农村贫困地区老年人心理社会问题及应付方式的研究

目的分析讨论农村贫困地区老年人心理社会问题及应付方式,探讨心理社会问题与应付方式的关系。方法采用老年人心理社会问题调查表及应付方式问卷对62名农村贫困地区老年人进行调查研究。结果农村贫困地区的老年人存在的主要社会问题依次是收入减少(79％),功能减退或慢性疾病、孤独、丧偶、面临死亡和害怕等。应用最多且有效的应付方式为解决问题(8．81士2．41),其次是退避和合理化,应用最少的是自责。孤独、害怕、独居、代沟．搬迁、离退休、收入减少、丧偶、面临死亡与应付方式有相关关系。结论社区护理人员应关注贫困老年人的心理社会问题,开展老年健康教育活动,鼓励积极的应付方式。配合有关部门积极开展扶贫项目,完善社会保障制度,提高老年人生活水平。     

Coping with stress incontinence: women's experiences of everyday inconveniences

Stress incontinence (SI) is a growing health concern among women. However, sufferers would choose to accept and not report their condition until it becomes too much to bear. Scant research is available to examine women who begin coping with SI and later decide to seek active advice and treatment. This study examined community‐dwelling women’s experiences of coping with SI and coping strategies used to manage incontinent situations prior to seeking professional help. A qualitative study was conducted on nine women from an out‐patient nurse‐led continence clinic of a Hong Kong hospital. Participants diagnosed with genuine SI and who were first‐time visitors to the clinic were interviewed. Data were content analysed. Five categories emerged to encapsulate the participant’s unique experiences of coping. The essence of coping with SI was for sufferers to gain ‘personal’ understanding of how the physiological problem impacted on daily lives. Based on self‐assessment of the situation, sufferers reassured themselves that the problem was manageable and devised strategies to take control of everyday inconveniences, without needing to seek professional help. However, sufferers eventually succumbed to physical and psychosocial impacts of the condition. SI was difficult to conceal from others, and experiences were fearful and distressing. However, women were eager to share their coping experiences, particularly about fears and useful coping strategies. As it was women’s first visit to the continence clinic, findings will inform the development of interventions to support newly diagnosed women sufferers’ mixed emotions and unique disruptions of SI in daily living.     

Understanding loneliness in the lived experiences of Iranian elders

Scand J Caring Sci; 2010; 24; 274–280
Understanding loneliness in the lived experiences of Iranian elders Elderly people are especially vulnerable to loneliness. Loneliness as an important phenomenon is correlated with a variety of emotional, physical and health‐related complications. However, a few studies have investigated the experience of loneliness from the perspectives of elderly people living in communities. The aim of this study was to explore the lived experiences of Iranian elders of loneliness. A qualitative study using phenomenological approach was employed with four men and nine women living in their own houses. In‐depth interviews were transcribed verbatim and analysed using hermeneutic methods. The emerged themes were ‘an aversive emotional state’, ‘isolated from intimate relationships’, ‘being deprived from social and external support systems’ and ‘being abused and neglected’. Our study findings support the view that the experience of loneliness creates an aversive emotional state which is associated with negative and painful feelings. In addition, it was revealed that lack of access to intimate relationships and supportive systems as well as the experience of being abused and neglected were major factors contributing to the feelings of loneliness among Iranian elders. In terms of recommendation for practice, worldwide nurses are expected to be knowledgeable about the factors which increase feelings of loneliness. Alternatively, they should develop coping mechanisms among elders with the cooperation of their family members; also, attract community attention in order to improve social services in both quality and quantity.     

Caregiver self‐efficacy for managing behavioural problems of older people with dementia in Taiwan correlates with care receivers’ behavioural problems

