基于时机理论对肠造口患者照顾者不同阶段照护体验的质性研究

目的以时机理论为框架,了解肠造口患者照顾者在照护过程中的照护体验,为设计和实施能满足照顾者需求的有效干预提供依据。方法基于时机理论,选择40名处于不同照护阶段(围手术期、出院准备期、调整期和适应期)的患者照顾者,采用质性研究中的现象学研究方法,进行非结构访谈,并以Colaizzi现象学研究法分析资料,提炼主题。结果提炼出5个关于肠造口患者照顾者不同阶段照护体验的主题,(1)围手术期:疾病不确定感、创伤后应激障碍;(2)出院准备期:无助感;(3)调整期:实践与再认知;(4)适应期:创伤后成长。结论肠造口患者照顾者体验是一个动态变化的过程,且在不同阶段的内心照护体验和需求各有不同。患者照顾者在围手术期侧重信息和情感需求;在出院准备期具有较强的无助感;调整期侧重造口护理产品信息的需求;适应期侧重照顾能力的提高。应分阶段、有计划地给予肠造口患者照顾者相应的心理支持与提供信息资源的支持及相关知识的指导,从而提高其心理健康水平、照护知识和技能。     

基于时机理论对重型颅脑损伤病人主要照顾者不同阶段照护体验的质性研究

[目的]基于时机理论探讨重型颅脑损伤(severe traumatic brain injury,sTBI)病人照顾者在疾病发展不同阶段的照护体验。[方法]采用现象学研究方法,以半结构访谈的方式对53名处于不同照护阶段(院内诊断期、sTBI围术期、院内稳定期、出院前期及家庭康复期)的sTBI病人家属进行访谈,采用Colaizzi 7步分析法对资料进行分析。[结果]各阶段的主题:院内诊断期身心反应剧烈、负性心理过重、家庭及情感支持不足;sTBI围手术期缺乏照护相关经验、担忧手术结果;院内稳定期信息缺乏、怀疑治疗;出院前期失助感;家庭康复期延续护理需求。[结论]sTBI病人照顾者的护理体验是随着疾病发展的不同阶段动态变化的,医护人员应有计划、有针对性地提供院内健康教育和院外延续护理,从而提高照顾者的照护能力,促进病人康复。     

永久性心脏起搏器植入术围术期患者照顾者照顾体验的质性研究

目的探讨永久性心脏起搏器植入术围术期患者照顾者的照顾体验。方法采用质性研究中的现象学研究方法,对行永久性心脏起搏器植入术围术期患者照顾者进行非结构访谈,采用claizzi现象学方法分析资料和提炼主题。结果照顾者照顾体验的主要主题为:手术前由于知识缺乏带来的恐惧、焦虑与不安;手术后缺乏照护经验,躯体健康水平下降;出院前强烈健康教育需求,对居家照护缺乏信心。结论永久性心脏起搏器植入术患者照顾者在患者手术前后其照顾体验不同,护理人员应针对性地为其提供个性化的指导,以增强患者照顾者护理水平,从而促进患者康复。     

上消化道肿瘤术后出院患者主要照顾者照护体验的质性研究

目的 了解上消化道肿瘤术后出院患者的主要照顾者照护体验,以期为制订针对性的干预措施提供参考.方法 2016年1-6月,采用目的抽样法,选取泰安市某肿瘤专科医院收治的11名上消化道肿瘤术后患者的主要照顾者为研究对象,采用现象学研究方法在患者出院1周时对照顾者进行面对面深入访谈,现场录音,借助NVivo8.0软件,根据Colaizzi的7步分析法对资料进行分析,提炼主题.结果 上消化道肿瘤术后出院患者主要照顾者的照护体验可归纳为3个主题,即复杂的情感体验、角色适应问题和支持性照护需求.结论 上消化道肿瘤术后出院患者主要照顾者普遍存在角色适应不良和未满足的支持性照护需求,医护人员应关注主要照顾者这一群体,给予个性化支持,提高其生活质量.     

