多媒體護理指導緩解冠狀動脈成形術後心肌梗塞病患焦慮及疾病不確定感之成效

The Effectiveness of Multimedia Nursing Education on Reducing Illness-Related Anxiety and Uncertainty in Myocardial Infarction Patients after Percutaneous Coronary Intervention

背景：在工作繁忙的心臟加護病房（cardiac care unit, CCU）中，如何藉由合宜的衛教方式來協助心肌梗塞患者降低其焦慮及對疾病之不確定感，可說是一大挑戰。目的：探討多媒體護理指導對降低冠狀動脈血管成型術（percutaneous coronary intervention, PCI）後心肌梗塞患者焦慮及疾病不確定感之成效。方法：採類實驗研究設計，於南臺灣某醫學中心之CCU進行收案。對照組（n = 36）採常規護理指導（以書面護理指導手冊為指引+口頭護理指導），實驗組（n = 40）以多媒體護理指導為主並給予書面護理指導手冊輔助瞭解，分別探討轉入CCU時、衛教介入後、轉出CCU時以及出院當天等四個時期，病患的焦慮及不確定感之變化。研究工具包含疾病不確定感量表、情境特質焦慮量表及非侵入性的生理測量儀。結果：PCI術後心肌梗塞病患在CCU時有中、高度的焦慮及不確定感，可藉由人力及時間花費較少的多媒體護理指導顯著改善病患焦慮（t39 = -6.615, p < .001）與不確定感（t39 = -8.317, p < .001）；而書面護理指導亦可改善其焦慮（t35 = -4.767, p < .001）與不確定感（t35 = -9.739, p < .001）；實驗組於上述四個時期的改變量多數高於對照組。應用研究結果可提供CCU護理人員之實證資料，在繁忙的工作環境中，依病患情況選擇合適的衛教方式，達到個別化護理之目標；本文亦針對上述兩種不同的護理指導做較深入的論述。

Background: Properly educating myocardial infarction (MI) patients in the extremely busy cardiac care unit (CCU) work environment is difficult for CCU nurses.Purpose: This study examined the effectiveness of multimedia nursing education in reducing illness-related anxiety and uncertainty in MI patients following percutaneous coronary intervention (PCI).Methods: A quasi-experimental study with judgment sampling was designed and performed at a medical center in South Taiwan. The control group (n = 36) received written nursing education material and the experimental group (n = 40) received multimedia nursing education. Participant illness-related anxiety and uncertainty was measured at four specific periods, namely (1) at admission to the CCU, (2) immediately after completing the nursing education interventions, (3) upon transfer to the general ward, and 4) at discharge. Measurement tools included Mishel's uncertainty in illness scale (MUIS), the state-trait anxiety inventory (STAI), and noninvasive physiological monitoring instruments.Results: Results showed that both interventions lowered anxiety / uncertainty in participants with moderate to severe levels (experimental group - anxiety: t(subscript 39) = -6.615, p ＜ .001 and uncertainty: t(subscript 39) = -8.317, p ＜ .001; control group – anxiety: t(subscript 35) = -4.767, p ＜ .001 and uncertainty: t(subscript 35) = -9.739, p ＜ .001). The experimental group achieved significantly greater reductions than the control group in terms of anxiety and uncertainty in each of the four measurement periods.Conclusions / Implications for Practice: Based on the evidence, both nursing education formats are valid for patient education and may be chosen based on CCU clinical conditions.