社区慢性阻塞性肺疾病缓解期患者遵医行为的调查分析

目的 了解社区慢性阻塞性肺疾病缓解期患者的遵医行为.方法 对32例患者进行问卷调查,计数资料以百分比统计.结果 慢性阻塞性肺疾病缓解期患者对纠正不良生活习惯、药物治疗、康复训练的重要性认识不足,不能按医嘱正确实施,疾病出现反复时多数患者没有立即就医.结论 慢性阻塞性肺疾病缓解期患者对疾病遵医行为和正确认知态度不仅有个体和时间段坚持性的差异,同时受亲情等因素的影响,社区卫生服务中应提供更客观、符合个体需求的有效服务措施.     

Need of support in people with chronic obstructive pulmonary disease

Aim and objective

The aim of this study was to describe peoples’ experiences and expectations of support when living with chronic obstructive pulmonary disease.

Method

We conducted and analysed face‐to‐face or telephone interviews with 17 individuals (aged 44–77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open‐ended questions aimed at encouraging further narration, and we analysed the participants’ narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines.

Results

The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self‐reliance versus self‐blame, and the Internet – feeling safe but uncertain.

Conclusions

People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person‐centred eHealth approach may be suitable for this group as it offers both collaboration and support.

Relevance to clinical practice

There is a demand for access to genuine professional knowledge as additional support to patients’ own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.     

慢性阻塞性肺疾病患者社区支持性干预及健康管理研究进展

文章归纳了慢性阻塞性肺疾病患者社区干预研究中的支持性药物干预、长期氧疗、戒烟干预、肺康复干预、支持性心理行为干预及健康管理的内容、形式和方法,在此基础上对慢性阻塞性肺疾病社区支持性干预及健康管理研究进行了展望。     

老年慢性阻塞性肺疾病合并肺性脑病的护理

目的探讨护理干预对老年慢性阻塞性肺疾病(COPD)合并肺性脑病的影响。方法对5例COPD合并肺性脑病患者进行心理护理、合理氧疗护理、血气分析监测护理、病情观察、饮食护理、出院指导。结果 5例患者均好转出院,护理满意率为100%。结论护理干预能提高治疗依从性,有利于患者康复。     

Smoking cessation interventions in chronic obstructive pulmonary disease and the role of the family: a systematic literature review

AIM: This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. BACKGROUND: Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. METHODS: All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. RESULTS: Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. CONCLUSION: No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes.     

慢性阻塞性肺疾病患者营养支持的研究进展

文章指出了慢性阻塞性肺疾病患者发生营养不良的机制,综述了慢性阻塞性肺疾病患者能量型方案、宏量营养素方案及微量营养素方案等营养支持方案,以及营养支持对患者的影响,以期为营养支持方案具体细节的制订提供参考。     

慢性阻塞性肺疾病病人姑息照护模式的应用进展

介绍了姑息照护的概念和应用范畴,综述了慢性阻塞性肺疾病(COPD)病人对姑息照护的需求及国内外研究现状。     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.     

慢性阻塞性肺疾病患者血氧变化特点及护理

目的　探讨慢性阻塞性肺疾病 (COPD)患者血氧变化特点及护理。方法　观察 5 0例COPD患者 2 4h动态SaO2 及心电图变化情况。结果　 5 0例患者夜间SaO2 均下降 ,其中 35例SaO2 下降幅度大于 10 % ,凌晨 1:0 0 3:0 0SaO2 最低 ;夜间房性早搏较白天明显增高 ,经t检验 ,t=10 .7,P <0 .0 1,具有显著性差异。结论　根据COPD患者夜间SaO2 明显下降的特点 ,加强夜间呼吸道管理 ,防止SaO2 下降 ,是提高COPD患者生存质量 ,降低死亡率的关键。     

A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVE: A community-based programme for chronic obstructive pulmonary disease (COPD) patients in group sessions is designed, and the feasibility, acceptability and physical and psychosocial outcomes evaluated. METHODS: Patients with COPD discharged from hospital, or those attending specialist outpatient clinic, with a history of hospital admission owing to COPD in the preceding 12 months were recruited. Those who had malignancy or were housebound were excluded. Group sessions were arranged once a week in a Community Centre, and consisted of two hourly sessions. The components of each session consist of education regarding the disease, breathing techniques, use of oxygen and other medication, smoking cessation, nutrition, dyspnoea management skills, relaxation and energy conservation techniques, introduction of social and community support, and strengthening as well as aerobic exercises. Assessments before and after intervention include lung function, 6 minutes walk test (6MWT), general Health Questionnaire (GHQ), the St. George's Respiratory Questionnaire (SGRQ), and a COPD knowledge Questionnaire. A programme evaluation was carried out using questionnaire and group discussions. RESULTS: Forty-four subjects were recruited, with 75% completing the programme, and 20% with drawing for unavoidable reasons. Statistically significant improvement was noted in all domains of the GHQ, SGRQ, and knowledge test, while the mean 6MWT improved, although statistical significance was not reached. Subjects were enthusiastic about the provision of this service in helping them cope with the disease through empowerment and mutual support. CONCLUSION: A group community intervention programme for COPD patients is feasible and acceptable, with positive psychosocial outcomes. Such a model could be further developed and cost-effectiveness evaluated as a model of chronic disease management in the community.     

