祺我老年高血压病患者心理干预对照分析

目的：探讨心理干预在社区老年高血压病治疗中的作用。方法：将50例老年高血压患者随机分为实验组和对照组各25例，实验组采取心理干预结合躯体治疗，对照组仅采用单纯躯体治疗，对两组患者进行为期半年的观察，对患者的血压变化以及90项症状自评量表（symptom checklist 90,SCL-90)评价的结果进行比较。结果：老年高血压患者的心理状态明显比一般人群差，实验组患者的心理状态改善和血压稳定性与对照组均有显著性差异（P＜0．01）。结论：加强社区老年高血压病患者的心理干预对其治疗具有治疗意义。     

社区护理干预对老年高血压病患者的影响

目的探讨社区护理干预对老年高血压病患者的方法及作用。方法对69例老年高血压病患者实施血压监测、服药、饮食、戒烟限酒、心理行为等护理干预措施,并采用自制调查问卷对干预前后患者的知晓率、服药率、血压控制率及生活方式进行调查和比较。结果干预前患者平均收缩压为（161．7±9．3）mmHg（1mmHg=0．133kPa）,平均舒张压为（98．9±15．2）mmHg,经过2年护理干预后,平均收缩压为（131.5±8．4）mmHg,平均舒张压为（82．7±10．6）mmHg,明显低于干预前,更加接近或处于正常范围（P〈0．01）;不良生活方式明显改变（P〈0．01）;患者健康意识增强,对高血压病的知晓率达到81．2％,服药率达到88．4％,血压控制率达到84．1％。结论社区护理干预能使老年高血压病患者积极配合治疗,提高了患者的防病治病意识,有效地控制了血压,改善了预后,有利于提高其生活质量。     

原发性高血压病人社区综合心理护理干预

我国原发性高血压患病率逐年增高,已成为危害人民健康的重要问题。70年代以来国外已进行了高血压社区干预研究犤1犦,取得了明显效果,我国“八五”期间也开展了“心脑血管病”高发区社区人群的综合性预防研究,并已受到高度重视。我院于2002年7月至2005年7月4日对106例原发性高血压病人进行药物治疗的同时,采用了社区综合心理护理干预措施,收到了良好效果。现将有关方法及结果报道如下。1对象与方法1.1对象:106例经1978年W H O高血压病诊断标准即收缩压两次21.3K Pa、舒张压两次12.7K Pa诊断,在家继续服药治疗的病人。随机分为2组:实验组(药物治疗 综合心理护理干预)54例,对照组(单纯药物治疗)52例。2组年龄分布、性别、病情资料基本相同。1.2方法:106例原发性高血压病人均作两次基础血压测定,第1次在治疗前连续测定5天,治疗后1个月再连续测定5天。干预前后分别测定情绪和A型行为,记录病人住院情况等。1.3综合心理护理干预方法1.3.1健康教育,以传统养生名言与现代医学知识相结合进行健康教育犤2犦,帮助病人树立战胜疾病的信心,每位病人均发一本高血压保健手册。内有高血压易患因素及防治方法,高血压的...     

社区老年轻型高血压患者社区护理干预研究

目的探讨社区综合干预对老年轻型高血压的影响。方法按随机原则选择248例社区轻型老年高血压患者,通过对人群建立居民健康档案,开展健康教育,提倡低盐低脂合理膳食,戒烟限酒,保持良好情绪,适量体育锻炼,连续监测血压等护理措施进行干预。比较干预前后的效果。结果干预后患者对高血压的知晓率、低盐低脂饮食率、适量运动率有很大程度提高,干预时间越长血压控制率越高(均P0.05)。结论进行社区综合干预,加强高血压基础、病因、临床症状知识等的健康教育十分必要。     

心理干预对社区老年抑郁病人的影响

[目的 ]探讨心理干预对社区老年抑郁病人的影响。 [方法 ]采用对照研究的方法 ,按区域用老年抑郁量表(GDS)将筛选出的符合标准的老年抑郁病人分为干预组及对照组 ,对干预组病人进行 3个月的心理干预 ,3个月后两组进行GDS评分及抑郁障碍缓解率的比较分析。 [结果 ]干预前两组GDS分数比较无统计学意义 ,3个月后干预组GDS得分显著低于对照组 ;干预后干预组的抑郁障碍缓解率显著高于对照组。 [结论 ]心理干预可以显著减轻老年抑郁病人的抑郁症状 ,提高抑郁病人的缓解率。     

社区护理干预在老年高血压患者中的应用

目的:探讨社区护理干预在老年高血压患者中的应用。方法:对128例老年高血压患者实施社区护理干预,观察干预前后患者血压控制情况和不良生活习惯改善状况。结果:本组患者干预后收缩压与舒张压均低于干预前(P<0.05),不良生活习惯改善状况明显优于干预前(P<0.05)。结论:社区护理干预对老年高血压患者效果显著,可有效控制血压,改善不良生活习惯。     

