脑卒中患者康复护理研究进展

脑卒中是一种常见病、多发病。康复训练的早期介入在保持患者社会适应性方面具有重要意义。本文对脑卒中患者早期康复的意义、目标、康复介入时间、康复护理内容、注意事项等进行综述。     

Evaluation of the research agenda for rehabilitation nursing.

From 1993 to 1995, under the direction of the board of directors of the Association of Rehabilitation Nurses (ARN), the Rehabilitation Nursing Foundation (RNF) created a research agenda for the field, which was published in 1996. The goal of the agenda was to identify a broad range of issues in rehabilitation practice that could be examined to advance the scientific knowledge base. Ten years later, the board of directors of ARN directed RNF to evaluate and update the agenda. A committee of three ARN members was formed to undertake this task. This article reports the committee's evaluation of the 1996 Rehabilitation Nursing Research Agenda. A separate article reports on the process of revising the agenda.     

Geriatric rehabilitation nursing: developing a model

In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One-third of these articles has been evaluated on the strength of the articles' evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal-oriented work, nursing decision-making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.     

基于人文关怀理念的护理干预在神经康复患者护理管理中的应用效果

目的探讨基于人文关怀理念护理干预在神经康复患者护理管理中的应用效果。方法选取2018年3月至2020年3月在本院接受神经康复干预的80例患者,采用随机数字表法将其分为对照组和观察组,每组40例。对照组在护理管理中行常规性康复护理,观察组在护理管理中行基于人文关怀理念的护理干预。比较两组的干预效果。结果干预后,两组的HAMA、HAMD及NIHSS评分均较干预前显著降低,且观察组低于对照组(P<0.05)。观察组的各项护理满意度评分均高于对照组(P<0.05)。干预后,两组的FMA及FIM评分均较干预前显著升高,且观察组高于对照组(P<0.05)。结论在神经康复患者护理管理中行基于人文关怀理念的护理干预,可明显改善患者的心理状态及生理功能,提高康复效果。     

国内老年康复护理研究热点与研究趋势的可视化分析

目的 通过可视化图谱挖掘国内老年康复护理的研究热点和研究趋势.方法 以中国知网数据库为检索平台,运用CiteSpace软件对建库至2019年12月15日收录的老年康复护理相关文献进行可视化分析.结果 国内老年康复护理文献量呈上升趋势.该领域研究热点包括脑卒中、吞咽障碍、患肢、髋关节、髋关节置换术、针灸、生活质量、功能锻...     

Daily rehabilitation nursing increases the nursing time spent on residents

Nurses are primary managers of rehabilitation nursing activities. When improving rehabilitation nursing, it is important to understand the content of care provided and time spent on residents. This study discusses the allocation of nursing staff time within a context of rehabilitation nursing. The variables of rehabilitation nursing and residents' characteristics were derived from the Resident Assessment Instrument. The wage-adjusted direct nursing time was obtained from a time measurement study carried out in November 2002 in long-term care facilities in southern Finland. The average direct wage-adjusted nursing time spent on resident was 93.8 min per day. Residents receiving daily rehabilitation nursing were allocated ∼8 min more wage-adjusted direct nursing time than their peers. More 'hands in care' staff is required for adopting rehabilitation nursing in long-term care units. Maximizing residents' independency should be the goal for rehabilitation care and therefore the focus for allocating both nursing and rehabilitation staff to units and facilities.     

Mapping the organizational culture research in nursing: a literature review

AIM: This paper reports a critical review of nursing organizational culture research studies with the objectives of: (1) reviewing theoretical and methodological characteristics of the studies and (2) drawing inferences specific to the state of knowledge in this field. BACKGROUND: Organizational culture is regarded as significant in influencing research use in clinical practice yet it is not understood how culture shapes practitioners' behaviours. Only one review of this empirical literature in nursing has been completed. METHOD: Using selected computerized databases, published nursing research studies in English that examine organizational culture were accessed. Organizational culture studies were categorized using Hatch's three perspectives on organizational culture: (1) modern, (2) symbolic-interpretive and (3) postmodern. The review was conducted in 2005. RESULTS: Twenty-nine studies were in the final data set. Results pointed to variations in cultural definitions and incorporation of organizational sciences theory. In classifying the studies, modern perspectives dominated (n = 22), symbolic-interpretive approaches were an emerging group (n = 6) and one study was unclassifiable. Our results expand current cultural instrument reviews by pinpointing tools that have been previously overlooked and by identifying ongoing theoretical and methodological challenges for researchers. CONCLUSION: An exclusive reliance on modernistic approaches in organizational culture research cannot yield a complete understanding of the phenomenon. Rather, the field could benefit from a variety of cultural approaches. In a similar vein, researchers need to be mindful of the terminology and the unit of analysis they use in their research, as these are the two largest research challenges.     

