摘要
目的了解老年重症肺炎患者肠内营养管饲期间的旅程体验及需求,为优化该群体的全程照护提供参考。方法采用描述性质性研究的方法。采用目的抽样法,选取2025年2月—4月北京某三级甲等医院呼吸与危重症医学科行肠内营养管饲的老年重症肺炎患者进行半结构式访谈,采用主题分析法,结合NVivo 11.0软件进行资料分析。结果共访谈15例研究对象。以肠内营养时间轴为横轴,以任务、情绪、痛点三方面内容为纵轴,提炼出患者在诊断与评估期、早期肠内营养期、调整与优化期、维持与康复期、出院与随访期5个阶段的体验主题。共归纳出25个主题,包括理解治疗必要性、感知并发症风险、情绪波动与宣泄、照护支持需求、症状管理困难等,最终构建出老年重症肺炎患者肠内营养管饲体验的旅程地图。结论老年重症肺炎患者肠内营养管饲支持过程较为漫长,发生喂养不耐受概率高且个体差异大,采用旅程地图将患者管饲需求细化,如调整优化期缺乏细微观察从而无法及早识别患者肠内营养不耐受,致症状管理挑战较大,针对此痛点应加强每班风险评估和症状观察,减少患者肠内营养不耐受症状加重的风险。另外同伴角色互动会直接影响患者体验,尤其需重视出院后患者家属的照护质量,并探索适合老年重症肺炎患者的远程延续护理模式。
Objective To explore the lived experiences and needs of elderly pneumonia patients during enteral tube feeding,providing insights for optimizing comprehensive care in this population.Methods A descriptive qualitative study was conducted.Using purposive sampling,15 elderly pneumonia patients receiving enteral nutrition in the Department of Respiratory and Critical Care Medicine at Beijing Hospital from February 2025 to April 2025 were enrolled for semi-structured interviews.Thematic analysis was performed with NVivo 11.0 software.Results Interviews with 15 participants were completed.By mapping the enteral nutrition timeline as the horizontal axis and categorizing content into three dimensions(task-related,emotional,and pain points),25 themes were identified,including understanding necessity,risk perception,emotional venting,care support,and symptom management.These findings were synthesized to construct an experience journey map of enteral nutrition for elderly pneumonia patients.Conclusion The enteral nutrition support process for elderly patients with severe pneumonia is often prolonged,with a high incidence of feeding intolerance and significant individual variability.Using journey mapping,the needs of patients during tube feeding can be elaborated in detail.For instance,the lack of meticulous observation during the adjustment and optimization phase may lead to failure in early identification of enteral nutrition intolerance,thereby posing greater challenges in symptom management.To address this issue,it is essential to strengthen shift-based risk assessments and symptom monitoring to reduce the risk of worsening enteral nutrition intolerance symptoms.Furthermore,peer interaction and role dynamics directly influence patient experience,particularly highlighting the need to emphasize the quality of post-discharge care provided by family members.Additionally,exploring suitable remote continuity-of-care models for elderly patients with severe pneumonia is crucial.
作者
李京南
胡紫月
孙超
武全莹
胡慧秀
郭红
樊娟
黄竞缘
LI Jingnan;HU Ziyue;SUN Chao;WU Quanying;HU Huixiu;GUO Hong;FAN Juan;HUANG Jingyuan(Department of Respiratory and Critical Care Medicine,National Center for Geriatrics,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing Hospital,Beijing 100010,China;Department of Nursing,National Center for Geriatrics,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing Hospital,Beijing 100010,China;School of Nursing,Beijing University of Chinese Medicine,Beijing 100020,China)
出处
《中华急危重症护理杂志》
2026年第2期133-140,共8页
Chinese Journal of Emergency and Critical Care Nursing
基金
北京市卫生健康科技成果和适宜技术推广项目(BHTPP2024054)。
关键词
老年人
重症肺炎
喂养不耐受
旅程地图
Aged
Pneumonia
Severe
Feeding Intolerance
Patient Journey Mapping
