从科尔卡巴的理论模型看重症患者的舒适感

IF 1.1 Q3 NURSING

Enfermeria Intensiva Pub Date : 2024-10-01 DOI:10.1016/j.enfi.2023.11.001

M.D. Gonzalez-Baz RN, MSN, PhD , E. Pacheco-del Cerro RN, MSN, PhD , M.I. Durango-Limárquez RN, MSN , A. Alcantarilla-Martín RN , R. Romero-Arribas RN , J. Ledesma-Fajardo RN , M.N. Moro-Tejedor RN, MSN, PhD

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引用次数: 0

摘要

背景重症监护病房（CCU）的住院对患者的身体状况有严重影响，会引起许多不适，如疼痛或交流困难。所有这些都与重症监护室（ICU）出院后可能出现的后遗症（重症监护室出院后综合症）有关。科尔卡巴舒适理论（Kolcaba Comfort Theory）允许使用一般舒适度问卷（GCQ）等工具，从整体角度确定患者的护理需求。 Objectives To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.MethodsCross-sectional descriptive observational prospective study.研究对象访谈2015年6月至2020年3月期间入住两家高复杂性医院成人CCU、住院时间≥24小时的580名患者。使用 SPSS v26 和 STATA v16 进行描述性分析、学生 t 检验、方差分析和多变量分析。结果平均年龄为 52.62（16.21）岁，357（61.6%）人为男性，434（74.8%）人为信徒。322人（55.5%）的入院类型为计划入院，486人（83.8%）的入院原因为手术。疼痛评分（NRS）中位数为 3.00 [0-4]，严重程度评分（APACHE II）为 13.26 (5.89)，住院时间中位数为 4.00 [2-7] 天。平均舒适度为 3.02 (0.31)，其中复苏室最高，为 3.02 (0.30)，急诊和创伤室最低，为 2.95 (0.38)。在 65 岁患者的舒适度方面，各病房之间存在明显的统计学差异（P=0.029）。在三个科室中，救济舒适度的平均值最低，为 2.81（0.33），物理舒适度的平均值为 2.75（0.41）。在多变量分析中，舒适度与疼痛程度之间存在显著的统计学差异：无痛（P=.000）OR：4.361；IC：2.184-8.707，轻度疼痛（P=.000）OR：4.007；IC：2.068-7.763；中度疼痛（P=.007）OR：2.803；IC：1.328-5.913；APACHE II 评分等于或大于 10（P=.000）OR：0.472；IC：0.316-0.705。物理和环境背景以及缓解舒适类型对舒适感有负面影响。解释舒适度的变量是疼痛和疾病的严重程度。通过 GCQ 从患者角度对舒适度进行评估，可被视为护理干预质量的一项指标。

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Percepción del confort en el paciente crítico desde el modelo teórico de Kolcaba

Background

The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).

Objectives

To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.

Methods

Cross-sectional descriptive observational prospective study. Population: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.

Results

The mean age was 52.62 (16.21), 357 (61.6%) were male and 434 (74.8%) were believers. The type of admission was planned in 322 (55.5%) and the most prevalent reason for admission was surgical 486 (83.8%). The median pain score (NRS) was 3.00 [0-4] and severity score (APACHE II) was 13.26 (5.89), the median length of stay was 4.00 [2-7] days. The mean comfort level was 3.02 (0.31) showing the highest value for the Reanimation Unit 3.02 (0.30) and the lowest fort the Emergency and Trauma Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (P=.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (P=.000) OR: 4.361; IC: 2.184-8.707, mild pain (P=.000) OR: 4.007; IC: 2.068-7.763, moderate pain (P=.007) OR: 2.803; IC: 1.328-5.913, and the APACHE II score equal to or greater than 10 (P=.000) OR: 0.472; IC: 0.316-0.705.

Conclusions

The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.

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来源期刊

Enfermeria Intensiva NURSING-

CiteScore

2.50

自引率

23.10%

发文量

期刊介绍： Enfermería Intensiva es el medio de comunicación por antonomasia para todos los profesionales de enfermería españoles que desarrollan su actividad profesional en las unidades de cuidados intensivos o en cualquier otro lugar donde se atiende al paciente crítico. Enfermería Intensiva publica cuatro números al año, cuyos temas son específicos para la enfermería de cuidados intensivos. Es la única publicación en español con carácter nacional y está indexada en prestigiosas bases de datos como International Nursing Index, MEDLINE, Índice de Enfermería, Cuiden, Índice Médico Español, Toxline, etc.