老年高血压病人社区干预效果评价

随着我国老年人的逐渐增多 ,高血压的发病率也逐年增加。为了探索老年高血压病人的社区管理方法 ,笔者于 1999年4月— 2 0 0 0年 12月对 2 43例 6 0岁以上的老年高血压病人采取了干预措施 ,现将干预效果评价如下。1　资料与方法1.1　对象　选取某社区部分离退休干部 2 43例 ,男 117例 ,女12 6例 ,年龄 6 0岁～ 87岁 ,平均年龄 72 .5岁 ,经临床诊断均为 1级以上高血压 ,其中收缩压 (ＳＢＰ) >2 1.3ｋＰａ( 16 0ｍｍＨｇ)和 /或舒张压 (ＤＢＰ) >12 .0ｋＰａ( 90ｍｍＨｇ) 14 9例。伴靶器官损害 79例 ,糖尿病 82例。1.2　方法1.2 .1　血压测量…     

社区高血压患者心理干预的研究进展

综述社区高血压患者心理干预的研究进展,包括社区高血压患者的心理状况及特点,社区高血压患者的心理干预现状及存在的问题,认为目前我国社区高血压患者的健康管理仍处于中、低下水平,心理干预模式也处于探索阶段,因此,应寻求适合我国社区特点的心理干预模式,以提高护理服务水平,改善患者生活质量,进而推动我国慢性病管理事业的发展.     

老年高血压病人心理干预疗效观察

近年研究证实，心理社会因素不仅是高血压发生、发展的重要因素，而且还影响高血压的转归、预后及治疗疗效。笔者于2000年1月-2003年1月对60例老年高血压病人在进行药物治疗的同时，施加心理干预，获得较满意的降压效果。现介绍如下。     

山西省武乡县老年高血压患者社区干预防治模式探讨

目的：了解山西省武乡县农村地区老年高血压人群对高血压病的认知和防治现状,探讨在农村地区开展社区综合防治措施管理老年高血压群体的可行性。方法：自2008年8月—2010年8月在武乡县8个乡镇,随机抽样调查年龄在65岁以上高血压患者223例,进行高血压现状分析及高血压防治情况研究;通过以各村级卫生服务站为单位,采用社区前后对照实验研究进行随访观察。结果：经过健康教育、指导用药等干预防治管理,农村老年人群中高血压患者的生活方式有了较大改善,对高血压诊断标准和危险因素的知晓率从干预前的45.74%上升至87.68%,显著高于干预前（P〈0.001）。血压均值水平有显著下降,基线血压异常者经过干预管理后有较大改善,血压控制率从34.08%上升至76.35%。结论：农村老年高血压患者的社区干预管理模式,可作为社区慢性病管理的重要手段,考虑到人群的特殊性在开展农村地区此项工作的同时应建立＂医院—社区—家庭＂三级网络干预防治模式。     

两种社区护理对高血压患者的干预效果评价

目的评价两种社区护理对社区高血压患者的干预效果。方法2002年1月-2003年5月接受社区服务站护理的47例患者由医院护理部在医院门诊设立一个点,安排护士做社区护理工作为社区服务站护理组,2003年6月-2004年10月接受新社区护理的43例患者由医院成立专门的社区护理中心,对社区人员规范培训,改革现行的护理教育模式,开展全科医学教育,定期到居民区开展专家义诊,举行健康讲座,成立病友会,进行护理干预为新社区护理组。结果新社区护理组的标准血压控制率(93.0%)高于社区服务站护理组(55.3%),经字2检验,P<0.01,有显著性差异;高血压知识知晓率及不良饮食习惯改变率,新社区护理组患者高于社区服务站护理组患者,两组比较分别经字2检验,P均<0.05,有显著性差异。结论建立健全社区护理的组织管理体系,落实全科医疗服务模式,有利于规范社区服务,提高服务质量。     

Nutritional screening in community dwelling older adults

callen b.l. (2010) Nutritional screening in community dwelling older adults. International Journal of Older People Nursing 6 , 272–281
doi: 10.1111/j.1748‐3743.2010.00241.x Aims and objectives. The purpose of this study was to test whether a combination of validated tools, one for each of five leading nutritional risk factors, could predict unintentional weight loss in community dwelling older adults. Background. Non‐invasive, easily administered nutritional screening tools for community dwelling older adults are few and those that are available are problematic. Method. Convenience samples of 115 adults ≥65 were interviewed. Height, weight and measures of the five nutritional risk factors were collected at interviews 6 months apart. Design. Repeated measures. Results. 91 subjects completing T2 were largely white (95.6%), female (69%), well educated and in good health. Multiple regression was conducted with unintentional weight loss as the dependent variable and depression (the GDS‐SF), the Lubben Social Networking Scale, food security, food intake and Independent Activities of Daily Living as the predictor variables. The regression model was statistically significant (F (5, 85) = 0.30852, P = 0.003) with an adjusted r² of 0.137. Conclusions. Five validated tools can be administered by nurses or non‐professionals to screen for nutritional risk factors leading to unintentional weight loss. Implications for practice. Early screening has the potential to identify either nutritional risk or nutritional decline in older adults.     

