加護病房病人的舒適感受與其相關因素之探討

研究背景：現今國內的重症醫療環境擁有豐富的資源，隨著醫療與護理品質的提升，僅評估入住加護病房病人之死亡率已不足以呈現醫療品質，病人的舒適度也逐漸應受到重視。雖然先前研究發現影響病人的舒適感包含身體、心理靈性、社會文化與環境層面，但對於加護病房以維持病人的生命為首要任務，無形中可能忽視了病人的舒適需求，也缺少整體性的評估。因此，本研究為探討加護病房病人的舒適感受與其相關因素，期望未來可以提供加護病房提升照護病人舒適度之參考。研究目的：本研究旨在探討加護病房病人的舒適感受與其相關因素，並分析之間的關連性。研究方法：採相關性研究設計（correlational study designs），與方便取樣，以中部某醫學中心內科加護病房病人為選樣對象，共收案163人。研究工具包含自擬結構式問卷(基本人口學特質問卷、個人與疾病因素問卷、醫療相關處置與環境因素問卷)、格拉斯哥昏迷指數、疾病嚴重度評估表、簡短版一般舒適量表。以獨立t檢定、變異數分析、相關性檢定及階層迴歸進行資料分析。研究結果：本研究共收案163位加護病房病人，平均年齡62.13歲（標準差 = 15.14），病人舒適程度分數介於54分至147分，標準化後之平均分數為57.6分(標準差 = 10.01)，屬於中等強度。年齡與舒適程度呈負相關(r = -.18, p = .022)，亦即年齡越高舒適程度越低，家庭組織型態中核心家庭者舒適程度高於三代家庭者(F = 4.522, p = .012)；入院診斷為呼吸系統相關診斷者舒適程度較低(t = -2.187, p = .03)，病人與醫師或護理師溝通程度佳者舒適程度亦較高 (F = 11.758, p < .001；F = 4.532, p = .012)；留置管路種類中以導尿管舒適程度較低(t = -2.239, p = .027)，檢查項目中以電腦斷層舒適程度較低(t = -1.992, p = .048)，醫療處置項目以輸血舒適程度較低(t = -2.602, p = .01)，護理處置項目以換尿布(t = -2.369, p = .019)、翻身(t = -2.332, p = .021)、灌食(t = -3.101, p = .002)、抽痰(t = -2.107, p = .037)、使用拍痰機(t = -2.107, p = .041)等項目與舒適程度有顯著差異，病人有使用常規止痛藥物的舒適程度較低(t = -3.553, p < .001)，環境感受中光線(t = -5.742, p < .001)、噪音(t = -6.594, p < .001)、溫度熱(t = -3.139, p = .002)、溫度冷(t = -6.585, p < .001)及隱私(t = -3.301, p = .001)，皆與舒適程度達顯著差異。階層迴歸分析顯示家庭組織型態為核心家庭 (β = .153, p = .047)、護理處置中更換尿布 (β = -.181, p = .009)、使用常規止痛藥 (β = -.160, p = .036)、環境感受中對光線感到困擾 (β = -.204, p = .009)及環境感受中對室溫感到冷(β = -.211, p = .022)是加護病房病人舒適程度的預測因子，而模型總解釋變異量為45.2%，調整後之總解釋變異量為36.6% (F = 5.247, p < .001)。研究結論：本研究顯示家庭組織型態為核心家庭、護理處置為更換尿布、常規使用止痛藥物、環境感受(如：光線、噪音及室溫感覺冷)是加護病房病人舒適感受的預測因子。因此，建議加護病房護理師除了了解影響病人舒適度的相關因子外，還要清楚病人的家庭組織關係、於執行更換尿布時動作輕柔、使用止痛藥物同時能落實疼痛評估以達良好的疼痛控制，環境感受部分，光線可由燈光及窗簾適時調整，人為噪音盡可能降低，也應留意病人的體溫，可善用烤燈及被子的增減以促進病人的舒適度。

Background: Today’s critical care environment is more abundant than ever in its resources. However, precisely thanks to improvements in medical and nursing quality, assessing the mortality of patients admitted to intensive care units (ICUs) is no longer sufficient to demonstrate quality-of-care, and increasing attention will need to be paid to the comfort of patients going forward. In this context, despite widespread reports on the comfort of patients with regards to physical, psychological, sociocultural, and environmental aspects, the comfort of ICU patients continues to be neglected in many cases, which may be exacerbated by the persistent lack of an overall assessment for patient comfort. Therefore, this study aimed to assess the comfort level of patients in the ICU and identify potentially related factors in order to provide a framework for nurses working in ICUs to improve the comfort of their patients.Aims: The purpose of this study was to evaluate the level of comfort ICU patients and factors related to comfort, and analyze any potential correlations between them.Methods: This study used a correlational research design and a convenience sampling method. A total of 163 patients from the Medical ICU of a medical university hospital in Taichung, Taiwan, were enrolled. The study tools included self-designed structured questionnaires (Basic Demographic Traits Questionnaire, Personal and Illness Factors Questionnaire, Medical Related Treatments Dispositions and Environmental Factors Questionnaire), the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Shortened General Comfort Questionnaire (SGCQ). Independent t-test, analysis of variance (ANOVA), Pearson’s correlation test, and hierarchical regression were used to