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Article(id=1322931496683708922, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.13.016, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1761062400000, receivedDateStr=2025-10-22, revisedDate=1779033600000, revisedDateStr=2026-05-18, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341047688, onlineDateStr=2026-10-30, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341047688, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341047688, creator=13701087609, updateTime=1793341047688, updator=13701087609, issue=Issue{id=1322931411006665649, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='13', pageStart='2193', pageEnd='2384', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341027261, creator='13701087609', updateTime=1793343114456, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940165425082661, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940165425082662, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931411006665649, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2306, endPage=2311, ext={EN=ArticleExt(id=1322931496931172859, articleId=1322931496683708922, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Sense of security in patients undergoing high-flow nasal cannula oxygen therapy based on Schmitt's strategic experiential modules: a qualitative study, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the authentic feelings and experiences of sense of security in patients receiving high-flow nasal cannula oxygen therapy,and to provide references for developing targeted interventions.

Methods

Using purposive sampling,semi-structured in-depth interviews were conducted with 14 patients from the respiratory department of a tertiary hospital in Tianjin.Data were analyzed using Colaizzi's seven-step analysis method.

Results

Based on Schmitt's strategic experiential modules,four themes and fifteen sub-themes were identified:sensory experience (discomfort from airflow impact,thermal distress from heated air,perceived improvement in ventilation,individual variability in device perception); emotional experience(initial anxiety and fear,gradual development of dependence and trust,helplessness from loneliness and passivity,dynamic fluctuation of security experience);cognitive experience(unclear understanding of device principles,enhanced sense of control through information transparency,improved confidence through self-assessment,rethinking of device dependence);and action experience(active posture adjustment for comfort,enhanced control through expressing needs,comparative experience from brief device removal).

Conclusions

Patients undergoing high-flow nasal cannula oxygen therapy experience a dynamic and multidimensional sense of security.Healthcare providers should monitor changes in patients' sense of security across different treatment stages and implement individualized interventions to promote physical and psychological recovery.

, authors=Xue CONG1, Xin'an FAN1, Dan LYU2, Xiuchen GENG2, Wei YANG2, Zhijie GENG2, authorsList=Xue CONG, Xin'an FAN, Dan LYU, Xiuchen GENG, Wei YANG, Zhijie GENG, authorCompany=null, correspAuthors=Zhijie GENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322931497287688700, articleId=1322931496683708922, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于Schmitt战略体验模块理论的经鼻高流量吸氧病人安全感体验的质性研究, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探究经鼻高流量吸氧病人对安全感的真实想法和体验，旨在为制定针对性干预提供参考。

方法

采用目的抽样法，选取天津市某三级甲等医院呼吸科14例病人进行半结构式深度访谈，采用Colaizzi 7步分析法进行资料分析。

结果

依据Schmitt战略体验模块理论共归纳出4个主题、15个亚主题，即感官体验（气流冲击的不适感、加温气流导致的热感困扰、呼吸通畅的感知提升、设备感知的个体差异性）、情感体验（初始阶段的不安与恐惧、逐步建立的依赖与信任、孤独与被动带来的无助感、安心体验的动态波动性）、认知体验（设备原理理解模糊、信息透明增强掌控感、自我评估能力提升信心、对设备依赖性的再思考）、行动体验（主动调节姿势寻求舒适、表达需求提升控制感、短暂脱机引发对比）。

结论

经鼻高流量吸氧病人伴随着动态多维的安全感体验，医护人员应关注病人在治疗各阶段的安全感变化，实施个体化干预以促进其身心康复。

, authors=丛雪1, 范欣安1, 吕丹2, 耿秀晨2, 杨威2, 耿志洁2, *, *, authorsList=丛雪, 范欣安, 吕丹, 耿秀晨, 杨威, 耿志洁, authorCompany=null, correspAuthors=耿志洁, authorNote=

丛雪，护师，硕士研究生在读

, correspAuthorsNote=
耿志洁，E-mail：
GENG Zhijie, E-mail:
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tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, orderNo=1, keyword=经鼻高流量吸氧), Keyword(id=1322931501515547175, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, orderNo=2, keyword=安全感), Keyword(id=1322931501586850344, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, orderNo=3, keyword=体验), Keyword(id=1322931501679125033, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, orderNo=4, keyword=质性研究), Keyword(id=1322931501779788330, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, orderNo=5, keyword=护理)], refs=[Reference(id=1322931502081778221, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, doi=null, pmid=null, pmcid=null, year=2015, volume=372, issue=23, pageStart=2185, 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General information of respondents（n=14）

