[[alternative]]The Exploration of Life Experiences and Posttraumatic Stress Disorder among Sudden Cardiac Arrest Survivors.

[[abstract]]背景：突發心因性心跳停止(Sudden cardiac arrest; SCA)之病因來源，大多為冠狀動脈疾病 所造成，其倖存者約有19~40%會產生創傷後壓力症(posttraumatic stress disorder; PTSD)，會造成倖存者做噩夢、憂鬱及焦慮等負向情緒，進而造成慢性之健康問題。目的及研究設計：本研究共有三部分研究。第一部分為建立SCA倖存者之生活經驗與歷程之描述性 理論，以紮根理論為研究設計。第二部分為工具發展，翻譯及測試中文版「創傷後壓力症會 談量表5版」(C-PSSI-5)之信效度。第三部分以回溯性、橫段性研究設計，探討影響SCA倖 存者之創傷後壓力症及其相關因素。結果：第一個研究共收集10位SCA倖存者，深度訪談於病發後至出院返家後第一次回診之間的生活 經驗(約發病後1.5個月)，「珍惜我的重生」為倖存者適應過程之核心類屬，其中三位接受 急救前意識仍清醒的病人有「伴隨複雜情感的歡慶生存」--「震驚」、「害怕」及「感 謝」，然而其他七位急救時未有意識者則沒有記憶被急救情況，一旦病人自覺其生存下來， 其過程中之互動類屬如下:「竭盡能力求生存」，「不確定感」、「擔心」及「恢復我的健 康」，以感激和樂觀的態度來面對其新生命。第二個研究以34位SCA倖存者於病發後平均 10.6個月接受測試，Cronbach’s alpha為Cronbach’s alpha為0.83，而效度之驗證性因 素分析結果，顯示整體模型的良好適配性，並驗證了C-PSSI-5的四因素模型之有效性。第三 個研究結果顯示，發現34位倖存者平均年齡58.8歲，收案時間為個案急救後1-2年(平均 10.6月)，其生活品質屬於中等程度滿意、憂鬱狀態屬於輕度憂鬱、PTSD屬於輕度，僅有8位 23.5%初篩有創傷後壓力症，PTSD總分與生活品質呈現顯著負相關，與憂鬱狀態呈現顯著正 相關，有宗教信仰者之PTSD總分明顯低於無宗教信仰者。結論與建議：SCA倖存者需要持續的支持，而急救前仍有意識之倖存者，應立即處理他們「震 驚」、「害怕」之情緒及而返家前賦予自我監測其健康以建立其重生的信心，同時宜於加護 病房期間評估其PTSD並及早介入處理。[[abstract]]Background: About 80% of sudden cardiac arrest (SCA) is caused by coronary artery disease. The survival rate is 7.6% while 19-40% experiences post- traumatic stress disorder (PTSD), resulting in negative emotions such as nightmares, depression and anxiety, which can ultimately manifest into chronic health problems.Aims and Research Design: There are three sections in this study. The first aim attempts to establish the descriptive theory of life experience in SCA survivors as the grounded theory of study design. The second aim concerns tool development: to translate and examine the reliability and validity of the Chinese version of the "PTSD Symptom Scale-Interview Version for DSM-5" (C-PSSI-5). The final aim consists of a retrospective, cross-sectional study design exploring the impact of post-traumatic tress related factors on SCA survivors.Results: To address the first aim, ten SCA survivors after attack 1.5 month were invited in-depth interviewy. The results indicated that "valuing my rebirth" was the core category of the survivors’ adaptive process. Three f the participants who were conscious during resuscitation were "rejoiced at surviving, with complex feelings" of "shock", "fear" and "appreciation," while the other seven participants lost consciousness and did not have any memory during resuscitation. However, once all participants had regained consciousness, the reported categories in the interactive process were as follows: "Making efforts for surviving," "Uncertainty," "Worry," and "Resume my health." They were grateful and optimistic to face a new life. Meanwhile, data on 34 participants were analyzed to evaluate the psychometric properties of C-PSSI-5 as part of the second aim. The Cronbach’s alpha of the entire C-PSSI-5 was determined as 0.83. The confirmatory factor analysis confirmed the construct validity with a good model fit while integrated moderate to good psychometric properties were demonstrated and a four-factor model of the C-PSSI-5 was verified in SCA survivors. Finally, the third study found that the quality of life of the 34 survivors, with an average age of 58.8 years and whose data were collected 1 to 2 years after resuscitation (average 10.6 months), were reported as moderately satisfactory with mild depression and mild PTSD. Only 8 participants (23.5%) were screen for PTSD. In addition, PTSD total score negatively correlated with quality of life significantly whereas it positively correlated with depression status significantly. Furthermore, the PTSD total score of participants having religious beliefs was significantly lower than those without religious beliefs.Conclusions and recommendations: SCA survivors require ongoing support and should deal with their "shock" and "fear" emotions immediately after CPR. Additionally, self-monitoring of patient health status is recommended to establish their security before returning home while suitable assessments of PTSD and early nursing interventions in intensive care unit should be provided