重症慢性阻塞性肺疾病病人生命意义感的现象学研究(1)
[摘要] 目的 探讨重症慢性阻塞性肺疾病病人对生命意义感的理解，为临床护理干预提供理论依据。方法运用质性研究中的描述性现象学研究方法，选取青岛市某三级甲等医院呼吸内科住院治疗的13例重症慢性阻塞性肺疾病病人进行半结构式、面对面深度访谈，运用Colaizzi资料分析法对访谈结果进行整理分析。结果 资料经分析后，共析出4个主题、10个亚主题，分别为生存意识的转变(疾病支配感、损失和危机)，自身存在的理解(关系、希望、责任)，自我实现的感悟(奉献、遗体捐献、自我调适)，死亡的认知及态度(正视结局、恐惧过程)。结论 重症慢性阻塞性肺疾病病人对生命意义感的理解受多重因素影响，且在缓解疾病带来的压力中发挥重要作用。
[关键词] 肺疾病，慢性阻塞性;危重病;生命意义感;定性研究
[中图分类号] R473.5 [文献标志码] A [文章编号] 2096-5532(2020)06-0734-04
doi：10.11712/jms.2096-5532.2020.56.146 [开放科学(资源服务)标识码(OSID)]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20200708.1535.006.html;
[ABSTRACT] Objective To investigate the understanding of life meaning in patients with severe chronic obstructive pulmonary disease， and to provide a theoretical basis for clinical nursing intervention. Methods The descriptive phenomenological research method in qualitative research was used to conduct semi-structured face-to-face interviews with 13 patients with severe chronic obstructive pulmonary disease who were hospitalized in Department of Respiratory Medicine in a grade A tertiary hospital in Qingdao， China， and the Colaizzi data analysis method was used to analyze the results of these interviews. Results A total of 4 themes and 10 sub-themes were identified by data analysis， i.e.， transformation of survival consciousness (the feeling of being do-minated by disease， losses， and crises)， understanding of self-existence (relationship， hope， and responsibility)， realization of self-value (dedication， body donation， and self-adjustment)， and perception and attitude of death (facing up to the outcome and a fear of process). Conclusion The understanding of life meaning is influenced by multiple factors in patients with severe chronic obstructive pulmonary disease and plays an important role in alleviating the stress caused by this disease.
[KEY WORDS] pulmonary disease， chronic obstructive; critical illness; meaning in life; qualitative research
慢性阻塞性肺疾病(COPD)是一種常见慢性呼吸系统疾病。流行病学调查显示，我国COPD死亡人数占全球该病死亡总人数的30%，导致了巨大的健康及疾病负担[1-2]。重症COPD病人肺功能急剧恶化，入院次数及病死率显著增加。如何使病人保持良好的身体及精神健康状态是当前急需解决的问题。生命意义感作为一种精神需求，可帮助病人超越痛苦，达到善终的目的[3]。如果没有对病人的精神需求做出反应，容易导致病人抑郁、绝望和丧失生活意愿[4]。因此，了解重症COPD病人生命意义的认知状态，可以明确病人的精神需求。本研究旨在通过质性研究的方法，探讨我国重症COPD病人的生命意义感现状，为临床护理干预提供理论依据。
1 对象与方法
1.1 研究对象
本研究采用目的抽样法，选取2018年6—10月于青岛市某三级甲等医院呼吸内科住院的COPD的病人。纳入标准：①符合《慢性阻塞性肺疾病全球诊断、治疗与预防全球策略(2013年版)》诊断标准，为COPD Ⅲ或Ⅳ期;②在休息时或轻微活动下呼吸困难;③曾因COPD急性加重住院治疗;④思维清晰，自我表达能力良好;⑤知情同意，自愿参加调查。排除标准：①病情严重，不能接受调查者;②既往有严重的心、肝、肾及神经系统疾病史;③心理疾病的病人。本研究样本量以资料饱和为标准。最终纳入13例病人(分别以英文字母A～M编号)，男10例，女3例;年龄49～80岁。见表1。, 百拇医药(姜园园 尹霄朦 莘秀芳 赵亚玲 刘庆伟 朱秀丽)
[关键词] 肺疾病，慢性阻塞性;危重病;生命意义感;定性研究
[中图分类号] R473.5 [文献标志码] A [文章编号] 2096-5532(2020)06-0734-04
doi：10.11712/jms.2096-5532.2020.56.146 [开放科学(资源服务)标识码(OSID)]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20200708.1535.006.html;
[ABSTRACT] Objective To investigate the understanding of life meaning in patients with severe chronic obstructive pulmonary disease， and to provide a theoretical basis for clinical nursing intervention. Methods The descriptive phenomenological research method in qualitative research was used to conduct semi-structured face-to-face interviews with 13 patients with severe chronic obstructive pulmonary disease who were hospitalized in Department of Respiratory Medicine in a grade A tertiary hospital in Qingdao， China， and the Colaizzi data analysis method was used to analyze the results of these interviews. Results A total of 4 themes and 10 sub-themes were identified by data analysis， i.e.， transformation of survival consciousness (the feeling of being do-minated by disease， losses， and crises)， understanding of self-existence (relationship， hope， and responsibility)， realization of self-value (dedication， body donation， and self-adjustment)， and perception and attitude of death (facing up to the outcome and a fear of process). Conclusion The understanding of life meaning is influenced by multiple factors in patients with severe chronic obstructive pulmonary disease and plays an important role in alleviating the stress caused by this disease.
[KEY WORDS] pulmonary disease， chronic obstructive; critical illness; meaning in life; qualitative research
慢性阻塞性肺疾病(COPD)是一種常见慢性呼吸系统疾病。流行病学调查显示，我国COPD死亡人数占全球该病死亡总人数的30%，导致了巨大的健康及疾病负担[1-2]。重症COPD病人肺功能急剧恶化，入院次数及病死率显著增加。如何使病人保持良好的身体及精神健康状态是当前急需解决的问题。生命意义感作为一种精神需求，可帮助病人超越痛苦，达到善终的目的[3]。如果没有对病人的精神需求做出反应，容易导致病人抑郁、绝望和丧失生活意愿[4]。因此，了解重症COPD病人生命意义的认知状态，可以明确病人的精神需求。本研究旨在通过质性研究的方法，探讨我国重症COPD病人的生命意义感现状，为临床护理干预提供理论依据。
1 对象与方法
1.1 研究对象
本研究采用目的抽样法，选取2018年6—10月于青岛市某三级甲等医院呼吸内科住院的COPD的病人。纳入标准：①符合《慢性阻塞性肺疾病全球诊断、治疗与预防全球策略(2013年版)》诊断标准，为COPD Ⅲ或Ⅳ期;②在休息时或轻微活动下呼吸困难;③曾因COPD急性加重住院治疗;④思维清晰，自我表达能力良好;⑤知情同意，自愿参加调查。排除标准：①病情严重，不能接受调查者;②既往有严重的心、肝、肾及神经系统疾病史;③心理疾病的病人。本研究样本量以资料饱和为标准。最终纳入13例病人(分别以英文字母A～M编号)，男10例，女3例;年龄49～80岁。见表1。, 百拇医药(姜园园 尹霄朦 莘秀芳 赵亚玲 刘庆伟 朱秀丽)