基于人文关怀视角的ICU探视制度对患方心理影响的比较与启示

A Comparative Study on the Psychological Impact of ICU Visitation Policies on Patients and Families from a Humanistic Care Perspective and Its Implications

摘要: 重症监护病房(ICU)作为危重患者救治的关键场所，其探视制度直接影响患者及家属的心理状态与康复结局。当前，国内普遍实行限制性探视制度，表现为时间固定、人数受限、非接触式探视，而许多发达国家则推行弹性或开放探视模式，允许家属更长时间陪伴甚至参与部分护理。本研究基于人文关怀视角，系统比较了不同探视制度对患者及家属心理健康的影响，重点关注焦虑、抑郁、谵妄、创伤后应激障碍等心理结局的差异，并分析其内在机制与现实制约。研究发现，限制性探视易加剧患者与家属的负面情绪，增加谵妄风险，降低治疗依从性与医患信任；而弹性探视则有助于提供情感支持、增强安全感，改善双方心理状态。研究进一步从医疗资源、物理环境、感染控制、文化认知等方面剖析了影响探视制度改革的阻滞因素，并提出建立分层弹性探视策略、规范家属赋能教育体系、推动混合式探视技术常态化应用等建议，以期为构建契合中国国情、兼具科学性与人文关怀的ICU探视管理模式提供参考。

Abstract: The Intensive Care Unit (ICU) is a critical setting for the treatment of critically ill patients, and its visitation policy directly influences the psychological well-being and recovery outcomes of both patients and their families. Currently, restrictive visitation policies are widely implemented in China, characterized by fixed visiting hours, limited numbers of visitors, and non-contact interactions. In contrast, many developed countries have adopted flexible or open visitation models, allowing family members to stay longer and even participate in certain aspects of patient care. From a humanistic care perspective, this study systematically compares the effects of different visitation policies on the psychological health of patients and families, with a focus on outcomes such as anxiety, depression, delirium, and post-traumatic stress disorder, while also analyzing underlying mechanisms and practical constraints. The findings indicate that restrictive visitation tends to exacerbate negative emotions in both patients and families, increase the risk of delirium, and reduce treatment compliance and trust in healthcare providers. In contrast, flexible visitation helps provide emotional support, enhance a sense of security, and improve the psychological state of both parties. Furthermore, this study examines barriers to visitation policy reform from perspectives such as medical resources, physical environment, infection control, and cultural perceptions. It proposes recommendations including the establishment of a tiered flexible visitation strategy, standardization of family empowerment education systems, and the promotion of hybrid visitation technologies for routine use. These suggestions aim to contribute to the development of an ICU visitation management model that is suited to China’s context, scientifically sound, and grounded in humanistic care.