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编号年龄（岁）性别民族职业文化程度主要诊断是否首次接受HFNCHFNC治疗时间（年）
N176女汉退休初中脓毒性休克后呼吸衰竭否7
N247男汉职员专科慢加急性肝衰竭是5
N374男汉退休小学呼吸衰竭否9
N456男汉个体经营高中急性胰腺炎并急性呼吸窘迫综合征是6
N562女汉退休小学呼吸衰竭是8
N672女汉退休初中肺炎否10
N758女汉职员高中肺部感染是5
N872女回退休小学肺炎是7
N958男汉工人初中COPD急性加重否6
N1075男汉退休小学COPD否12
N1174男汉退休初中胸腔积液是5
N1262女汉工人高中呼吸衰竭是9
N1360男汉无初中肺部感染是7
N1468女汉退休小学肺炎并低氧血症是6
), ArticleFig(id=1322931501989503532, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931496683708922, language=CN, label=表1, caption=

受访者一般资料（n=14）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号年龄（岁）性别民族职业文化程度主要诊断是否首次接受HFNCHFNC治疗时间（年）
N176女汉退休初中脓毒性休克后呼吸衰竭否7
N247男汉职员专科慢加急性肝衰竭是5
N374男汉退休小学呼吸衰竭否9
N456男汉个体经营高中急性胰腺炎并急性呼吸窘迫综合征是6
N562女汉退休小学呼吸衰竭是8
N672女汉退休初中肺炎否10
N758女汉职员高中肺部感染是5
N872女回退休小学肺炎是7
N958男汉工人初中COPD急性加重否6
N1075男汉退休小学COPD否12
N1174男汉退休初中胸腔积液是5
N1262女汉工人高中呼吸衰竭是9
N1360男汉无初中肺部感染是7
N1468女汉退休小学肺炎并低氧血症是6
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基于Schmitt战略体验模块理论的经鼻高流量吸氧病人安全感体验的质性研究
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丛雪 1 , 范欣安 1 , 吕丹 2 , 耿秀晨 2 , 杨威 2 , 耿志洁 2, *, *
护理研究 | 综合研究 2026,40(13): 2306-2311
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护理研究 |综合研究 2026 , 40 (13) : 2306 -2311
基于Schmitt战略体验模块理论的经鼻高流量吸氧病人安全感体验的质性研究
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丛雪1, 范欣安1, 吕丹2, 耿秀晨2, 杨威2, 耿志洁2, *, *
作者信息
  • 1天津中医药大学，天津 301617
  • 2天津市第三中心医院
通讯作者:
耿志洁，E-mail：
GENG Zhijie, E-mail:
作者简介:

丛雪，护师，硕士研究生在读

Sense of security in patients undergoing high-flow nasal cannula oxygen therapy based on Schmitt's strategic experiential modules: a qualitative study
Xue CONG1, Xin'an FAN1, Dan LYU2, Xiuchen GENG2, Wei YANG2, Zhijie GENG2
Affiliations
  • 1Tianjin University of Traditional Chinese Medicine, Tianjin 301617 China
  • 2Tianjin Third Central Hospital
出版时间: 2026-07-10 doi: 10.12102/j.issn.1009-6493.2026.13.016
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摘要
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目的

探究经鼻高流量吸氧病人对安全感的真实想法和体验，旨在为制定针对性干预提供参考。

方法

采用目的抽样法，选取天津市某三级甲等医院呼吸科14例病人进行半结构式深度访谈，采用Colaizzi 7步分析法进行资料分析。

结果

依据Schmitt战略体验模块理论共归纳出4个主题、15个亚主题，即感官体验（气流冲击的不适感、加温气流导致的热感困扰、呼吸通畅的感知提升、设备感知的个体差异性）、情感体验（初始阶段的不安与恐惧、逐步建立的依赖与信任、孤独与被动带来的无助感、安心体验的动态波动性）、认知体验（设备原理理解模糊、信息透明增强掌控感、自我评估能力提升信心、对设备依赖性的再思考）、行动体验（主动调节姿势寻求舒适、表达需求提升控制感、短暂脱机引发对比）。

结论

经鼻高流量吸氧病人伴随着动态多维的安全感体验，医护人员应关注病人在治疗各阶段的安全感变化，实施个体化干预以促进其身心康复。

经鼻高流量吸氧  /  安全感  /  体验  /  质性研究  /  护理
Objective

To explore the authentic feelings and experiences of sense of security in patients receiving high-flow nasal cannula oxygen therapy,and to provide references for developing targeted interventions.

