| Summary: | 碩士 === 國防醫學院 === 護理研究所 === 105 === Background: People between the age of 20 and 50 contributes to 66% of the main income source for a family. Therefore, when they succumb to major illnesses, it will not only affect the health of family members, but more importantly, the family’s ability to function properly will be impacted tremendously. During the process of saving the patient’s life, family members will also have to endure physical and emotional pains. Research has shown that the disease symptoms and the degree of physical dysfunction of critically ill young adult patients can result in post traumatic stress disorder (PTSD) of family members who are taking care of them. 72-75% of the family members of critically ill patients experience negative emotions, furthermore, when patients are discharged from ICU, 46% experience complicated grief and 35% experience PTSD. The solution to such problems is to investigate the family’s response to stress as well as factors affecting their ability to adapt; in order to develop a special nursing plan and support system for the target group; and help to maintain a normal family function for young adult patients who are critically ill.
Purpose: This research aims to investigate a few key issues: the negative emotions and acute stress experienced by family members of critically ill young adult patients, as well as their ability to adapt and manage stress during the transition period. Moreover, this research hopes to provide a basis of reference for relevant clinical departments in the future.
Methods: In order to achieve prospectiveness and long-term traceability of the research: a mixed-methods approach was taken. Samples were chosen from a group of families of critically ill patients, and they were classified according to: Time1 (admission into ICU within 48 hours), Time2 (discharged from ICU within 48 hours), Time3 (discharged from ICU after 3 months), Time 4 (discharged from ICU after 6 months). After that, the results were used to measure the families’ level of anxiety and acute stress, as well as their ability to maintain family function and manage stress. Data was collected from a certain northern medical centre’s neurosurgery and burn department through structured surveys and voluntary interviews with family members. A total of 42 sets of survey results were collected from the 4 different time slots (Time1-Time4) as well as the interview results of 4 family members made in two sessions.
Result: Based on the section on qualitative research, a total of 5 theses were discovered: (1) Concern towards the patient’s condition, (2) Family members’ personal feelings, (3) Caring about responses from the external world (the general public, the media, et cetera), (4) Plans for the future, (5) Returning to a normal life. In the beginning, family members would have to endure the sufferings of having to watch their children in pain as well as their medical condition worsen; which is also the reason why they feel that any amount hard work they put in for their children is worth it. Besides that, the way the external world responds towards their children’s condition also affects them greatly. Finally, when their children’s condition begins to get better, their families will start to put down their worries, return to a normal, adopt a positive mentality towards the future, and think that what’s past is past. Quantitative research has shown that family member’s level of anxiety and depression peak at Time1 & Time2, and normalizes at Time3 & Time4. Even though the acute stress level at Time1 has a mean score greater than 59 and a prevalence rate of around 79%, the decrease in scores of Time2 & Time3 is close to normal. After getting discharged for 3 months & 6 months, the scores of both The Chinese version of Impact of Event Scale–Revised (CIES-R) are greater than 65. Furthermore, as the scores decrease with time, it shows that there are no PTSD cases within the studied group.This research analyzes the effects of family function & stress control on the negative emotions & stress response of family members in three different spheres. From the perspective of baseline tracking model analysis, FFFS of Time1 has a negative correlation with respect to HADS of Time3 and Time4. There is a significant correlation between the mastery of stress of Time1 and the acute-stress of Time2 and Time3. Similarly, there is also a significant correlation between the mastery of stress of Time1 and HADS of Time3 and Time4. Both of these shows that when young adult patients are admitted into ICU, the immediate increase of family function and mastery of stress will significantly affect the emotions and stress response of family members 3 & 6 months later. Based on the repeated time-dependent model, there is cause and effect and a significant negative correlation between FFFS of Time2 & Time3 and HADS of Time3 and Time4. Furthermore, there is a significant negative correlation between FFFS and HADS of Time3. Similarly, there is also a negative correlation between mastery of stress & HADS and ASD & CIES-R of Time3. In addition, for Time4, there is also cause and effect and a significant negative correlation between depression & CIES-R. This shows that, when young adult patients are discharged from ICU, it is important to continue to monitor their family function and mastery of stress, so as to predict their emotions and stress response. At the same time, through the cumulative effects model, the accumulated effect on family function after four hours has a significant correlation with HADS of Time4. The accumulated effect on mastery of stress at two different time slots has a negative correlation with ASD of Time3 & HADS of Time4. This shows that by maintaining good family function and mastery of stress, it can improve the emotions and stress response of critically ill young adult patients.
Conclusion: This research shows that as mastery of stress improves, it can lower the after-effects of trauma. Based on qualitative research, it can explain for the personal feelings of parents when in face of major illnesses and injuries, and make use of the personal experiences of these parents to understand the impacts of critically ill young adult patients on their families as well as the process that these families go through to adapt to the situation. On the other hand, based on quantitative research, it shows that a good family function and mastery of stress can improve the emotions and stress response of family members. Moreover, this research also explores how families look for resources to maintain family function, the way family members support each other, as well as how other families with similar experiences provide support to the current families who are in need. Clinical medical personnel should try to provide the relevant family members with the care and support that they need so as to increase their ability to control stress, and give focus to possible issues of emotional traumas that could have been neglected and come up with relevant countermeasures. As such, through the cooperation between all the relevant medical personnel, a high quality nursing plan can be drafted.
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