急診重症病人家屬與護理人員對家屬需求重要性及滿足程度認知之差異

Abstract

病人因緊急情況或意外傷害到急診室就醫，醫護人員大多將重點放在病人醫療處置上，家屬隔離在急救室外，家屬的需求經常被忽視。本研究目的在探討急診重症病人家屬需求重要性及需求獲得滿足程度，並比較護理人員與家屬之間對需求重要性及獲得滿足程度的認知差異。研究採描述比較性、橫斷面式結構問卷調查法，以「重症病人家屬需求量表」為研究工具（分家屬版與護理人員版），立意取樣選取北部某醫學中心急診室70位重症病人家屬與70位急診護理人員，探討其對家屬需求重要性及需求獲得滿足程度之認知，並以描述性統計、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關與階層式複迴歸統計方式進行資料分析。 研究結果顯示：（1）家屬認知需求重要性平均得分為8.03分，護理人員認知家屬需求重要性平均得分為7.05分，皆認知「溝通與訊息獲得」需求重要性最高，「舒適」需求重要性最低。（2）家屬認知需求獲得滿足程度平均得分為7.12分，護理人員認知家屬需求獲得滿足程度平均得分為6.17分，皆認知「溝通與訊息獲得」需求獲得滿足程度最高，「舒適」需求獲得滿足程度最低。（3）家屬與護理人員認知40項家屬需求重要性中，有25項達顯著差異，且大多為家屬認知需求重要性得分高於護理人員；家屬與護理人員認知40項家屬需求獲得滿足程度中，有35項達顯著差異，且家屬認知需求獲得滿足程度得分亦高於護理人員。（4）家屬與護理人員認知需求重要性與需求獲得滿足程度呈顯著正相關，即認知需求重要性得分愈高，需求獲得滿足程度得分也愈高。（5）影響家屬認知需求重要性之因素為：家屬陪伴病人在急診時間、家庭平均月收入、家中人口數、家屬年齡及病人曾來急診次數。影響家屬認知需求獲得滿足程度之因素為：家屬性別以及家屬與病人居

住情形。（6）影響護理人員認知家屬需求重要性之因素為：護理人員婚姻狀況。影響護理人員認知家屬需求獲得滿足程度之因素為：護理人員年齡、急診工作年資以及護理工作總年資。（7）家屬認知需求重要性之重要預測變項有：「家屬陪伴病人在急診時間」、「家屬年齡」、「家中人口數」及「家屬是否為主要照顧者」，可解釋總變異數48.8％。家屬認知需求獲得滿足程度之重要預測變項有：「家屬性別」、「家屬年齡」及「家屬與病人居住情形」，可解釋總變異數37％。（8）護理人員認知家屬需求獲得滿足程度之重要預測變項有：「急診工作年資」及「護理工作年資」，可解釋總變異數35.9％。本研究結果協助護理人員暸解急診重症病人家屬需求，提供未來照護家屬的重要參考依據，幫助家屬發展合適的因應能力與調適行為，共同維護病患健康與福祉。

When a patient appears in the emergency room for emergency situations or accidents, the medical team usually only focuses on the medical situation of the patient, leaving the patient’s family members outside the emergency room and neglected. The purpose of this study is to identify the needs important of family members of critical patients, and the level to which such needs are satisfied. Also, the differences of family need perception assessed between these two groups are compared. This study is a cross-sectional design with a descriptive comparison approach, using the structured questionnaires of Critical Care Family Needs Inventory－Emergency Department (with different versions for family members and nurses) as our main research tool. All subjects are recruited from the emergency room of medical center in northern Taiwan, using a purposive sampling method. Seventy family members of critical patients and seventy nurses in the emergency room are recruited. The data is analyzed by using descriptive statistics, independent t test, one-way ANOVA, Pearson’s correlation and hierarchical multiple regression analysis. The results show that:（1）The mean score of the needs importance for the family members is 8.03, and for the nurses is 7.05. Both groups rank order needs importance for “communication with family members” the highest and needs importance for “comfort” the lowest.（2）The mean score of the needs satisfaction for the family members is 7.12, and for the nurses is 6.17. Both groups rank order needs satisfaction for “communication with family members” the highest and needs satisfaction for “comfort” the lowest.（3）Out of 40 categories being presented to the family members and nurses, there exists significant differences in needs importance score of 25 categories by the two groups, mainly with family members deciding that a certain category is more important than what nursing staff thought. Out of the level of satisfaction of the same 40 categories, 35 statements showed significant differences in mean scores by family members and by nurses. The finding indicate that family members rated the needs mean score of the needs satisfaction higher than the nurses .（4）There exists a positive correlation between the needs importance score and the needs satisfaction score for both groups, meaning that the higher the needs importance score for a category, the higher the needs satisfaction score for that same category.（5）The influencing factors of needs importance in family members includes: amount of time family members spent with patients in emergency room, average family monthly income, number of family members, age of family members, and number of times patient has been to the emergency room. The influencing factors of needs satisfaction in family members includes: sex of family member and living situation of the family member with the patient.（6）The influencing factors of needs importance in nurses includes: nurses’ marital status. The influencing factors of needs satisfaction in nurses includes: age of nursing staff, length of experience in the emergency room and length of experience in nursing.（7） Predictors of needs importance in family members includes: amount of time members spent with patient in emergency room, age of member, family size, and whether the family member is the primary care provider for the patient, accounting for 48.8% of total variation. Predictive factors for family members’ needs satisfaction score includes: age, sex and residency of family member, accounting for 37% of total variation.（8）Predictors of needs importance for nurses’ needs satisfaction score includes: length of experience in the emergency room and length of experience in nursing, accounting for 35.9% of total variation. These findings can serve as a useful reference for future application in effective family members care and assist nurses to understand the needs of family members. Results of this study may be of use to clinical nurses in helping family members in forming appropriate responses and making reasonable adjustments, so as to work together for the good of the patient.