Methods

Using purposive sampling,semi-structured in-depth interviews were conducted with 14 patients from the respiratory department of a tertiary hospital in Tianjin.Data were analyzed using Colaizzi's seven-step analysis method.

Results

Based on Schmitt's strategic experiential modules,four themes and fifteen sub-themes were identified:sensory experience (discomfort from airflow impact,thermal distress from heated air,perceived improvement in ventilation,individual variability in device perception); emotional experience(initial anxiety and fear,gradual development of dependence and trust,helplessness from loneliness and passivity,dynamic fluctuation of security experience);cognitive experience(unclear understanding of device principles,enhanced sense of control through information transparency,improved confidence through self-assessment,rethinking of device dependence);and action experience(active posture adjustment for comfort,enhanced control through expressing needs,comparative experience from brief device removal).

Conclusions

Patients undergoing high-flow nasal cannula oxygen therapy experience a dynamic and multidimensional sense of security.Healthcare providers should monitor changes in patients' sense of security across different treatment stages and implement individualized interventions to promote physical and psychological recovery.

high-flow nasal cannula oxygen therapy  /  sense of security  /  experience  /  qualitative study  /  nursing
丛雪, 范欣安, 吕丹, 耿秀晨, 杨威, 耿志洁. 基于Schmitt战略体验模块理论的经鼻高流量吸氧病人安全感体验的质性研究. 护理研究, 2026 , 40 (13) : 2306 -2311 . DOI: 10.12102/j.issn.1009-6493.2026.13.016
Xue CONG, Xin'an FAN, Dan LYU, Xiuchen GENG, Wei YANG, Zhijie GENG. Sense of security in patients undergoing high-flow nasal cannula oxygen therapy based on Schmitt's strategic experiential modules: a qualitative study[J]. Chinese Nursing Research, 2026 , 40 (13) : 2306 -2311 . DOI: 10.12102/j.issn.1009-6493.2026.13.016