基于CiteSpace的颈椎病康复护理可视化分析

目的:分析国内外颈椎病康复护理的发展趋势与前沿热点,旨在为国内该领域的护理研究提供借鉴和参考。方法:采用CiteSpace软件对Web of Science数据库和中国知网(CNKI)中有关颈椎康复护理的文献进行定量分析和全面展现。结果:检索文献共计742篇,其中英文文献421篇、中文文献321篇,年度发文量整体呈上升趋势;发文量高的国家、机构集中在经济发达地区;国外研究集中于颈痛、功能锻炼、心理康复等方面,国内则聚焦于不同分型颈椎病康复护理、围术期护理、针灸康复护理等领域。结论:我国颈椎病康复护理发展处于不稳定阶段且研究力量薄弱,研究热点与前沿较国外有特色之处但也存在差距,国内学者在借鉴国外先进经验的同时更应探索我国特色的颈椎病康复护理体系,以提高人民群众的生活质量并促进我国卫生事业健康发展。     

“吞咽评估及吞咽仪康复干预护理流程表”设定的行动学研究

目的:评价行动研究法在吞咽障碍早期判断及康复护理流程中的效果。方法:根据"洼田饮水试验",按照提出问题、设计合理流程、行动、观察、反思、再设计、再实施、再观察和反思的螺旋循环方式,制订、修订"吞咽评估及吞咽仪康复干预护理流程表"并有效应用于临床。结果:应用"洼田饮水试验"于临床,及时评估、判定、对应宣教/请示医生给予鼻饲,及时提示康复师给予吞咽治疗仪治疗,能达到吞咽安全、吞咽功能改善的临床效果。结论:行动研究法应用于临床护理,对脑卒中患者进行吞咽功能评估与干预的护理流程,实现早评估、早宣教、早期康复干预、早恢复。     

膝关节术后患者无痛康复护理的临床研究

目的:评价无痛康复护理方案在膝关节术后镇痛中的作用,并与传统护理方案进行比较。方法:选择2008年1月～2009年7月在我科实施膝关节手术的120例患者,并随机分为实验组和对照组各60例,其中对照组按照传统护理模式进行护理,实验组按照无痛康复护理方案进行护理。观察比较两组患者术后疼痛、睡眠、活动等情况及患者的满意度。结果:120例患者进行结果分析:(1)术后3d实验组患者的静息痛、活动痛均显著低于对照组(P0.01)。(2)术后3d实验组患者的睡眠质量均高于对照组(P0.01)。(3)术后实验组患者的主动直腿抬高时间、主动屈膝90°时间均显著低于对照组,出院时的实验组平均膝关节活动度显著大于对照组(P0.05)。(4)实验组的出院满意度均显著高于对照组(P0.01)。结论:无痛康复护理措施可以减轻膝关节手术患者的术后疼痛,改善睡眠质量,提高护士对疼痛的认知,缩短住院时间,提高患者的出院满意度,有助于患者的早期康复,同时具有并发症少、安全、可行的优点。     

阶段式康复护理对颅脑外伤患者术后肢体运动及神经功能的影响

目的探讨阶段式康复护理对颅脑外伤患者术后功能恢复的影响。方法将80例颅脑外伤手术患者随机分为2组各40例,对照组术后给予常规护理,观察组在常规护理基础上采用阶段式康复护理,比较2组术后肢体运动功能、神经功能的恢复情况,统计并发症、住院时间及预后。结果观察组1个月后NIHSS评分低于对照组,上肢Fugl-Meye、下肢FuglMeye评分均高于对照组(P0.05);观察组术后并发症少于对照组,住院时间短于对照组,预后优良率高于对照组(P0.05)。结论阶段式康复护理遵循颅脑外伤术后恢复的特点,能够显著促进患者术后的肢体运动功能和神经功能康复。     

运动想象疗法在脑卒中康复中的应用现状

综述运动想象(MI)的概念、机制以及在脑卒中康复的应用现状。目前MI的研究虽多,但各研究的治疗方案并无统一标准,仍需大样本、多中心的随机对照临床研究,以验证并形成一套规范化的治疗方案。现有研究将运动想象在社区护理中进行应用和强化的较少。     

产后综合康复护理对产妇产后抑郁及子宫康复的影响

目的：探究产后综合康复护理对产妇产后抑郁及子宫康复的影响。方法选取2013年1月至2014年1月在我院进行分娩的产妇120例作为研究对象,将产妇分为对照组和观察组,每组60例产妇,观察组产妇采用产后综合康复护理法进行护理,对照组产妇采用常规的护理法进行产后护理。观察两组护理方法对产妇产后抑郁及子宫康复情况的影响。结果对采用不同方法进行护理产妇产后抑郁和子宫康复情况进行比较,对照组产妇的抑郁率（70．00％）明显高于观察组产妇的抑郁率（30．00％）,两组比较差异具有统计学意义（P＜0．05）,观察组的子宫恢复良好率（70．00％）明显好于对照组的子宫恢复良好率（35．00％）,两组比较差异具有统计学意义（P＜0．05）。结论在对产妇进行产后护理时采用产后综合护理的方法可以降低产妇产后抑郁情况的发生,促进子宫的康复,能够提高产妇和婴儿的生活质量,值得在临床的护理工作中广泛推广应用。     

Evaluation of a nurse-led social rehabilitation programme for neurological patients and carers: An action research study

Background

Very few neurological rehabilitation programmes have successfully dealt with patients’ and relatives’ social needs. Furthermore, the nurses’ contribution in those programmes is poor or unclear.

