排除标准：主要照顾者存在躯体功能障碍，生活不能完全自理或与病人为雇佣关系；ICU转出病人近3个月内入住ICU次数≥2次；主要照顾者认知、交流障碍；提前出院、转院等未能完成研究调查者。

    • 1.2.   方法

  • 采用照顾者准备度量表(CPS)对120例ICU转出病人主要照顾者进行评分，包括生理需求、情感需求、服务计划、照顾压力、双方满意的照顾、应对和处理紧急情况、获取信息资源和帮助、整体照顾8个条目，每个条目0~4分，得分越高，照顾者准备度越高。根据得分将ICU转出病人主要照顾者分为CPS≤16分组、CPS>16分组，比较2组性别、年龄、文化程度、家庭收入、照顾经验、对病人疾病知识的了解度、与病人的关系。病人的健康状况：(1)ADL, 包括进食、修饰、穿衣、行走、如厕、洗澡、控制大便、控制小便、转移、上下楼梯10项，每项10分。总分0~20分，机体功能极严重或严重缺陷，生活完全依赖他人；总分21~40分，机体功能中度缺陷，生活大部分依赖他人；总分41~60分，生活部分依赖他人；总分>60分，生活基本自理。(2)简化Fugl-Meyer运动功能评分, 包括上肢和下肢运动17个条目，50项评分，每项2分，得分越高，运动功能越好。(3)简易精神状态量表(MMSE), 包括定向力10分，记忆力3分，注意力及计算力5分，回忆力3分，语言能力9分。总分27~30分表示精神状态和认知功能良好，21~>27分为轻度痴呆，伴认知行为偏差；10~20分为中度痴呆，存在认知功能障碍；≤9分为重度痴呆，认知功能损害严重。

    • 1.3.   统计学方法

  • 采用χ2检验、t检验和logistic回归分析。

2.   结果

    2.1.   120例病人主要照顾者的CPS评分和基本资料分析

  • 120例ICU转出病人主要照顾者中，CPS≤16分55例，>16分65例。2组性别、家庭收入、照顾经验、与病人的关系差异均无统计学意义(P>0.05)；CPS≤16分组的年龄显著高于CPS>16分组(P＜0.01)，文化程度、对病人疾病知识的了解度显著低于CPS>16分组(P＜0.05和P＜0.01)(见表 1)。

    项目 CPS≤16分组
    (n=55)    		 CPS>16分组
    (n=65)    		 χ2 P
    性别
      男
      女    		 24(43.64)
    31(56.36)    		 28(43.08)
    37(56.92)    		 0.01 >0.05
    年龄/岁
      18~40
      >40    		 19(34.55)
    36(65.45)    		 40(61.54)
    25(38.46)    		 8.69 ＜0.01
    文化程度
      高中以下 17(30.91) 9(13.85)
      高中到大专 26(47.27) 30(46.15) 7.12 ＜0.05
      本科及以上 12(21.82) 26(40.00)
    家庭收入/千元
      < 5 18(32.73) 14(21.54)
      5~10 32(58.18) 41(63.08) 2.46 >0.05
      >10 5(9.09) 10(15.38)
    照顾经验
      有
      无    		 16(29.09)
    39(70.91)    		 30(46.15)
    35(53.85)    		 3.67 >0.05
    对病人疾病知识的了解度
      完全了解 16(29.09) 40(61.54)
      部分了解 29(52.73) 22(33.85) 14.28 ＜0.01
      不了解 10(18.18) 3(4.62)
    与病人的关系
      父母 7(12.73) 8(12.31) 0.48 >0.05
      配偶 29(52.73) 32(49.23)
      子女 15(27.27) 18(27.69)
      其他 4(7.27) 7(10.77)

    • 2.2.   2组病人的健康状况比较

  • CPS≤16分组病人的ADL、简化Fugl-Meyer运动功能评分、MMSE均显著低于CPS>16分组(P＜0.01)(见表 2)。

    分组 n ADL 简化Fugl-Meyer运动功能评分 MMSE
    CPS≤16分组 55 45.77±6.36 57.89±8.43 20.31±3.58
    CPS>16分组 65 49.25±7.84 62.55±9.67 23.56±4.32
    t — 2.64 2.79 4.44
    P — ＜0.01 ＜0.01 ＜0.01