正文
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经鼻高流量吸氧（high-flow nasal cannula oxygen therapy,HFNC）作为一种非侵袭性呼吸支持方式，已广泛应用于急性低氧性呼吸衰竭[1]、慢性阻塞性肺疾病（COPD）急性加重[2]等多种临床情境中。与传统氧疗相比，HFNC在提供高流量、稳定氧浓度的同时，具备良好的气体湿化与加温功能，可改善氧合、提高舒适度并降低呼吸功等优势[3]。尽管HFNC在改善生理参数方面疗效显著，但其持续高流速、鼻塞异物感及佩戴束缚等特性仍使部分病人在治疗过程中出现焦虑、恐惧[4]及不适应[5]等反应，病人会出现不同程度的安全感缺失。研究显示，安全感缺失可导致治疗依从性下降[6]，部分病人因焦虑而中断治疗[7]，影响氧合改善[8]。长期缺乏安全感还可能引发睡眠障碍和情绪抑郁，对心理健康及预后造成不利影响[9-10]。因此，深入探究 HFNC 治疗过程中病人安全感的形成、体验及其影响因素，对优化护理方案和提升治疗质量具有重要意义。
Schmitt的战略体验模块理论（strategic experiential modules,SEMs）是由Schmitt[11]于1999年提出，最初广泛应用于市场营销与品牌管理领域。近年来，Gheorghe等[12-14]将该理论引入眼科、慢性阻塞性肺疾病及重症监护等病人体验研究中，为质性研究中体验维度的资料收集与分析提供了有力理论支撑。本研究基于Schmitt 的战略体验模块理论，采用质性研究方法对HFNC病人进行深度访谈，探讨其治疗过程中的安全感体验特征，为优化呼吸管理与制定针对性护理策略提供参考。
1　对象与方法
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1.1　对象
采取目的抽样法，选取2025年6月—2025年9月天津市某三级甲等综合医院呼吸科接受HFNC治疗的住院病人作为访谈对象。纳入标准：病人合作，能够正常沟通交流；符合《成人经鼻高流量湿化氧疗临床规范应用专家共识》[15]治疗标准；HFNC治疗时间>48 h；年龄≥40岁。排除标准：患有严重心、肝、肾等脏器功能不全；精神系统疾病。访谈样本量依据信息饱和原则确定，即在资料分析过程中不再产生新的主题为止[16]。最终共访谈病人14例，其中男8例，女6例；年龄47~76岁；受访者一般资料见表1。本研究已获得医院伦理委员会批准（IRB2024-018-02）,研究对象均已知情同意并自愿参加本次访谈。
1.2　资料收集方法
Schmitt的战略体验模块理论强调个体在特定情景中的整体体验，并将体验划分为感官、情感、认知、行动与关系5个维度。1）感官体验是依据病人的视、触、听、嗅觉等所建立的生理性的体验；2）情感体验是指病人在患病期间内心受到触动所产生的情感和情绪；3）思考体验是指病人在治疗过程中通过综合、归纳等思维活动所获得的认知体验；4）行动体验是指病人参与医疗护理活动以及康复过程中所获得或期望获得的行动体验；5）关联体验因与情感体验存在高度一致性，在实际运用中两者不易区分，有研究建议将关联体验去除[17]。
本研究在前期查阅相关文献的基础上，课题组成员共同设计制定访谈提纲，对符合纳入标准的2例HFNC病人进行预访谈，确定最终访谈提纲：1）请您谈一下您如何看待经鼻高流量吸氧？2）请描述下您在使用经鼻高流量吸氧设备期间的印象或感受？3）在使用经鼻高流量吸氧的过程中，有哪些时刻您会觉得比较安心或有些不安？4）在使用经鼻高流量吸氧设备以外，有哪些时候您会觉得比较安心或有些不安？5）您觉得哪些情境会让您特别没有安全感？6）您觉得哪些情境能让您感到更安心、更信任？7）当您出现这些感受时，您通常会采取哪些方式进行调节？8）请您谈一下您是如何适应这个设备的？9）请您用几句话来总结您这次经鼻高流量吸氧治疗的整个感受。研究者秉承匿名和严格保密的原则，访谈前向病人详细说明访谈的目的、内容和方法，同时取得病人信任，与病人建立良好的护患关系；访谈中鼓励病人表达自己的真实感受，营造轻松气氛。访谈期间保持全程录音且观察并记录病人的手势、表情、行为等非语言信息。根据实际情况，共实施访谈14 次，访谈时长共计779 min，每次访谈时长为35~89（42.00±8.19）min，并及时向病人核实访谈的重点内容和信息。
1.3　资料整理与分析