不同时期脑卒中患者主要照顾者照护知识调查

目的 调查首次入住康复医学科的不同时期脑卒中患者主要照顾者对照护知识的掌握情况。方法 2014年7月-2015年11月入住上海市静安区老年医院神经康复医学科且符合纳入标准的脑卒中患者及主要照顾者90例,调查不同时期照顾者对于照护知识的掌握情况及其心理健康状况,并分析两者之间的相关性。结果 入院48小时内照顾者对于照护知识的总体掌握率最低;出院后3个月照顾者对于如何预防和识别再次中风,及再次中风后的处理掌握率较低;三个时期照顾者对并发症的护理掌握率均最低;照顾者各项照护知识掌握程度与自我肯定程度呈正相关,与忧郁、焦虑及健康问题总分呈负相关。结论 对于脑卒中照顾者的照护知识的教育,在形式上要多样化,不同时期的照顾者教育内容要有针对性。     

痴呆患者照顾者初期居家照护体验的现象学研究

目的探讨痴呆患者照顾者初期居家照护体验。方法采用现象学研究中的半结构式访谈法,依据Clolaizzi提出的7步质性研究资料分析法,访谈14名痴呆患者照顾者,了解照顾者初期照护体验。结果痴呆患者照顾者初期照护体验包括:专业知识缺乏;照顾负荷过重;情绪行为反应:担惊受怕与睡眠紊乱;应对方式:独自忍耐或与他人分享4个主题。结论针对痴呆患者照顾者初期居家照护体验,身心反应等,医务工作者应给予相关疾病、照护信息,专业支持等,以实现其良好心理适应。     

基于时机理论对宫颈癌患者照顾者照护体验的研究

目的应用时机理论,探讨宫颈癌患者照顾者在疾病不同阶段的照顾体验。方法采用目的抽样方法,选取2017年3—12月收治于华中科技大学同济医学院附属协和医院的宫颈癌患者照顾者30名为研究对象,进行半结构式访谈,采用Colaizzi分析法分析资料并提炼主题。结果宫颈癌患者照顾者在疾病4个阶段的需求情况可归纳为:①疾病诊断期:忧虑与不适;②疾病治疗期:信息和心理支持不足;③出院准备期:缺乏经济支持与失助;④疾病调整期及适应期:渴望持续信息指导。结论宫颈癌患者照顾者在不同疾病阶段的需求是动态变化的,医护人员应实施有针对性的护理干预,通过满足照顾者不同阶段的需求,提高照顾者及患者的生活质量。     

基于时机理论对1型糖尿病患儿家属不同阶段照护体验的质性研究

目的以时机理论为框架,探讨1型糖尿病患儿家属在疾病不同阶段的照护体验。方法采用质性研究中现象学方法,对50名处于不同照护阶段的1型糖尿病患儿家属采取半结构式深入访谈并用Colaizzi分析法进行资料分析提炼主题。结果按时机理论,提炼出5个关于1型糖尿病患儿家属不同阶段照护体验的主题,分别为:(1)诊断期:应急反应强烈。(2)治疗期:应对态度不同。(3)出院准备期:失助感。(4)调整期:个人和家庭不堪重负。(5)适应期:积极投入。结论 1型糖尿病患者家属在疾病不同阶段的照护体验是动态变化的,医护人员应为其制订针对性、个性化的有效干预,以发挥延续护理在家庭护理中的作用。     

基于时机理论对慢性阻塞性肺疾病病人家属不同阶段照护体验的质性研究

[目的]在时机理论的基础上,探讨慢性阻塞性肺疾病(COPD)病人家属在疾病不同阶段照护体验的真实感受。[方法]采用质性研究中现象学研究方法,对27名COPD病人家属进行半结构式访谈,用现象学方法对资料进行分析。[结果]以时机理论为基础,提出5个关于COPD病人家属不同阶段照护体验的主题,分别是①急性加重期:应激反应强烈;②稳定期:信息支持缺乏及应对态度不同;③准备期:照顾信心不足及失助感;④调整期:个人和家庭不堪重负;⑤适应期:积极面对和投入。[结论]COPD病人家属在疾病不同阶段照护体验是动态变化的,积极关注其动态变化的照护体验,可以帮助医护人员及时发现问题,给予针对性个性化的干预措施,有利于维持护理的延续性,帮助家属缓解照护负担,在提高病人生活质量的同时促进医疗服务质量的改进。     