Impact of community care in enabling older people with complex needs to remain at home

Aim.  This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home.
Background.  Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community.
Design.  A qualitative approach using semi-structured interviews was used to collect data from older people ( n  = 17) and carers ( n  = 14).
Method.  Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners.
Results.  Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed.
Conclusions.  The provision of high-quality community care for older people is a globally significant challenge and one that requires creative solutions, both at a local and strategic level.
Relevance to clinical practice.  Nurses and other health and social care professionals need to understand the significance of 'home' for older people and take steps to ensure that additional and appropriate resources are targeted towards community care.     

The meaning of good and bad care in the community care: older people's lived experiences

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological–hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data.
The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.     

Retaining older nurses in primary care and the community

Title.  Retaining older nurses in primary care and the community.
Aim.  This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England.
Background.  Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay.
Methods.  A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations.
Results.  Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P  = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P  = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P ≤  0·001), and lack of workplace support ( P  = 0·029). Retirement and pensions advice was not widely available.
Conclusion.  Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention.     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

Determinants of quality of life for older people living with a disability in the community

Title.  Determinants of quality of life for older people living with a disability in the community.
Aim.  This paper is a report of a study conducted to identify the determinants of quality of life for older people with a disability living in the community and to construct a model to explain these.
Background.  There is no consensus in the literature as to the meaning of quality of life. Few studies have focused on the determinants of quality of life for people with a disability.
Methods.  A grounded theory study was conducted between 2005 and 2006, using semi-structured interviews to collect data. The constant comparative technique was used to analyse data. The sample comprised 122 older people with one of six disabilities: stroke ( n  = 20), arthritis (20), depression (20), vision and hearing deficits (20), learning disability (24) or dementia (18) who were living in the community.
Findings.  A model of the factors that determine quality of life of older people with a disability was developed. 'Living well' was conceptualized as the core category. The potential to 'live well' was influenced by foundation, mediating and facilitating/constraining factors. Quality of life of older people with a disability was revealed as a complex mix of these factors.
Conclusion.  Quality of life cannot be fully understood unless the totality of factors that have an impact on and shape perceptions are taken into account. The model implies that good support from nurses, a focus on a person's abilities and access to information and connectedness to others can make a difference and may help people cope in a better way.     

社区老年高血压患者自我效能增强干预的研究

目的:探讨自我效能增强干预对社区老年高血压患者血压控制及治疗依从性的影响。方法:以年龄、性别及病程为配对条件,将92例入组高血压患者分配至干预组和对照组(每组各46人),干预组给予自我效能增强干预,对照组给予常规性社区护理干预,共干预6个月。结果:在干预结束时、干预结束后1个月、干预结束后3个月,两组患者血压控制及治疗依从性差异均具有统计学意义(P<0.05)。结论:自我效能增强干预可提高高血压患者的治疗依从性,促进血压控制,同时具有较强的可操作性及实用性,值得在社区护理中推广应用。     

社区失能老年人照护服务需求调查研究

[目的]了解社区失能老年人基本情况及照护服务需求现状,为政府及社区制定完善的失能老年人长期照护政策提供有力支撑。[方法]采用方便抽样法,对北京市海淀区两个社区的220名失能老年人进行问卷调查。[结果]220名失能老年人中,轻度失能105人(47.73%)、中度失能60人(27.27%)、重度失能55人(25.00%);10项身体照顾服务需求中排序前5位的是：散步、聊天,使用生活辅助用具,翻身、叩背,服药,更换衣服;9项家务及日常生活照顾服务需求中排序前5位的是送餐服务、陪同就医或联络医疗机构、家务助理、家庭访视、陪同或代购;11项居家护理服务需求中排序前5位的是输液、抽血化验、雾化吸入、更换胃管、伤口换药;13项其他服务需求中排序前5位的是定期查体、医护人员上门服务、照护者指导、紧急救援、康复训练与指导。[结论]社区失能老年人对照护服务表现出非常迫切的需求,政府及相关部门应以失能老年人主观需求为基本导向,结合客观评估,制定更加规范的照护标准,提供行之有效且针对性强的长期照护服务,提高失能老年人生存质量。