每次访谈由2名研究者在48 h内将录音内容转写成文字，并将转录资料导入NVivo 12.0质性资料分析软件。本研究采用Colaizzi 7步分析法[18]进行资料分析：认真多次阅读访谈记录；提取关键且富有意义的陈述；对频繁出现且重要的观点进行编码；整合编码后的内容；撰写详尽且完整的描述；识别并归纳相似观点，提炼出核心主题；最后回访研究对象进行确认与验证[19]。
2　结果
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2.1　感官体验
2.1.1　气流冲击的不适感
多数病人在HFNC初始使用阶段因气流较强而感到鼻腔与呼吸道刺激，短期内削弱了对设备的信任与安全感。N2：“刚戴上那会儿，感觉鼻子里被风顶着，有点发慌，不知道是不是戴错了。”N6：“就像小鼓风机对着鼻孔吹，忍不住想打喷嚏。”持续的冲击感使部分病人产生排斥心理。N8：“那股风一直往里灌，真想把管子拽下来不戴了。”随着治疗推进，病人逐渐适应并感受到呼吸改善。N3：“一开始挺难受，我就这么忍过来，后来慢慢习惯了，呼吸也顺畅多了”。
2.1.2　加温气流导致的热感困扰
部分病人认为HFNC气流温度过高，产生持续闷热感，在环境温度较高或湿化设置不当时尤为明显，闷热不适不仅加重生理负担，也引发烦躁情绪，降低治疗依从性与安全感。N1：“我本来就怕热，那气送进来像冒热气似的，老觉得胸口发闷，不舒服，燥得慌。”N4：“这病房开着空调都觉得鼻子热，后来实在受不了就跟护士说调小点，不然越戴越烦。”N9：“感觉吸进来是热水蒸气，出了汗，头发都粘在额头上”。
2.1.3　呼吸通畅的感知提升
多数病人适应后最显著的积极感受是呼吸阻力下降和胸闷缓解，从初期的呼吸不畅到逐渐顺畅的转变带来明显的舒适与安全感。N3：“一开始喘不上来气，戴了一会儿呼吸顺畅很多，人也安心了。”N9：“戴上以后慢慢感觉气能下去，不像之前老是憋得慌，觉得这个机器还是挺有用的。”N7：“以前老感觉胸口堵着，一口气提不上来，现在气顺了。”对于病情反复的病人，这种呼吸通畅的体验更显珍贵。N14：“之前老是大口喘都不管用，戴上以后能感觉气慢慢下去，那种憋气的感觉少了很多，就觉得有希望坚持下去”。
2.1.4　设备感知的个体差异性
对于某些病人而言，这种个体差异甚至会在同一时期内反复波动，体验随状态不同而变化。N3：“医生说这个设备很好，对我来说这个风有点大了，鼻子就觉得不舒服。”与这种不适应相反的是一些病人在同样的设备下获得了舒适感。N5：“我觉得吹进来的风暖暖湿湿的，挺舒服的，就像给干燥的喉咙做了个SPA，呼吸起来一点不费劲，很快就睡着了。”然而，也有病人始终无法适应。N4：“从头到尾都觉得不舒服，不是风大就是太热，耳朵后面也被带子磨得疼，各种感觉加在一起，就没觉得这东西好受过”。
2.2　情感体验
2.2.1　初始阶段的不安与恐惧
初次佩戴HFNC设备时，面对陌生的机器、持续的气流声和异常的鼻腔体感，病人普遍感到一种对未知的不安和恐惧。这种紧张情绪与对设备的陌生感、对自身病情的担忧交织在一起，严重削弱了初期的安全感。N2：“设备刚推过来的时候我没注意，但是后面知道鼻塞要一直插在鼻子上。”N13：“看着那根粗管子，我心里就发怵，第一次往里送气之前，我整个人都是绷紧的。”N7：“机器有时候会响，我就担心是不是出了什么问题，有一次我睡着了它一响我还吓一跳”。
2.2.2　逐步建立的依赖与信任
随着治疗的持续，当呼吸困难的症状得到显著缓解后，大多数病人的情感发生了根本性的转变。N2：“起初戴上时确实有些不适应，但随着时间推移，我发现胸口慢慢不那么闷了，呼吸也顺畅了，逐渐适应下来，心里也觉得这个设备确实有用。”N6：“慢慢地我发现，这个机器就像是在帮我撑着气，一戴上就能踏实，晚上也不怕睡着会喘不上来气”。
2.2.3　孤独与被动带来的无助感
夜间独处的时候能听见机器运行声但缺乏人际互动，易产生强烈孤独与无助感。N6：“有时候深夜听着机器规律的响声，反而觉得更孤单了，好像全世界就只剩下我和这台冰冷的机器，它再高效也给不了一句温暖的安慰。”N9：“半夜醒来，房间里只有这个机器在亮着灯、响着，护士也不能一直在身边。感觉自己很渺小，很孤独”。
2.2.4　安心体验的动态波动性
病人的安全感并非持续稳定，而是随使用时间、环境及病情变化呈动态波动。部分病人在初始阶段因陌生感和呼吸焦虑对设备产生排斥，但随着适应过程逐步增强安全感。N6：“刚开始戴的时候很紧张，怕喘不上气，一两个小时后慢慢适应了，气道也通了，心里就踏实了。”N11：“起初不敢睡，后来呼吸明显顺畅，也能睡着了。”这种安心感并非恒定。夜间或环境安静等情境仍会波动。N8：“晚上听到机器声音，偶尔又会紧张，天亮人多就好了”。
2.3　认知体验
2.3.1　设备原理理解模糊
