某醫學中心住院病人第六生命徵象現況、變化與健康問題之探討

The Status, Change and Health Issues of Inpatients' Sixth Vital Sign in a Medical Center

背景：住院病人普遍有情緒困擾問題，瞭解病人困擾問題，有助提供合適的情緒照護，促進病人復原。目的：探討台灣某醫學中心住院病人第六生命徵象得分、變化及相關健康問題，做為病人情緒照護重點參考。方法　採回溯性描述性研究，收集2013整年共27,885位住院病人，評估245,814人次之困擾相關資料。結果　住院病人有情緒困擾者佔58.3%，≥ 4分佔0.8%。整體而言，除血液腫瘤科、神經外科及整形外科病人外，住院病人住院天數越長，其第六生命徵象得分越低。家庭醫學科、皮膚科及整型外科病人困擾得分較其他科別為高。當病人有疼痛、焦慮及睡眠型態紊亂健康問題時，困擾分數顯著較高。結論／實務應用　需加強血液腫瘤科、神經外科、家庭醫學科、皮膚科及整形外科病人，以及有疼痛、焦慮或睡眠型態紊亂健康問題病人的情緒照護，以提供病人更優質的全人照護。本研究顯示，住院病人困擾≥4分者僅佔0.8%，與其他文獻相比明顯較低，建議介入教育訓練，提升護理人員能正確評估及照顧情緒困擾病人的知能，及進一步探討更適當詢問病人困擾的用詞、方法及環境，改善病人困擾之評估與照護。

Background: Hospitalized patients generally have elevated levels of emotional distress. Gaining a better understanding of the problem of emotional distress among hospitalized patients is conducive to providing appropriate emotional care and promoting their recovery. Purpose: To analyze the scores for the “sixth vital sign” (i.e., emotional distress), diversification, and the healthrelated problems of hospitalized patients at a medical center in Taiwan. The results may offer an important reference for providing effective emotional care to hospitalized patients. Methods: A retrospective descriptive research design was used. Data were collected from all of the 27,885 inpatients that were registered at the target hospital in 2013. Further, a total of 245,814 attendance records were assessed to extract the data that were relevant to emotional distress. Results: The findings revealed that 58.3% of hospitalized patients had earned a sixth vital sign score ≥ 1 and that 0.8% of these patients had earned a score ≥ 4. On the whole, the sixth vital sign scores of hospitalized patients were found to decrease progressively with the number of hospitalization days except for hematology and oncology, neurosurgery, and plastic surgery patients. The highest emotional distress scores were found among family medicine, dermatology, and plastic surgery patients. Moreover, emotional distress scores were significantly higher in patients who had health problems that involved pain, anxiety, or sleep disorder. Conclusions / Implications for Practice: The present study suggests that improving the emotional care of hematology, oncology, neurosurgery, family medicine, dermatology, and plastic surgery patients and of patients with health problems involving pain, anxiety, or sleep disorder may significantly improve the quality of inpatient holistic healthcare. Only 0.8% of the subjects in the present study had an emotional distress score ≥ 4, which is significantly lower than the level reported in other similar studies. Our findings suggest that related education and training for nursing staffs may improve their assessment and care practices in caring for patients with emotional distress. Furthermore, using more appropriate words, methods, and environments to evaluate the emotional distress of patients holds the potential to improve assessment and care for these patients.