Objectives

To determine the rationale, effectiveness and adequacy of a nurse-led social rehabilitation programme implemented with neurological patients and their carers.

Design

In this action research study Hart and Bond's experimental and professionalizing typologies were applied through Lewinian cycles. A social rehabilitation programme was planned, based on the results of an in-depth baseline assessment of the context and individual needs. The programme focused on increasing the level of acceptance/adaptation of the disease through verbal and written education, easing the discharge planning, and offering social choices based on the social assessment of individual needs and possibilities at home.

Settings

Two neurological wards of a hospital in Spain.

Participants

The programme evaluation included 27 nurses, and two groups of patients and relatives (control group = 18 patients and 19 relatives, intervention group = 17 patients and 16 relatives).

Methods

The two groups of patients and relatives were compared before and after discharge to determine the effectiveness of the programme. Socio-demographic forms, semi-structured interviews, participant observations, and validated scales to measure activities of daily living and social life were used, and data were analysed using content (QSR Nudist Vivo, v.2.0) and statistical (SPSS v. 13.0) analyses.

Results

The new programme resulted in social care being integrated in daily practice and developed knowledge about social rehabilitation. This had a positive impact on nurses’ attitudes. Patients and relatives had more realistic expectations and positive attitudes towards social life, and developed a wider variety of choices for social changes. Better adaptation, and more coping skills and satisfaction were achieved.

Conclusions

This rehabilitation programme was feasible and effective. Patients and relatives benefited from better understanding of the socialisation process, as a result of advancing nurses’ knowledge, experience and role in psychosocial care.     

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.     

Establishing a super-link system: spinal cord injury rehabilitation nursing

AIM: This paper reports a study to identify the needs of clients with spinal cord injury and their family/carers during rehabilitation, and the strategies used by rehabilitation nurses to meet those needs. BACKGROUND: In Taiwan, spinal cord injury is a major problem with financial implications for the state and major bio-psycho-social and spiritual implications for the individual. Rehabilitation nurses do not have an appropriate nursing theory to guide their care. METHODS: Using a grounded theory approach, data were collected from October 2002 to March 2003 in a rehabilitation hospital in Taiwan by means of interviews, participant observations and documentary resources; analysis was an interrelated process. A total of 39 interviews was carried out with 31 individuals, including eight rehabilitation nurses, one nurse supervisor, seven clients with tetraplegia, eight with paraplegia and seven family/carers. There were 18 participant observations. Data were analysed using a multi-step analytic procedure, based on the works of Glaser, Charmaz, and Strauss and Corbin. FINDINGS: The core category, 'establishing a super-link system', explained the complex structure of interactions observed during the investigation and the importance of developing a middle-range theory entitled the 'Super-Link System Theory'. This theory includes the following four links: 'linking to client', 'linking to family/carer', 'linking to interdisciplinary rehabilitation team' and 'linking to community'. CONCLUSION: This Super-Link System Theory will help rehabilitation nurses to organize their thinking about spinal cord injury rehabilitation nursing, to transfer their thinking into practice by making links effective, and to promote their professional position in the interdisciplinary rehabilitation team.     

Neurological rehabilitation: a science struggling to come of age

Over the last few decades, there have been considerable improvements in the outcome of stroke patients both as regards mortality and disability. At least some of these improvements can be attributed to better organization of services and improved rehabilitation. Many patients, however, remain severely disabled and we will need to develop new strategies in which the focus will be on reversing impairments rather than simply helping patients to adapt to unaltered impairments. For this to happen, neurological rehabilitation research will have to develop therapies that have a clearly defined rationale and are rooted in neurosciences, are clinically described, are addressed to a well‐characterized target population and are evaluated using appropriate outcome measures. Few studies at present meet all these criteria. The recent revolution in our understanding of the nervous system as being soft‐wired, of the potential for recovery through reorganization and of the central role of afferent information associated with normal activity is ground for optimism and indicates the direction in which future therapies should be sought. The paper considers some approaches to providing appropriate afferent information, including inputs such as that from electrotherapy, novel approaches to assisted activity and constraint‐induced therapy. We are on the verge of a revolution in neurological rehabilitation. If we exploit the new understanding of the nervous system arising from basic neurosciences in developing and evaluating therapies we should be able to build on the achievements of the last few decades so that fewer of our patients have to carry the burden of severe disability. Copyright © 2002 Whurr Publishers Ltd.     

The effectiveness of nursing: a review

• ? This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sixes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions.
• ? Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research.