多数病人对HFNC缺乏了解，常凭感官体验主观推断，易引发误解与焦虑。N3：“这机器滴滴响，我还以为要炸了，后来护士说是缺水报警才放心。”N4：“风一会儿大一会儿小，我就担心氧气是不是快用完了。”N7：“每次机器响我都紧张，后来护士解释了原理，才慢慢放松”。
2.3.2　信息透明增强掌控感
医护人员讲解HFNC的原理、效果与注意事项，可有效纠正误解、增强安全感。N8：“医生说这机器帮我打开肺泡，我就想着它在帮我省力，呼吸顺多了。”N10：“护士长比划着讲气是怎么被加压加湿送进肺里的，我一下就明白了。”N14：“以前看到管子就紧张，护士讲清楚后就踏实多了”。
2.3.3　自我评估能力提升信心
有经验的病人会通过观察脉氧、呼吸频率等指标自主判断状况变化，并及时反馈给医护人员。这种能力给予病人更多心理控制感，让他们相信自己能够判断是否安全。N11：“我每次看脉氧和呼吸频率，就能判断自己是不是需要调整姿势或者叫护士帮忙，感觉自己也能掌控一点状况，比以前心里踏实。”N14：“知道这些指标能告诉我身体情况后，我就不再总是慌了，呼吸顺不顺、稳不稳，心里有底气”。
2.3.4　对设备依赖性的再思考
随着病情好转，病人对HFNC产生辩证认知：既感激其带来的呼吸支持，又担忧长期依赖。N5：“现在离不开它了，但也怕呼吸功能偷懒，以后摘不掉怎么办？”N12：“医生说要停，我又想试试又怕不稳，就像孩子学走路。”N6：“离开它有点慌，但也想看看自己能不能独立呼吸”。
2.4　行动体验
2.4.1　主动调节姿势寻求舒适
在设备引起不适时，多数病人不会被动忍受，他们通过变换体位、轻轻移动或托起导管、调整头部角度等方式，试图找到最适合的佩戴状态，是一种寻求安全与舒适的方式。N7：“我不舒服的时候我会动一动，稍微歪一下头，好像鼻子里就不那么难受了。”N9：“我不能老是平躺着，气顶得难受。得让家里人帮我把后背垫高一点，侧着点身，再把管子顺一顺，这才能喘得顺当些”。
2.4.2　表达需求提升控制感
病人方面，无论是请求调节流量大小、松解固定带还是询问设备工作原理，积极、主动地向医护人员提出明确需求是提升自身控制感的重要途径。N6：“刚开始风太大，我觉得鼻子里顶得慌，和护士说能不能调小一点。护士帮我调完以后，呼吸顺了，人也安心了。”N9：“戴久了耳朵后面老被带子勒得疼，就主动跟护士说了，她帮我垫了个减压贴，还松了点。那一刻我就觉得，这东西不是死板的，我能自己参与进去”。
2.4.3　短暂脱机引发对比
在必须短暂脱机进行饮食、检查或设备更换等情境下，病人往往会迅速体验到呼吸困难的再次袭来。N5：“一摘下来马上就觉得喘不上来，戴上才踏实。”N9：“就喝碗粥的工夫，摘下管子那几分钟，胸口就有点闷，吃完立马戴回去”。
3　讨论
收起
本研究基于Schmitt战略体验模块理论，从感官、情感、认知与行为4个维度探讨了HFNC病人安全感体验。结果显示，病人的安全感并非单一心理状态，而是在设备体验、信息理解、情绪调节与行为参与的动态互动中逐步建构的综合体验。不同体验模块共同影响病人的主观安全感与依从性，为临床护理提供了多维干预的参考。
3.1　安全感的关键门槛：初始感知
HFNC最初的气流冲击、鼻腔刺激与气流温度是病人在早期即可感知的关键元素，这些感官体验直接影响其对治疗的依从性与安全感判断。高流量设置虽能改善氧合并减轻呼吸不畅，但也有病人会产生不适感[20]，尤其在初期易引发抵触和焦虑，导致病人在治疗过程中出现规避行为，并增加中途退出率[6-7]。因此，有效管理感官适应阶段至关重要。护理人员应在HFNC启动后的前1~2 h内重点观察与干预，密切监测病人对气流温湿度的耐受情况，确保吸入气体维持在适宜的温热与湿润状态[21]。若出现燥热或流速不适等不适表现，应根据个体差异及时调整参数。同时，应注意部分病人可能因焦虑或对设备不信任而不愿主动表达不适。医护人员需主动沟通，鼓励病人描述体感与需求，从而促进感官适应，增强依从性与安全感。Mauri等[20]研究表明，在相等流量下，较高的流量不会降低病人的舒适度，较低的温度可能更加舒适。故临床实践中，护理人员可密切观察病人对流量和温度的耐受性，及时反馈并协助个体化参数调节，避免因盲目追求高流量和高温度而加重病人不适[22]。
3.2　恐惧到信任的动态过程
HFNC病人常由早期的恐惧、焦虑向后期的信任与安心转变的动态过程。初始阶段，面对陌生设备、强烈气流及疗效不确定性，病人易出现焦虑或恐惧[23]，这类负性情绪会放大对治疗效果的担忧，削弱主观安全感与依从性。研究表明，长期HFNC使用者的焦虑评分随病情改善与设备熟悉度增加而下降[24]。此外，有研究表明，家庭和社会支持及医护团队的有效沟通与HFNC病人的依从性和舒适度提升相关[25-26]。因此，临床护理过程中应注重病人的情绪状态，早期识别并安抚焦虑情绪、通过同理沟通减少不确定性，并动员家庭和社会提供支持，以强化信任与安全感，从而提升病人耐受性与依从性，改善HFNC的整体疗效。