    • 2.3.   ICU转出病人主要照顾者准备度的多因素logistic回归分析

  • 经多因素logistic回归分析，主要照顾者年龄、文化程度、对病人疾病知识的了解度及病人ADL、简化Fugl-Meyer运动功能评分、MMSE均是ICU转出病人主要照顾者准备度的危险因素(P＜0.05~P＜0.01)；主要照顾者照顾经验与ICU转出病人主要照顾者准备度无相关性(P>0.05)(见表 3)。

    因素 B SE Waldχ2 P OR 95%CI
    主要照顾者年龄 1.32 0.646 4.36 ＜0.05 3.726 1.906~5.778
    主要照顾者文化程度 1.59 0.721 5.84 ＜0.05 4.849 1.112~7.219
    主要照顾者照顾经验 1.01 0.835 2.42 >0.05 1.153 0.947~2.123
    主要照顾者对病人疾病知识的了解度 1.70 0.722 6.78 ＜0.01 5.467 1.235~9.265
    病人ADL 1.53 0.689 5.57 ＜0.05 4.624 1.123~6.062
    病人简化Fugl-Meyer运动功能评分 1.74 0.802 6.84 ＜0.01 5.728 1.307~12.354
    病人MMSE 1.15 1.002 5.01 ＜0.05 4.543 1.004~6.596
3.   讨论

  • 近年研究[8]显示，ICU病人转入普通病房后更易发生呼吸系统及相关并发症，因此连续、规范的后续治疗和护理对预防病人病情突然恶化、降低其他疾病的发生尤为重要。除了医务人员要严格有效地完成诊疗任务外，照顾者有充分长期的准备来迎接照顾ICU转出病人的挑战，为病人提供正确的护理、情感支持、细心观察，也是促进病人早日康复或基础疾病得到长期控制的关键因素[9-10]。本文结果显示，CPS≤16分组的年龄显著高于CPS>16分组，这是因为病人从ICU转到普通病房后，主要照顾者需要付出更多的精力来照顾病人，难免会发生心理情绪及精神行为的变化，若主要照顾者的年龄过大，对照顾病人的准备度也会下降，甚至产生抵触、懈怠情绪[11]。CPS>16分组的文化程度、照顾经验、对病人疾病知识的了解度均显著高于CPS≤16分组，提示可根据病人的具体病情、照顾者的理解能力，向照顾者补充相关疾病的知识，并展示优秀案例，从而提高照顾者的准备度，改善照料质量。

    但也有不同的研究[12]认为，ICU转出病人病情易反复，康复过程和护理内容复杂，即使是专业的护理人员，也需经过长期的培训及临床经验才能熟练掌握相关知识及护理技巧，要照顾者在短时间内完成角色转变、加深对病人疾病知识的了解度，还具有相当的难度。病人的健康状况直接决定了其在日常生活中依赖他人的程度，如长期卧病在床或重度痴呆病人，洗脸、梳头乃至大小便都需要照顾者的帮助，这就在导致病人不能正确表达自我需求的同时，增加了照顾者的负担，降低了其准备度[13-14]。因此，CPS>16分组的ADL、简化Fugl-Meyer运动功能评分及MMSE均显著高于CPS≤16分组。唐青峰等[15]指出，经常照顾病人的家属，会产生比病人更为严重的心理问题，尤其是在得不到缓解的情况下，还会出现过激行为。故而，医务人员应将ICU转出病人与照顾者看作一个整体，在不影响正常诊疗工作的基础上，利用各类信息资源、干预手段提高照顾者的认知与心理弹性，从而使照顾者拥有良好且稳定的准备度[16]。

    综上所述，影响ICU转出病人主要照顾者准备度的危险因素是主要照顾者年龄、文化程度、病人疾病知识的了解度及病人健康状况。临床可通过降低照顾者的压力、加强对ICU转出病人的关注等方面来提高ICU转出病人主要照顾者准备度，达到护理人员与照顾者的共同协作，使照顾者为病人提供双方均满意的照顾。

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