test the research hypotheses.Results: The average age of the participants was 62.13 years (standard deviation (SD), 15.14). The comfort scores of the patients in the ICU ranged from 54 to 147 points. The average score after standardization was 57.6 points (SD, 10.01), indicating medium intensity. In terms of demographic characteristics, a low negative correlation was observed between age and comfort level (r = ‒.18, p = .022). In other words, patients who with a higher age presented lower levels of comfort. Regarding the family organization type, the comfort level of nuclear family members was higher than that of three-generation family members (F = 4.522, p = .012). In terms of personal disease factors, the comfort level of patients were admitted to the hospital with respiratory system-related diagnoses was lower (t = ‒2.187, p = .03). By contrast, the comfort level of patients with better communication between patients and doctors or nurses was higher (F = 11.758, p < .001 ; F = 4.532, p = .012). In terms of medical-related treatment and environmental experience, among the types of indwelling catheters, the comfort level of urinary catheters was lower (t = ‒2.239, p = .027). Similarly, among the examination items, the comfort level associated with computerized tomography was lower (t = ‒1.992, p = .048), Among the medical treatment items assessed, blood transfusion showed a lower comfort level (t = ‒2.602, p = .01). Similarly, among the nursing treatment items, diaper changing (t = ‒2.369, p = .019), changing position (t = ‒2.332, p = .021 ), nasogastric tube feeding (t = ‒3.101, p = .002), sputum suction (t = ‒2.107, p = .037), and High-Frequency Chest Wall Oscillation (t = ‒2.107, p = .041) were significantly difference with comfort level. The use of conventional analgesics (t = ‒3.553, p < .001), sensitivity to bright light (t = ‒5.742, p < .001) and noise (t = ‒6.594, p < .001), a higher room temperature (t = ‒3.139, p = .002), a lower room temperature (t = ‒6.585, p < .001), and privacy (t = ‒3.301, p = .001) were also significantly difference with comfort level. According to the results of hierarchical regression analysis, a nuclear family (β = .153, p = .047), the changing of diapers during nursing care (β = ‒.181, p = .009), the use of conventional analgesics (β = ‒.160, p = .036), being sensitive to bright environmental light (β = ‒.204, p = .009), and a lower room temperature (β = ‒.211, p = .022) were predictors of patient comfort in the intensive care unit. The total explained variance was 45.2%, and adjusted explained variance was 36.6% (F = 5.247, p < .001). Conclusion: A nuclear family organization type, nursing care involving the changing of diapers, the regular use of analgesics, and sensitivity to environmental factors, including light, noise, and room temperature, were predictors of comfort in the intensive care unit. Based on these findings, it is recommended that in addition to understanding the relevant factors that affect patient comfort, ICU nurses need to understand patients’ family structures, change diapers gently, really assess the pain relief effect when using analgesics. Furthemore, in terms of environmental factors, room lighting should be adjusted through the use of lights and curtains, artificial noise should be reduced as much as possible, and patients’ body temperature should be monitored to further promote patient comfort.