肠造口新生儿家长照护体验的质性研究

目的 基于时机理论,探讨肠造口新生儿家长在疾病不同阶段的照护体验,为制订相应的护理支持方案提供依据。方法 采用现象学研究法,选取2020年3月—12月在苏州市某三级甲等儿童医院新生儿科住院的43名处于不同阶段的肠造口新生儿的家长,对其进行非结构式访谈,应用Colaizzi 7步分析法对资料进行分析、归纳及提炼主题。结果 遵循时机理论,提炼出肠造口新生儿家长5个不同阶段照护体验的主题。①诊断期：情绪反应复杂,应对能力不足。②稳定期：不确定感增加,支持需求强烈。③出院准备期：缺乏信心,焦虑无助。④调整期：渴望专业支持。⑤适应期：积极适应,收获成长。结论 肠造口新生儿家长在疾病不同阶段的照护体验是动态变化的,医护人员应有针对性地给予其个性化的支持与指导,以帮助肠造口新生儿家长顺利度过特殊时期,增强家庭护理的延续性。     

The investigation of care burden and coping style in caregivers of spinal cord injury patients

PurposeThe level of care burden experienced by caregivers of patients with spinal cord injury and their coping style were evaluated in order to identify ways to improve their capacity to respond and reduce the care burden.MethodsA convenience sampling method was used to select 150 spinal cord injury patients who were discharged from the Second and the Third Affiliated Hospital of Nanchang University and their primary caregivers. The Chinese version of the Zarit Caregiver Burden Interview and the Simplified Coping Style Questionnaire were distributed to assess caregiver burden and coping strategies.ResultsThe care burden score of the caregivers of patients with spinal cord injury was 52.91 ± 11.56 points. Eighty-eight percent of caregivers reported moderate or severe care burden levels. The largest proportion of caregivers were female spouses, who were less likely to use an active coping strategy. A negative coping strategy was more frequently used by caregivers compared to healthy adults, and was positively correlated with burden of care. In contrast, a negative correlation was found between the care burden and an active coping style.ConclusionPrimary caregivers of spinal cord injury patients report a heavy burden of care. As active coping strategies are more beneficial, medical care providers should encourage caregivers to make more use of these coping styles to promote physical and mental health for themselves, their patients and their family, as well as to improve the quality of care provided.     

Clinical application of super-link system theory in spinal cord injury patients during rehabilitation stage

The purpose of this paper is to introduce Super-Link System Theory, which is a theory of spinal cord injury rehabilitation. This theory has been developed using the grounded theory research method. By explaining the procedure for establishing a super-link system the paper explains the complex structure of this theory. Super-Link System Theory emphasizes that rehabilitation nurses 'build up their interpersonal relationships' with clients, family caregivers, the interdisciplinary team, and the community, and attempt to 'establish links' among them. They know these links have to be made with appropriate 'timing', and must be able to access the appropriate people when necessary. Super-link systems include the following four links: link to client with spinal cord injury, link to family caregiver, link to interdisciplinary rehabilitation team, and link to community. It can enable rehabilitation nurses to provide a better quality of nursing care to clients and their family caregivers, as well as promote their professional position in the interdisciplinary rehabilitation team.     

不同阶段永久性造口患者的照顾者护理负担的影响因素调查分析

目的调查不同阶段永久性造口患者照顾者护理负担的影响因素。方法选择2015年7月-2016年7月在某三甲医院普外科及泌尿外科住院行永久性肠造口患者的63名主要照顾者为研究对象,采用一般资料调查表和Zarit护理负担量表,在出院1个月及出院3个月时进行问卷调查。结果出院1个月时的影响因素为造口并发症、照顾者文化程度、照顾者年龄、医疗付费方式、人均收入及照顾者性别6个因素;出院3个月时的影响因素为造口并发症、患者年龄、照顾者工作情况、照顾者年龄4个因素。结论照顾者在患者出院后不同阶段护理负担的影响因素是不同的,护理人员应针对照顾者的具体情况和时间阶段制定个性化延续护理方案,从而减少居家护理阶段照顾者的护理负担。     

Informal care providers for veterans with SCI: who are they and how are they doing?

Veterans with spinal cord injury (SCI) who received care at the Houston Department of Veterans Affairs Medical Center were interviewed about their use of formal and informal assistance to meet their daily physical needs. Informal caregivers were found to play an important role in the daily care of veterans with SCI, with 37% receiving some informal, unpaid assistance-with personal care. Primary informal caregivers were mostly women, had a mean age of 53, and provided an average of almost 12 hours of care a day. Nearly one-third of participants rated their primary caregiver as being only in fair or poor health, and one-fourth thought their caregiver was unlikely to be able to provide the same level of care 5 years from now. Of particular concern, more than half reported that they did not have anyone else willing and able to provide assistance if their primary family caregiver became permanently unable to care for them.     

