家屬叮嚀方案對減輕加護病人焦慮和非計畫性拔管之成效

The Effect of Family Member Reminders on Reducing Anxiety and Unplanned Extubation in ICU Patients

背景：放置氣管內管對病人而言，最大的壓力源是插管後無法順利表達自己的需要而感到焦慮，家屬能使病人情緒獲得安慰與鼓勵甚至給予實質性支持。目的：（一）比較實驗組與控制組病人焦慮分數、生命徵象、非計畫性氣管內管滑脫率之差異。（二）比較實驗組病人介入前後生命徵象之差異。（三）探討實驗組病人對叮嚀影音方案之滿意度。方法：本研究採類實驗前後測設計，採方便取樣，以加護中心接受氣管插管病人為研究對象。於氣管內管留置期間，實驗組病人聆聽由家屬錄製的「預防非計畫性氣管內管滑脫叮嚀影音」，一天3次共4天，控制組給予一般照護。結果：（一）兩組間焦慮分數無顯著差異（t = -1.282, p = .205）。（二）兩組病人每晚10點介入後之生命徵象以重複量數分析顯示兩組間無顯著差異（p > .05）。（三）實驗組每日3次介入前後生命徵象之差異，在部份時間點的心跳、收縮壓、舒張壓、平均動脈壓有顯著下降（p < .05），病人呼吸次數沒有顯著差異（p > .05）。（四）實驗組病人對於家屬叮嚀影音介入達89％滿意度。結論／實務應用：本研究設計以DVD播放家人叮嚀插管安全，研究獲得極高滿意度和達到降低病人焦慮。研究結果可作為未來加護單位插管病人照護之參考。

Background: Patients with endotracheal intubation often experience anxiety because they are unable to express their needs freely. However, the family members of these patients are able to provide encouragement, comfort, and substantive support. Purposes: The aims of the present study were: （1） to compare the anxiety scores, vital signs, and incidence of unplanned extubation （UE） between the two comparison groups; （2） to compare the differences in vital signs before and after the intervention in the experimental group; and （3） to explore the satisfaction of patients in the experimental group with the intervention. Methods: A quasi-experimental, pretest-posttest design was carried out. A convenience sampling was adopted to recruit patients with endotracheal intubation in intensive care units （ICUs）. The experimental group listened to the UEprevention reminders of their family members for three times a day for 4 days. The control group was provided with usual care. Results: （1） No significant difference was observed in the anxiety scores between the two groups （t = -1.282, p = .205）. （2） A repeated-measures analysis found no significant difference in vital signs, taken nightly at 10 p.m., between the experimental and control groups （p > .05）. （3） The experimental group registered significantly lower heart rates, systolic blood pressure, diastolic blood pressure, and mean arterial pressure after the conclusion of the intervention （p < .05）. However, no significant pre-test / posttest difference in breathing rate was observed for this group. （4） A large majority （89%） of the experimental group expressed satisfaction with the intervention treatment program. Conclusion/Implication for Practice: The present study, which used a DVD of family reminders encouraging and reminding patients about intubation safety, achieved a very high level of patient satisfaction and reduced their anxiety-related vital signs. The results may serve as a reference for providing intervention treatment to patients with endotracheal intubation in ICUs.