Application of a standard communication system-based continuous home remote visit mode in the management of visits to severely burned patients in the post-pandemic era of coronavirus disease 2019
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摘要:
目的 探讨基于标准化沟通制度的连续性居家远程探视模式在新型冠状病毒肺炎后疫情时代（下称后疫情时代）严重烧伤患者探视管理中的应用效果。 方法 采用回顾性队列研究方法。将陆军军医大学（第三军医大学）第一附属医院2020年2—12月收治的符合入选标准的69例严重烧伤患者及其69名家属纳入本研究。根据探视模式的不同，将2020年2—6月入住烧伤重症监护病房（BICU）的按照疫情防控要求实施完全限制性探视的33例严重烧伤患者及对应的33名家属纳入常规探视组，将2020年7—12月入住BICU的实施基于标准化沟通制度的连续性居家远程探视的36例严重烧伤患者及对应的36名家属纳入远程探视组。常规探视组家属只能通过电话与责任护士沟通，而远程探视组患者和家属通过微信视频通话与责任护士、责任医师、康复治疗师、营养治疗师共同沟通。比较患者入住BICU时2组患者及2组家属一般资料调查表调查结果和汉密尔顿焦虑量表（HAMA）评分，患者入住BICU第2周及转出BICU时2组患者及2组家属HAMA评分，患者转出BICU时2组患者及2组家属探视效果评价量表评分、2组家属重危患者家属满意度量表中文修订版（C-CCFSS）评分，患者转出BICU 1周内2组患者住院期间满意度调查评价量表评分。对数据行χ2检验、Fisher确切概率法检验、Mann-Whitney U检验。 结果 远程探视组患者中男29例、女7例，年龄为48（34，53）岁；家属中男15名、女21名，年龄为45（30，48）岁。常规探视组患者中男24例、女9例，年龄为49（38，54）岁；家属中男9名、女24名，年龄为44（35，48）岁。患者入住BICU时，2组患者和2组家属HAMA评分均相近（P>0.05）。远程探视组患者、家属在患者入住BICU第2周（Z=-3.195、-3.018，P<0.01）及转出BICU时（Z=-2.118、-2.380，P<0.05）HAMA总分均明显低于常规探视组。患者转出BICU时，2组患者探视效果评价量表各维度评分相近（P>0.05）；远程探视组家属探视效果评价量表中患者安全信息、诊疗质量信息、心理支持信息3个维度评分均明显高于常规探视组（Z=-2.372、-2.209、-2.174，P<0.05），仅家属探视感受维度评分与常规探视组相近（P>0.05）。患者转出BICU当日，远程探视组家属C-CCFSS评分为99（98，108）分，明显高于常规探视组的98（97，100）分（Z=-2.545，P<0.05）；患者转出BICU 1周内，远程探视组患者住院期间满意度调查评价量表评分为99（98，100）分，明显高于常规探视组的96（94，98）分（Z=-5.213，P<0.01）。 结论 在后疫情时代对严重烧伤患者探视管理应用基于标准化沟通制度的连续性居家远程探视模式，可提高探视效果及满意度，有效缓解患者及家属的焦虑程度。 Abstract:Objective To observe the application effects of a standard communication system-based continuous home remote visit mode in the management of visits to severely burned patients in the post-pandemic era of coronavirus disease 2019 (hereinafter referred to as post-pandemic era). Methods A retrospective cohort study was conducted. A total of 69 severely burned patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from February to December, 2020 and their 69 family members were recruited into this study. According to the difference of visit model, 33 severely burned patients who were admitted into burn intensive care unit (BICU) from February to June, 2020 and received completely restricted visits according to the requirements for epidemic prevention and control and their corresponding 33 family members were included into conventional visit group; 36 severely burned patients who were admitted into BICU from July to December, 2020 and received the standard communication system-based continuous home remote visits and their 36 corresponding family members were recruited into remote visit group. The family members in conventional visit group could only communicate with the primary nurses by telephone, while the patients and family members in remote visit group could communicate with the primary nurses, responsible doctors, rehabilitation therapists, and nutrition therapists through WeChat video call. The survey results of general information questionnaire and Hamilton Anxiety Scale (HAMA) scores of two groups of patients and their family members at BICU admission of patients, HAMA scores of the two groups of patients and their family members in the second week of BICU admission and at discharge from BICU of patients, the scores of the Visiting Effect Evaluation Scale of the two groups of patients and their family members and the scores of Chinese version of Critical Care Family Satisfaction Survey (C-CCFSS) of the two groups of family members at discharge from BICU, and the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients within the first week after the discharge of patients from BICU were compared. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. Results In remote visit group, there were 29 males and 7 females in patients, aged 48 (34, 53) years, and 15 males and 21 females in family members, aged 45 (30, 48) years. In conventional visit group, there were 24 males and 9 females in patients, aged 49 (38, 54) years, and 9 males and 24 females in family members, aged 44 (35, 48) years. At BICU admission of patients, the HAMA scores of the two groups of patients and family members were both similar (P>0.05). The total HAMA scores of patients and family members in remote visit group were significantly lower than those in conventional visit group in the second week when the patients were admitted to BICU (Z=-3.195, -3.018, P<0.01) and discharged from BICU (Z=-2.118, -2.380, P<0.05). At discharge from BICU of patients, the scores of each dimension in Visiting Effect Evaluation Scale of the patients in the two groups were similar (P>0.05); while scores of 3 dimensions including patient safety information, diagnosis and treatment quality information, and psychological support information in Visiting Effect Evaluation Scale of family members in remote visit group were significantly higher than those in conventional visit group (Z=-2.372, -2.209, -2.174, P<0.05), and only the scores of visit perception of family members were close to those in conventional visit group (P>0.05). At discharge from BICU of patients, the C-CCFSS scores of the family members in remote visit group was 99 (98, 108), which were significantly higher than 98 (97, 100) in conventional visit group (Z=-2.545, P<0.05). Within the first week after the discharge of patients from BICU, the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients in remote visit group were 99 (98, 100), which were significantly higher than 96 (94, 98) in conventional visit group (Z=-5.213, P<0.01). Conclusions In the management of visits to severely burned patients in the post-pandemic era, application of the standard communication system-based continuous home remote visit mode can improve the visit effect and satisfaction, and effectively alleviate the anxiety of patients and their family members. -
Key words:
- Burns /
- Visitors to patients /
- Continuity of patient care /
- Social support
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参考文献
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表1 2组严重烧伤患者一般资料及入住BICU时HAMA评分比较
组别 例数 性别［例（%）］ 年龄［岁，M（P25，P75）］ 文化程度［例（%）］ 男 女 大学 高中和中专 初中 小学 远程探视组 36 29（80.56） 7（19.44） 48（34，53） 4（11.11） 10（27.78） 15（41.67） 7（19.44） 常规探视组 33 24（72.73） 9（27.27） 49（38，54） 4（12.12） 6（18.18） 15（45.45） 8（24.24） 统计量值 χ2=0.592 Z=-0.066 Z=-0.782 P值 0.441 0.947 0.435 注：BICU为烧伤重症监护病房，HAMA为汉密尔顿焦虑量表，TBSA为体表总面积，APACHEⅡ为急性生理学和慢性健康状况评价Ⅱ；“—”表示无此统计量值 
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表2 2组严重烧伤患者家属的一般资料及在患者入住BICU时HAMA评分比较
组别 人数 性别［名（%）］ 年龄［岁，M（P25，P75）］ 文化程度［名（%）］ 与患者关系［名（%）］ 男 女 大学 高中和中专 初中 小学 父母或子女 配偶 其他 远程探视组 36 15（41.67） 21（58.33） 45（30，48） 2（5.56） 10（27.78） 14（38.89） 10（27.78） 8（22.22） 20（55.56） 8（22.22） 常规探视组 33 9（27.27） 24（72.73） 44（35，48） 3（9.09） 6（18.18） 15（45.45） 9（27.27） 10（30.30） 16（48.48） 7（21.21） 统计量值 χ2=1.573 Z=-0.036 Z=0.191 χ2=0.604 P值 0.210 0.971 0.849 0.739 注：BICU为烧伤重症监护病房，HAMA为汉密尔顿焦虑量表
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表3 2组严重烧伤患者各时间点HAMA评分比较[分，M（P25，P75）]
组别 例数 精神性焦虑 躯体性焦虑 总分 入住BICU第2周 转出BICU 入住BICU第2周 转出BICU 入住BICU第2周 转出BICU 远程探视组 36 12.0（9.0，14.0） 8.0（6.0，10.0） 9.0（8.0，10.0） 5.0（4.0，6.8） 21.0（17.3，23.0） 13.0（9.3，16.8） 常规探视组 33 14.0（10.5，18.0） 15.0（6.0，16.5） 10.0（8.0，15.5） 7.0（4.0，10.0） 26.0（20.0，36.5） 13.0（8.0，26.0） Z值 -2.436 -2.245 -2.161 -2.215 -3.195 -2.118 P值 0.015 0.025 0.031 0.027 0.001 0.034 注：HAMA为汉密尔顿焦虑量表，BICU为烧伤重症监护病房
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表4 2组严重烧伤患者家属在患者住院各时间点HAMA评分比较[分，M（P25，P75）]
组别 人数 精神性焦虑 躯体性焦虑 总分 入住BICU第2周 转出BICU 入住BICU第2周 转出BICU 入住BICU第2周 转出BICU 远程探视组 36 10.0（9.0，10.8） 6.0（4.0，8.0） 1.0（0，2.0） 0.5（0，1.0） 12.0（11.0，12.8） 7.0（4.3，9.0） 常规探视组 33 12.0（10.0，14.0） 7.0（6.0，10.0） 1.0（1.0，2.0） 1.0（1.0，2.0） 14.0（12.0，16.0） 8.0（6.5，11.5） Z值 -3.099 -2.321 -2.153 -2.419 -3.018 -2.380 P值 0.002 0.020 0.031 0.016 0.003 0.017 注：HAMA为汉密尔顿焦虑量表，BICU为烧伤重症监护病房
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表5 2组严重烧伤患者及其家属在患者转出烧伤重症监护病房时探视效果评价量表评分比较[分，M（P25，P75）]
组别 例（人）数 患者 家属 社会支持力量 社会信息获取 患者安全信息 患者诊疗质量信息 患者心理支持信息 探视感受 远程探视组 36 4.0（3.0，4.0） 4.0（3.0，5.0） 4.0（4.0，5.0） 5.0（4.0，5.0） 4.0（4.0，5.0） 4.0（3.0，5.0） 常规探视组 33 4.0（3.0，4.0） 4.0（3.0，4.0） 4.0（3.0，4.5） 4.0（4.0，5.0） 4.0（3.0，5.0） 4.0（3.0，5.0） Z值 -0.628 -1.560 -2.372 -2.209 -2.174 -0.058 P值 0.530 0.119 0.018 0.027 0.030 0.647
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