重症患者的疾病詮釋、壓力與焦慮之相關研究

研究背景：　　先前研究顯示當患者進入重症單位，因健康遭受威脅，可能產生不同的情緒反應，而患者住進加護病房時的壓力源，包含身體、心理、環境等方面，加上重症患者因無法順利表達其自己心理所需，經常出現焦慮的情緒反應。此外，疾病詮釋為個人因疾病認知的不同，患者對於疾病進展的程度、治療狀況，可能產生不同的觀感，然而針對重症患者探討其疾病詮釋、壓力與焦慮的相關研究尚缺乏。研究目的：　　因本研究旨在探討重症患者疾病詮釋、壓力與焦慮的相關性，並探討重症患者焦慮的相關預測因子。研究方法：　　本研究採相關性研究設計（correlational study designs），採方便取樣，以中部某醫學中心內科加護病房病患為對象，收案時間分別為患者在重症單位及普通病房時。研究工具包含，基本資料問卷、疾病詮釋量表、加護病房環境壓力源量表、視覺焦慮類比量表。資料以線性逐步迴歸，探討焦慮的預測因子。研究結果：　　本研究共收案90人，平均年齡65.3歲（標準差=15.5）。就疾病詮釋的七個面向而言，患者在ICU時，得分較高前三項為治療控制、個人控制性，及疾病理解程度，而患者在普通病房時，得分較高前三項則是治療控制、疾病理解程度、個人控制性。患者在ICU的壓力程度的四個面向，依照分數排序分別為，治療環境、患者自身體驗、物理環境、人文環境。而患者在ICU與普通病房時的焦慮表現分別為中度(平均數 = 4.39，標準差= 3.20)及中度以下(平均數 =3.12，標準差= 2.71）。患者在ICU時壓力與疾病詮釋某些面呈現顯著相關，如，急性、慢性病程、後遺症、情緒意象分別與壓力呈現顯著正相關（r = 0.23, p < .05; r = 0.44, p < 0.001; r = 0.38, p < 0.001），治療控制與壓力呈現則呈現顯著負相關（r = -0.24, p < .05）。至於壓力的面向與焦慮的相關分析中顯示：患者自身體驗和治療環境分別與焦慮都呈現顯著正相關（r = 0.28, p < .01；r = 0.30 p < .01）。整體而言，疾病詮釋的情緒意象為焦慮的預測因子，解釋變異為24.1 %。結論與建議：　　研究顯示患者在ICU時壓力越高，表示疾病持續時間越長、疾病所帶來的後遺症越多，及產生的負面情緒越多，但對於疾病透過治療達到控制的程度越低。患者在ICU時，焦慮分數越高，其對病人在醫療環境中所體悟到，及管路的束縛、抽痰、約束等行為所感受到的壓力分數越高，另外疾病詮釋的情緒意象為焦慮的預測因子，我們可了解到重症患者因疾病所產生的情緒越負面，患者焦慮的情形越高，因此我們需要及時給予患者關懷及傾聽，減輕患者會於疾病所產生的情緒產應而造成焦慮。

關鍵字

重症患者；疾病詮釋；壓力；焦慮

並列摘要

Background: Previous study reported that different emotional responses of critically ill patients in the ICU may be elicited secondarily by perceived threats to their health. The ICU patients’ perceptions of stressors include physical, psychological, and environmental and we also found that those who are unable to express their needs freely often experience anxiety, illness representations are patients’ beliefs and expectations about an illness, somatic symptoms, or therapy, and a study regarding the relationships among patient illness representations, stress, and anxiety in intensive care is lacking. Objective: The study explored the relationships between patients’ illness representations, stress, and anxiety in intensive care, and aimed to find the reliable predictors of anxiety in ICU patients. Material and Methods: This study used a correlational design and convenience sampling. This single-center study was conducted with patients referred to an ICU at Taichung, and we surveyed patients in the ICU and the ward. The tools of this study included: the Illness Perception Questionnaire, the Intensive Care Unit Environmental Stressor Scale (ICUESS), the State-Trait Anxiety Inventory (STAI), and the Visual Analog Scale for Anxiety (VASA). Descriptive statistics describe basic features of data in this study, and inferential statistics allow us to predict relationships between patient illness representations, stress, and anxiety in intensive care, which analyzed by the linear regression. Results: The study involved a total of 90 participants, with an average age of 65.3 years (SD=15.5). For patients in the ICU, high scores on illness representations were found in the domains of treatment control, personal control, and illness coherence; for patients in the ward, high scores in illness representation were found in the domains of treatment control, illness coherence, personal control. High scores were found in four aspects of stress of patients in the ICU: the treatment environment, the patient’s own experience, the physical environment, and the human environment. The anxiety of patients in the ICU and ward was moderate (Mean = 4.39, SD=3.20); the other was below at moderate (Mean = 3.12, SD= 2.71). The stress in the ICU was significantly correlated with the illness representation. For example, timeline, consequences, and emotional representations were significantly positively correlated with stress (r = 0.23, p < .05; r = 0.44, p < 0.001; r = 0.38, p < 0.001); there was a significant negative correlation between treatment control and stress (r = -0.24, p < .05). The correlations between stress and anxiety, the patient's own experience and treatment environment were significantly positively correlated with anxiety (r = 0.28, p < .01; r = 0.30, p < .01). Overall, the emotional representations were predictors of anxiety with a predictive power of 24.1%. Conclusion and Suggestion: Studies showed that patients in ICU had higher stress than did those in the ward, and that the longer the disease duration, the more were its consequences, the more were the negative emotions, but the lower was the degree of patient’s control over the treatment. For patients in the ICU, due to the medical environment involving constraints of the tubes and suction, the anxiety and stress scores would be high. The predictive factor of anxiety, we could understand that the more negative of emotional representation, and the higher of the anxiety, so we needed to attentive to the patients and listened, reduced the patients had negative emotions, and the side effects with anxiety.

並列關鍵字

anxiety ； illness representations ； intensive care unit patients ； stress

參考文獻

中文參考資料

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