Stressors Associated with Heart Surgery: A Follow up and Comparison Study of Patients' and Nurses' Perceptions of Pre-and Post-Heart Sugery Stressors

Abstract

心臟手術對病人的身、心、社會各方面產生極大的威脅與壓力。本研究探討心臟手術 病人經歷手術前、手術後的壓力源，并比較護理人員與病人之間對壓力源的評估差异 。研究采敘述性、追蹤、重復測量法，以研究者自行設計之壓力源量表為研究工具， 針對某醫學中心30位心臟手術病人及22位護理人員，探討其手術前後對心臟手術壓力 之感受。研究結果發現病人面對心臟手術的壓力是一個動態的復雜過程。身體上的不 適、增加他人負擔、擔心合并症、患了心臟病必需開刀、死亡的威脅等是病人與護理 人員手術前後确認的重要壓力源。病人的年齡、性別、職業、身心準備情況、焦慮與 憂鬱程度與某些奮力評估得分呈相關。護理人員有高估病人在手術前後的壓力感受的 情形，大約為病人自我評估壓力數目及強度之2倍。研究也發現護理 人員的年齡、 教育程度、臨床工作相關學識能力，顯著影響護理人員對病人身、心、社會壓力的評 估。本研究結果可提供日後進一步的心臟手術壓力護理處置的參考，對於護理教育、 行政以及護理實務有很大的益處。 Heart surgery is a stressful experience for the patients. We studied the pre— and post— operative stressors perceived by the open heart surgery patients themselves and those assessed by the nurses. Differences of stress perception assessed between these two groups were compared. A descriptive, longitudinal, repeated design was used. Thirty heart surgery patients and twenty—two nurses were included in this study. Patients were interviewed by the investigator using the stressor scale developed by the researcher. Nurses who took care of the subjects were then asked to fill the stressor scale for the patients. Our study revealed that the stress perception of heart surgery is a dynamic process. Physical discomfort, increasing of burden to others, complications, heart surgery, threat of death etc ., were found to be the most important stressors of the patients. Age, sex, occupation, physical and psychological readiness, anxiety, and depression were correlated with number and severity of some stressors. Nurses were over- estimating the number and intensity of stressors of their patients. About 2- fold as compared to the assessment of patients themselves. Nurses' ages, education , and clinical competence influenced the accuracy of stress assessment. These results can help the nurses better assess the number and intensity of stresses of heart surgery patients and assist them to cope with the stresses.