[[alternative]]Relevance of Physical and Psychological Response, Social Support and Spiritual Well-being of Family Members as Main Caregivers of Patients In ICU

[[abstract]]背景：病人入住重症加護單位時，通常是面臨突發且危及性命情形，家屬面對病人病況改變及陌生環境，會出現重大壓力並可能導致不良身心反應。臨床照護多著重於病人，較少評估到家屬層面，需進一步探討重症單位主要照顧者家屬身心反應、社會支持與靈性安適之間的相關性。目的：探討重症單位主要照顧者家屬身心反應、社會支持與靈性安適之相關性。方法:採橫斷式相關性研究，以立意取樣方式收集北部某區域教學醫院重症單位病人之主要照顧者家屬共161位。研究工具採用結構式問卷，包含基本資料表、SCL-35身心反應量表、醫療社會支持量表以及靈性安適指數量表，以SPSS 20.0軟體進行資料分析，統計方式包括皮爾森相關係數分析以及逐步迴歸分析等。結果：本研究發現重症單位主要照顧者家屬身心反應與社會支持有顯著負相關(r = -.192, p < .05)，身心反應與靈性安適有顯著負相關 (r = -.614, p < .01)，社會支持與靈性安適有顯著正相關 (r = .343, p < .01)。將身心反應、社會支持及靈性安適設為依變項，將具有顯著差異或相關性之主要照顧者家屬及病人之人口學資料與疾病特性設為自變項，進行逐步回歸分析。結果顯示主要照顧者家屬之性別、經濟狀況、自覺健康滿意度、病人有無保險以及病人年齡等五個變項對身心反應之總解釋變異量達32.7% (R2 = .327, p < .001)；主要照顧者經濟狀況、自覺健康滿意度等兩個變項對社會支持之總解釋變異量達17%(R2 = .170, p < .001)；主要照顧者家屬之性別、經濟狀況、目前有無服用藥物、自覺身體健康滿意度、病人有無保險、病人年齡、主要照顧者家屬之身心反應、主要照顧者家屬之社會支持等六個變項，對靈性安適之總解釋變異量達47.6%(R2 = .476, p < .001)，其中身心反應為最重要之解釋因子，可單獨解釋靈性安適之變異量為20.9%(R2 change = .209, p < .001)。結論：重症單位主要照顧者家屬社會支持程度越高、身心反應越小，其靈性安適的程度就越好。了解重症單位主要照顧者家屬身心反應之現況，適時介入必要的社會支持，能降低重症單位主要照顧者家屬的身心反應，並提高其靈性安適程度。臨床實務運用：本研究結果可提供未來想進行重症單位主要照顧者家屬相關研究之文獻佐證，以及提供臨床照護人員針對重症單位主要照顧者家屬之介入必要性關懷與照護措施，進而提升重症單位主要照顧者家屬之生理、心理、社會及靈性層面之安適程度。[[abstract]]Background: When a patient is admitted to an intensive care unit, he/she is usually faced with a sudden and life-threatening situation. Confronting the patient’s changing condition and an unfamiliar environment, family members also experience significant pressure, which may lead to adverse physical and mental responses, but clinical care mainly focuses on patients and seldom evaluates family members. Thus, it is necessary to further investigate the correlation among family primary caregivers’ physical and mental responses, social support, and spiritual comfort at intensive care units.Objectives: To investigate the correlation among caregivers’ physical and mental responses, social support, and spiritual well-being at intensive care units.Methods: This cross-sectional correlational study used purposive sampling to enroll a total of 161 family primary caregivers of patients admitted to intensive care units in a certain regional teaching hospital in northern Taiwan as the research subjects. The research tools were structured questionnaires, including basic information sheet, a scale of Symptoms Checklist-35 (SCL-35), a Medical Outcome Study Social Support Survey (MOS-SSS), and a Spirituality Index of Well-Being (SIWB). This study utilized SPSS 20.0 software for data analysis. The statistical methods included Pearson's product moment correlation analysis and stepwise regression analysis.Results: This study found that the physical and psychological response of family members acting as the main caregivers of patients in intensive care units was significantly negatively correlated with social support (r = -.192, p < .05) and spiritual well-being (r = -.614, p < .01), and there was a significant positive correlation between social support and spiritual well-being (r =.343, p < .01). The stepwise regression analysis was performed using physical and psychological response, social support and spiritual well-being as dependent variables and the demographic data and disease characteristics of family members acting as main caregivers and the patients with significant differences or correlations as independent variables. The results showed that the total variance of the physical and psychological response explained by the five variables of gender, economic status, perceived health satisfaction of family members acting as main caregivers, whether the patient has insurance, and patient age reached 37.2% (R2 =.327, p < .001). The total variance of social support explained by the two variables, including the economic status and the perceived health satisfaction of the main caregivers reached 17% (R2 = .170, p < .001). In addition, the total variance of spiritual well-being explained by six variables, namely the gender and economic status of the family members acting as main caregivers, current use of drugs (or not), perceived physical health satisfaction, whether the patients have insurance, patient age, the physical and psychological response of family members acting as main caregivers, and the social support of family members acting as main caregivers, reached 47.6% (R2 = .476, p < .001). Among those variables, the physical and psychological response was the most important explanatory factor and could explain 20.9% of the variance of spiritual well-being (R2 change = .209, p < .001).Conclusions: The higher the ICU caregivers’ social support is, the fewer their physical and mental responses are and the higher is their level of spiritual well-being. Therefore, understanding the current status of ICU caregivers’ physical and mental responses and providing intervention of necessary social support in a timely manner can reduce physical and mental responses of these caregivers and improve their spiritual well-being.Relevance to clinical practice: The research results may serve as reference for future studies on ICU caregivers and for clinical healthcare personnel to provide intervention of necessary concern and care measures to these caregivers in order to further improve their levels of physiological, mental, social, and spiritual well-being

加護病房病人主要照顧者的焦慮、 憂鬱、社會支持與其生活品質之關聯

[[abstract]]目的：本研究探討加護病房主要照顧者的焦慮、憂鬱、社會支持與其生活品質之關聯。方法：本研究採橫斷式研究設計，採用便利取樣方式，於北部某區域教學醫院內科加護病房共蒐集161位主要照顧者的問卷。問卷內容包含焦慮、憂鬱、社會支持及生活品質。統計方法以描述性統計、獨立樣本t檢定（independent samples t-test）、單因子變異數分析（one-way ANOVA）、皮爾森相關分析（Pearson's correlation analysis）及逐步複迴歸分析（stepwise multiple regression analysis）等。結果：焦慮（p＜.05）、憂鬱（p＜.01）與社會支持皆顯著負相關。焦慮（p＜.01）、憂鬱（p＜.01）與生活品質皆顯著負相關。社會支持與生活品質呈顯著正相關（p＜.01）。焦慮、憂鬱及社會支持可預測生活品質解釋力達45.7%。結論：加護病房病患主要照顧者之社會支持程度越低，其焦慮、憂鬱的心理反應程度就越高，生活品質就越低；重症單位病患主要照顧者的焦慮、憂鬱及社會支持可預測生活品質