Aims and objective. To investigate the relationship between family caregivers’ self‐efficacy for managing behavioural problems of older people with dementia and their behavioural problems in Taiwan. Background. Older people with dementia commonly have at least one behavioural problem, which caregivers complain is difficult to handle. To provide interventions that can help caregivers more effectively manage the behavioural problems of care receivers with dementia, caregivers’ self‐efficacy on managing behavioural problems must be assessed. However, it is not clear yet how these behavioural problems of older people with dementia may influence caregivers’ self‐efficacy for managing behavioural problems. Design. A prospective, correlational study. Method. Eighty dyads of older people with dementia and their family caregivers were recruited from neurological clinics of a medical centre in Taiwan. Care receivers were assessed for behavioural problems using the Chinese version of Cohen‐Mansfield Agitation Inventory, community form. Caregivers’ self‐efficacy for managing care receivers’ agitation was measured by the research team‐developed Agitation Management Self‐Efficacy Scale. Results. Caregiver self‐efficacy for managing behavioural problems was significantly and positively associated with more caregiver education, greater duration of caregiving and with care receivers’ less physically non‐aggressive behaviours. When caregiver characteristics were controlled for in hierarchical regression analysis, physically non‐aggressive behaviours explained 6% of the variance in caregiver self‐efficacy. Conclusions. Results of this study contradict the general belief that physically aggressive behaviours of elders with dementia are more difficult for family caregivers to handle than other behavioural problems. Clinicians need to address physically non‐aggressive problem behaviours. Relevance to clinical practice. Nurses could assess older patients with dementia for physically non‐aggressive behaviours and train less educated caregivers to improve their self‐efficacy for managing problem behaviours, thus enhancing the quality of life for both caregivers and care receivers.     

A comparison of the factors influencing life satisfaction between Korean older people living with family and living alone

SHIN S.H. & SOK S.R. (2012) A comparison of the factors influencing life satisfaction between Korean older people living with family and living alone. International Nursing Review 59 , 252–258 Background: As the global population of older people continuously increases, many countries are beginning to experience health problems associated with older age. These countries may be interested in knowing and understanding the health problems experienced by the older Korean population, which is projected to age the most rapidly. Aim: This study aimed to compare and examine the factors that influence the life satisfaction between older people living with their family and those living alone. Methods: A cross‐sectional survey was conducted. The participants comprised a total 300 older Koreans (150 living with their family, 150 living alone) aged 65 years or over who met the eligibility criteria. All measures were self‐administered. Data were analysed using the SAS statistical software program version 6.12 (SAS Institute Inc., Cary, NC). Results: The older people living with their family were better than the older people living alone in perceived health status, self‐esteem, depression and life satisfaction. Perceived health status, self‐esteem, depression, age and monthly allowance were found to be the factors related to the life satisfaction of older people living with their family and those living alone. The factors that were found to have the greatest influence on the life satisfaction of older people living with their family and those living alone were depression and perceived health, respectively. Conclusions: This study may help healthcare providers to understand the factors that can influence the life satisfaction among older people living with their family and living alone in Korea.     

Gender differences in pain and depressive tendency among Chinese elders with knee osteoarthritis

The purpose of this study was to explore gender differences in pain experiences, pain control beliefs, pain coping strategies, and depressive tendency among Chinese elderly with knee osteoarthritis (OA). Participants (N=199) were drawn from a previous convenience sample of outpatients with OA in Taiwan. Results indicated female elders tended to report higher scores on least pain, current pain and overall pain intensity than male elders (all p<0.01). Female elders also reported significantly greater pain disturbance than males across each item and for the overall score, except for walking. Males and females did not differ significantly in scores for pain control beliefs or for either pharmacological or non-pharmacological coping strategies. In addition, female elders tended to have greater depressive tendency than males. Results of regression analyses suggest that depressive tendency was a mediator of gender in predicting overall pain intensity and pain disturbance. In summary, this sample of elders showed gender differences in depressive tendency and some pain experiences but not in pain control beliefs and coping strategies. These results suggest that health care providers should be cautious about using gender differences to explain pain experiences among Chinese elders. In addition, health care providers may decrease these female patients' pain intensity and pain disturbance by treating depressive symptoms.     

The physical, mental, and emotional health of older people who are living alone or with relatives

In Korea, as in other countries, the number of older adults is growing substantially, and the proportion of older adults is projected to be 14.3% by 2022 [Ministry of Health and Social Affairs, Republic of Korea. (2003). Yearbook of health and social affairs statistics for 2003, vol. 49. Seoul, Korea: Government Printing Office]. The number of older people who are living alone in rural areas has been sharply increasing as a result of the migration of younger adults to urban areas for employment. However, information on the health status of elders who live alone is limited. Therefore, the purpose of this study was to compare the physical, mental, and emotional health status of elders who are living alone and those living with relatives in rural areas in South Korea. A cross-sectional survey design was used, and data were collected by interviewing subjects. A two-stage cluster sampling process was utilized for those living alone (n = 110) and those living with family members (n = 102). Both groups were enrolled in KyungRo-Dangs (senior centers), which are like community centers in the province. The results indicate that elders who are living with relatives scored significantly higher on several physical and mental health parameters than elders who are living alone. However, elders who are living with relatives had a significantly higher emotional health status in almost every item than elders who are living alone. These findings suggest that interventions to increase health status, especially the emotional health of elders who are living alone, are imperative and that the intervention should be sensitive to changes in the social structure of elders who are living alone in rural areas. Further studies are needed to understand the factors that are associated with the physical, mental, and emotional health of elders who are living alone and those who are living with relatives.     