Needs, concerns, strategies, and advice of stroke caregivers the first 6 months after discharge.

During the first few months after a stroke, family caregivers must quickly learn how to care for the stroke survivor in the home setting. Although there are some studies that addressed the needs and concerns of stroke caregivers during the early poststroke period, there are very few caregiver studies that reported strategies used by caregivers to deal with their needs and concerns, and studies are lacking that reported the advice that caregivers would offer to others. The purpose of this study was to determine the self-reported needs, concerns, strategies, and advice of family caregivers of stroke survivors during the first 6 months after hospital discharge. Using openended questions, we individually interviewed 14 female family caregivers of stroke survivors (8 African American, 6 white) to identify their needs and concerns, strategies they used to deal with stroke, and advice they would offer to other stroke caregivers. Findings revealed five major categories of caregiver needs and concerns: information, emotions and behaviors, physical care, instrumental care, and personal responses to caregiving. Based on the findings, an initial needs and concerns checklist was developed, along with a list of caregiver strategies and advice. Upon further testing, the needs and concerns checklist, as well as the list of strategies and advice, may help to identify relevant areas for caregiver intervention.     

Psychosocial factors affecting hip fracture elder's burden of care in Taiwan

OBJECTIVE: The aim of this study was to analyze the factors that affect the burden of care for primary caregivers of older people during the transition period after discharge from the hospital to home. METHODS: Using convenience sampling, 95 older patients who had been hospitalized for a hip fracture and their primary caregivers were enrolled. Data pertaining to the burden experienced by the caregivers were collected 1 week and 1 month after discharge from the hospital. RESULTS: The burden of care was characterized as moderate. Physical functioning of the older people improved gradually with time after discharge from hospital (F = 164.582, p < .001) and were negatively related to caregiver burden. The predictive factors for caregiver burden 1 week after hospital discharge included the older people's physical functioning and self-efficacy, which together contributed to 15.6% of the total variance in caregiver burden. The predictive factors for caregiver burden 1 month after hospital discharge were the degree of caregiver burden at 1 week and social support, which together contributed to 56.0% of the total variance in caregiver burden. CONCLUSION: A health education program should be designed to improve the primary caregiver's knowledge of providing care and suggest strategies to increase social support to reduce the overall burden of care.     

Male caregivers' use of formal support

The purpose of this study was to explore male caregivers' perceptions of formal support. The men were caregivers of adults with cognitive impairment. The study involved secondary analysis of interview data on perceptions of support that had not been previously analyzed from the perspective of formal support. Techniques of data analysis used in grounded theory were applied to 62 guided interactive interviews conducted with 24 male caregivers during a period of 18 months. The men experienced a process of making concessions for care in the following four sequential stages: resisting, giving in, opening the door, and making the match. Personal barriers deterred the caregivers from seeking help, and once the caregivers engaged formal help the influence of characteristics of the health care system and individual staff members had both enabling and disabling effects. For caregivers whose use of formal support involved admitting their relative to a long-term care facility, the phase of making the match was followed by redesigning their caregiver role.     

乳腺癌亲属照顾者照护体验与需求的质性研究

目的:探讨亲属照顾者在乳腺癌患者治疗及康复过程中的照护体验与需求。方法:对12例康复期乳腺癌患者亲属照顾者进行半结构式深入访谈,应用Colaizzi现象学研究法分析资料。 结果:康复期乳腺癌亲属照顾者的照护体验与需求可归纳为5个主题：不确定感、负性心理体验明显、生活方式改变、支持力量需求迫切、胜任力的建立。结论:了解康复期乳腺癌亲属照顾者的照护体验与需求,有助于引起家庭、医务人员及社会相关部门的重视,采取有效的支持和干预措施提高照顾者的生活质量和照护水平,更利于患者的康复。     

Role tuning between caregiver and care receiver during discharge transition: an illustration of role function mode in Roy's adaptation theory

The purpose of this study was to develop a conceptual framework to explain the interaction between the caregiver and the care receiver during the discharge transition. Data from face-to-face interviews with 12 care receivers and 16 caregivers were subjected to constant comparative analysis. Findings revealed that role tuning was the process used by caregivers and care receivers to achieve a harmonious pattern of caregiving and care receiving during the transition from hospital to home. This empirical finding can illustrate the concept of role function mode in the Roy adaptation theory and sensitize healthcare providers to the needs of the families during the discharge transition.