家庭干预对慢性阻塞性肺疾病患者的影响

目的:观察家庭干预对慢性阻塞性肺疾病(COPD)患者的影响。为有效控制COPD病情进展,提高患者生活质量和治疗效果,提供合理、有效的健康教育和护理方法。方法:根据就诊时间编号,分研究组和对照组,给与不同方法的宣教及心理护理。采用SF-36生存质量表、症状自评量表、自编调查问卷,进行考评分析。结果:1年后,患者各观察项目经统计学处理,研究组各观察因子明显优于对照组,其中患者生活质量、症状自评量表各因子、药物治疗依从性等因数,除生理功能外,差异皆有统计学意义(P<0.05)。两组患者戒烟情况,研究组为96.67%,对照组为39.29%。结论:家庭干预可有效控制COPD患者病情进展,提高COPD患者治疗依从性和生活质量。     

延续护理对慢性阻塞性肺疾病稳定期患者肺功能及负性情绪的影响

目的 探讨延续护理对慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）稳定期患者肺功能及负面情绪的影响。方法 将2017年10月～2018年10月期间住院治疗的112例AECOPD患者随机分为对照组和观察组,各56例。对照组患者实施常规护理,观察组则在对照组常规护理基础上附加进行延续护理,比较两组患者的肺功能及负面情绪。结果 两组患者在一般资料方面比较差异不明显,具有可比性（P＞0.05）;护理前两组患者的肺功能各指标、焦虑自评量表（SAS）和抑郁自评量（SDS）评分相比,差异均不显著,无统计学意义（P>0.05）;延续护理2周后观察组患者的肺功能各指标、SAS和SDS评分与护理前及对照组相比,差异均显著,具有统计学意义（P＜0.05）。结论 与常规护理相比,对患者开展延续护理干预可显著提高患者的肺功能,改善患者的焦虑抑郁负面情绪,值得在临床中推广使用。     

开展家属健康指导对COPD病人生活质量的影响

目的探讨开展家属健康指导对COPD病人生活质量的影响。方法将64例COPD病人随机分为观察组与对照组各32例,同时选择观察组每位病人的一个家属并对其进行健康指导,采用Spitzer的QLI评定量表对两组病人进行评定分析。结果观察组生活质量各维度得分明显高于对照组。结论为提高COPD病人的生活质量,应认真开展家属健康指导工作。     

老年慢性阻塞性肺疾病病人营养护理的研究进展

阐述营养不良的概念、现状及筛查手段,综述影响老年慢性阻塞性肺疾病(COPD)病人营养状况的相关因素、膳食营养干预的研究进展,指出在学习西方国家营养护理经验的同时,加强临床调研以便充分了解我国老年COPD病人的身体状况及社会经济情况,再结合我国老年COPD病人的具体情况制定出切实可行的营养干预方案,以帮助更多的COPD病人早期恢复健康。     

慢性阻塞性肺疾病患者社会支持与生活质量的研究

目的探讨慢性阻塞性肺疾病(COPD)缓解期患者社会支持与生活质量。方法对40例老年(>60岁)COPD缓解期患者和40例正常老年对照组患者分别进行社会支持评定量表(SSRS)、日常生活能力量表(ADL)的调查和评定。结果COPD组的社会支持总分显著低于对照组(P<0.01);日常生活总分均值29.55,显著高于对照组(P<0.01),表明有明显功能障碍。结论COPD患者社会支持度较低,日常生活能力较差;对COPD患者进行康复治疗,减少反复发作是提高生活质量的重要措施之一。     

The use of telecare for people with chronic obstructive pulmonary disease: implications for management

AIM: To evaluate the telecare service offered by Home Care teams to patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: The use of telecare aims to support older people in remaining independent at home, reducing hospital admissions and improving the quality of life for older people and their informal carers. In the redesign of managed care for people with COPD using telecare, an evaluation of the implementation process is necessary. METHOD: A focus group with Home Care teams and social care staff was conducted. Six case studies identified by nursing staff were used to examine key issues relating to telecare implementation. FINDINGS: The experience and expectation in telecare, the usability of equipment, and changes in practice can impact on COPD care. Case studies highlight that the rapid access to care, an increased sense of personal safety and security, and the continuity of care are perceived as benefits. However, the equipment was perceived as not 'user friendly' and bulky. CONCLUSION: It is important that any service redesign to include telecare is evaluated and targeted at its specific role. IMPLICATIONS FOR NURSING MANAGEMENT: Partnership working has to be negotiated, and leadership roles include addressing tensions and motivation within the team.     

Care of patients with chronic obstructive pulmonary disease in primary health care

Aim.  This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease.
Background.  Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved.
Method.  A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease.
Findings.  In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments.
Conclusion.  The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.