丧偶独居老人的心理问题及护理对策

介绍了威胁丧偶独居老人心理健康的心理问题,提出从护理人员、老人自身以及社会支持方面着手,运用适宜的沟通技巧进行护理,满足由低层次向高层次的需要,从而解决不同级别、不同层次的丧偶独居老人的心理问题。     

Self‐expressed strengths and resources of children of parents with a mental illness: A systematic review

The aim of the present study was to explore the strengths children reported to have acquired while coping with their parents illness, and the external factors these children indicated had facilitated their coping process. A systematic literature search was conducted of peer‐reviewed papers that focused on self‐reported experiences of children with parents who had mental illness, and revealed their strengths and resources. The search included the following databases: MEDLINE, PsycINFO, and CINAHL. Results were filtered according to whether search terms appeared in the title or abstract. Fifty‐seven full‐text papers were reviewed; 26 of them met the inclusion criteria and were included in the review. The statements were analysed using content analysis. The search identified 160 relevant statements, 38 (24%) of which could be described as self‐reported strengths, and 122 (76%) as self‐reported resources. According to these statements, the children described themselves as more mature, independent, and empathic than their peers who did not have a parent with a mental illness, and as having acquired several abilities. The statements about resources indicated that the children regarded social support, information, and particularly the support of mental health‐care professionals as helpful when living with a parent with a mental illness. Recommendations for nursing actions to support children's ability to cope with their parents' illness are outlined.     

A review of older people''s experiences with residential care placement

BACKGROUND: Transition to the care and environment of a residential home has been identified in the literature as the most significant relocation affecting older people. However, little effort has been made systematically to review and synthesize the body of knowledge relating to older people's experiences with such placement. This has led to lack of concerted effort in the development of strategies to help elders adjust to such placement with dignity and success. AIM: This paper presents a critical review of the literature related to older people's experiences with residential care placement, with an attempt to identify how knowledge in this area could be moved forward. CONCLUSIONS: It is concluded that, while understanding of older people's pre and postplacement experiences was abundant, there was a dearth of literature on the actual experiences involved as older people made their day to day adjustment after placement. There is a need for future research to identify the dynamic processes of how older people come to terms with residential living. Future research should also focus on developing an accurate understanding of the adjustment experiences of elders with different ethnic background.     

Pain Experiences and Coping Strategies in Rural Older Adults With Chronic Musculoskeletal Pain in Mountainous Areas of Taiwan

BackgroundAlthough rural communities are home to a higher proportion of older residents, they provide fewer healthcare services than do urban core communities. Chronic musculoskeletal (MSK) pain is often associated with reduced daily activity and quality of life in older adults, particularly those in rural areas.AimsThis study investigated the pain experiences and coping strategies in rural older adults with MSK pain in Taiwan.MethodsA structured questionnaire was used to collect data from rural older adults with chronic MSK pain in mountainous areas of Taiwan.ResultsIn total, 55 rural older adults were enrolled in this study. The most common pain sites were the low back and knees. The main cause of pain was osteoarthritis. Three quarters of the participants suffered from moderate to severe chronic MSK pain on average. The results revealed that behavioral strategies were used more often than cognitive strategies. Regarding behavioral strategies, the most common non-pharmacologic and pharmacologic pain coping strategies were to rest and to take Chinese medicine, respectively. The most common cognitive strategy for pain coping was to talk to others.ConclusionsThe findings suggested that pain management for chronic MSK pain in rural older adults was inadequate in mountainous areas of Taiwan. Most rural older adults used multiple coping strategies to deal with their pain, and behavioral strategies were favored over cognitive strategies.     

"Nobody ever asked me before": understanding life experiences of African American elders.