3.3　安全感的隐形阻碍：理解不足
病人对HFNC治疗目标与工作原理的理解不足是影响其安全感形成的重要障碍。临床观察发现，病人未能正确理解设备功能，对报警声或气流变化等常规现象产生误解与恐惧，从而削弱信任和安全感，这可能与医患沟通不足、宣教内容专业化或解释不充分有关。李杰红等[27]指出，病人在认知水平不足的情况下，常因医护沟通不充分而产生错误认知，影响其对治疗安全性的主观评估。此外，Won等[28]在住院病人研究中发现，信息透明与沟通充分能增强病人的掌控感与参与意愿。因此，临床护理应在认知层面实施针对性干预，通过通俗易懂、循序渐进的健康宣教，帮助病人理解HFNC的作用与治疗目的，纠正错误认知，减少因未知带来的心理威胁。同时，鼓励病人积极反馈问题、参与沟通，使其由被动接受转变为理性理解与信任参与。
3.4　主动探索，构建安全感
HFNC病人在治疗过程中并非被动接受支持，而是通过具体行为主动建构并强化安全感。部分病人会通过调整体位和温度或松解绑带以减轻气流不适；亦有病人在进食或休息时短暂脱机，通过对比使用和暂停使用的状态，从而更加确信HFNC带来的益处。这些行为既是应对不适的自我调节，也是安全感逐步形成的过程。病人的探索与反馈可视为一种实践性学习，使其在体验中验证设备有效性并获得安全感。Mauri等[20]研究表明，鼓励病人参与自我调节能够显著提升安全感。Vaismoradi等[29]研究指出，病人参与是安全管理的核心环节，但必须依托医护支持才能发挥正向作用。因此，临床实践中医护人员不仅要鼓励病人主动表达与参与，还应提供具体的指导与反馈，例如教授病人安全的体位调整方法、及时回应设备操作请求等。通过这种互动支持，病人能够在行为层面不断强化对HFNC治疗的信任，从而获得更稳定、持久的安全感。
4　小结
收起
本研究基于Schmitt 的战略体验模块理论，对14例HFNC病人开展面对面深度访谈，结果显示，HFNC病人的安全感形成是一个过程。感官舒适度是起点，情感信任是桥梁，认知理解是基础，而行为参与是稳定安全感的关键环节。护理人员在临床中应从多维度出发，通过改善感官体验、情绪支持、认知宣教与行为引导，构建全程动态的安全感促进策略，从而提升 HFNC 治疗依从性与整体护理质量。基于研究结果，临床需多维度优化护理。感官层面：关注初始1~2 h适应期，动态调整气流与温湿度；情感层面：早期识别负性情绪，通过共情沟通与家庭支持建立信任；认知层面：以通俗易懂的健康宣教填补HFNC认知空白；行为层面：鼓励病人参与自我调节并提供专业指导，最终提升安全感与治疗依从性。本研究的结果可为呼吸科及重症监护科的护理实践提供参考，尤其是HFNC治疗的成人病人群体。本研究仅对1所三级甲等医院的病人进行访谈，具有一定的局限性，建议今后进一步扩大地区范围和样本量开展更深入的研究，此外，也可通过量性研究进一步探讨HFNC病人患病体验的影响因素，为构建有针对性的护理干预方案提供参考。

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2026年第40卷第13期
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doi: 10.12102/j.issn.1009-6493.2026.13.016
  • 接收时间：2025-10-22
  • 首发时间：2026-10-30
  • 出版时间：2026-07-10
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  • 收稿日期：2025-10-22
  • 修回日期：2026-05-18
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    1天津中医药大学，天津 301617
    2天津市第三中心医院

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耿志洁，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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