With the unprecedented growth in the African American elderly population, there exists an urgent need to prepare nurses to deliver culturally competent care. The purpose of this study was to increase the knowledge available about the cultural heritage, worldviews, and life experiences of African American elders. Reminiscence interviews were conducted with African American elders living in a medium-sized northeast urban community. Data were analyzed using Spiegelberg's phenomenological Method. The following themes emerged: (a) nobody ever asked me before, (b) stories of discrimination, (c) coping with discrimination, (d) the hurt of discrimination, and (e) self-discoveries. Nurses, through the use of reminiscence, can gain insight into the cultural heritage, worldviews, and life experiences of African American elders and improve their ability to deliver culturally competent care to this population.     

Community case management for frail, elderly clients: the nurse case manager's role

Capitated payment systems have forced healthcare providers to explore new methods of care delivery for frail, older clients who consume a disproportionate amount of time and resources. The authors describe the experiences of frail elders in a community case management program within a managed care setting. The experiences of living with frailty in a changing healthcare system, and perceptions of the case manager's ability to help navigate that system, are described. This article presents the benefits of community case management toward client goals of safety, support, and control.     

Personal assistance for patients living with a severe neurological disorder.

Patients with neurological diseases increasingly are being cared for at home. The purpose of this study was to describe stressful everyday experiences in connection with neurological disorders, to learn how people cope with such experiences, and gain knowledge about coping resources. Twenty-seven persons receiving personal assistance were interviewed twice at home. The 54 interviews were subjected to inductive content analysis. The persons encountered many problems in everyday life and usually handled them by means of acceptance, avoidance, practical problem solving, and reappraisal. Dependence on personal assistance gave rise to a sense of helplessness, but it was also the major coping resource. Nurses can improve home care by giving instruction and guidance to persons working as personal assistants.     

Alone together: A grounded theory study of experienced burden,coping, and support needs of spouses of persons with a bipolar disorder

Bipolar disorder is a chronic and severe mental disorder. Little is known about the experiences of the spouses of such patients. A grounded theory study was undertaken to examine the burden for spouses living with a partner with a bipolar disorder and to explore how they cope and what support they need. Fifteen spouses and ex‐spouses were interviewed; they experienced heavy burden and found themselves to be ‘alone together.’ Their coping process is found to involve appraisal of the situation and attempts to achieve a balance between self‐effacement and self‐fulfilment. While support can clearly reduce experienced burden, the spouses surprisingly receive virtually no professional support. A theory is developed that constitutes a starting point for the development of adequate support for spouses.     

The experiences of primary caregivers raising school‐aged children with attention‐deficit hyperactivity disorder

Aims and objectives. To understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder. The research findings will help address the problems related to caring for school‐aged children with attention‐deficit hyperactivity disorder. Background. In Taiwan, the rate of school‐aged children diagnosed with attention‐deficit hyperactivity disorder ranges from 7·9–11·7%. This study is the first, which tries to understand the experiences of primary caregivers who are bringing up school‐aged children with attention‐deficit hyperactivity disorder in Taiwan. Design. The study used a qualitative phenomenological approach to explore the experiences of caregivers raising school‐aged children with attention‐deficit hyperactivity disorder. Methods. Purposive sampling and in‐depth, face‐to‐face interviews were used to collect data. The unstructured interview guide allowed the major caregivers to express their experiences of raising school‐aged children with attention‐deficit hyperactivity disorder. When data saturation was reached, the sample size comprised 12 major caregivers. Narratives were analysed according to Colaizzi’s seven‐step method. Results. Three themes and seven sub‐themes emerged from this study: the burdens of caring (parenting burdens, emotional burdens and family conflicts), the lack of adequate support systems (lack of support from professionals, spouses and other family members) and the mechanisms of coping (cognitive coping strategies and social coping strategies). Furthermore, several other factors that affected the caregivers of children with attention‐deficit hyperactivity disorder are also revealed in the study. Conclusion. The findings of the study demonstrate the importance of understanding the experiences of primary caregivers, bringing up school‐aged children with attention‐deficit hyperactivity disorder. Improving professional services in family care should be a major concern for all healthcare professionals. Relevance to clinical practice. The recommendations that have been made based on the findings of this research can be used as a guide to improve the delivery of caring by people who have school‐aged children with attention‐deficit hyperactivity disorder and by the wider family.