成都市社区脑卒中患者自我护理能力与护理需求的调查研究

目的了解成都市社区脑卒中患者自我护理能力现状和护理需求情况。方法采用方便取样的方法,选取符合条件的195例成都市社区脑卒中患者作为研究对象,采用自我护理能力测定量表和社区脑卒中患者的护理需求问卷来评估社区脑卒中患者的自我护理能力和护理需求,并分析自我护理能力的影响因素。结果成都市社区脑卒中患者的自我护理能力得分为(86.36±16.48)分;影响其自我护理能力的因素有年龄、文化程度、婚姻状况、居住情况及日常生活活动能力(P<0.05)。成都市脑卒中患者社区护理需求总分为(105.96±19.68)分,对社区护理内容需求依次为:健康教育、其他护理需求(自护能力提高、访视等)、生活护理、社会支持、康复训练、心理护理及并发症的护理需求。结论成都市社区脑卒中患者的自我护理能力处于中等水平,对社区护理需求较高。在社区护理工作中,应考虑患者自身情况,制定针对性的护理措施,提高社区脑卒中患者的自我护理能力,促进康复。     

脑卒中患者延续性护理的研究进展

脑卒中(stroke)又称中风或脑血管意外,是指由于机体脑循环障碍所致的局限或全面性脑功能缺损综合征或急性脑血管病事件,包括脑出血、脑梗死、蛛网膜下腔出血等[1]。脑卒中发病率、死亡率高、致残率和复发率高。目前,国内脑卒中护理的重点在患者住院期间,如超早期的溶栓治疗和护理、急性期的治疗和护理、病情稳定后的早期康复护理[2]。     

Utilizing Peplau's psychodynamic theory for stroke patient care

• • A theory which enables the recipient of care to identify health-care needs is paramount.
• • Hildegard Peplau's (1952) theory of psychodynamic nursing enables this process to occur in collaborative identification and resolution of need.
• • The psychodynamic approach can direct the user to focus on the psychosocial problems created by a stroke.
• • The advantages and limitations of the theory are still to be investigated with the continued application to varied clinical situations.
• • There is a need to generate an expanded research-based taxonomy of psycho-social interventions for this client group.

     

Partners in care: investigating community nurses’ understanding of an interdisciplinary team‐based approach to primary care

Aim. This study investigated community nurses understanding of teamwork in primary care. Background. Internationally trends indicate a movement towards the development of primary care as a key element in health service delivery. This will have implications for the organisation of community nursing services by creating the need for more coherent integrated structures for service delivery. In this context, teamwork is associated with a range of positive outcomes including higher levels of quality care and job satisfaction. Design. A research study was undertaken to investigate community nurses’ understanding of an interdisciplinary team‐based approach to primary care using a qualitative research design. Focus groups were held with community nurses working in the areas of public health nursing, general nursing and practice nursing. Methods. Three focus groups were established. Twenty seven participants were recruited to form three groups comprising public health nurses (n = 10), general nurses (n = 10) and practice nurses (n = 7). A sequenced‐questioning framework guided the systematic process of data collection. Data analysis engaged a thematic content analysis framework. Results. The analysis of the data revealed the following themes: teamwork, promoting community services, promoting health, professional roles and skills and knowledge for primary care. Conclusion. Nurses can contribute significantly to the re‐orientation and development of primary care services. There must be greater efforts to encourage interdisciplinary approaches. The outcomes of this study can inform strategies for effective team working in primary care. Collective team efforts enhance patient care and effective teamwork requires a greater understanding of group processes and team development. Relevance to clinical practice. Nurses clearly articulated their contribution to primary care, but recognised that there are many challenges to overcome. An enhanced primary care team has the potential to allow the public access to both the individual and collective skills and knowledge of team members.     

The impact of stroke consequences on spousal relationships from the perspective of the person with stroke

Aims and objectives. This paper aims to provide a subjective insight into the experience of stroke recovery within spousal relationships. The aftermath of stroke and its impact on the physical, emotional, psychological and social effects of spousal relationships are explored. Background. Many studies have examined observable functional recovery following stroke from the perspective of health care professionals. Longer‐term effects of stroke such as changes in role and perception of self can alter significantly the dynamics of spousal relationships. Despite this, little attention has been given to the subjective impact of stroke on spousal relationships. Design. A qualitative study design was adopted. Individual, audio‐taped interviews were carried out over three months. Methods. A convenience sample of 16 stroke survivors was recruited from the Stroke Nurse Specialist Register. All participants were over 18 years old and had been discharged from hospital following a diagnosis of stroke. Transcribed interviews were analysed using content data analysis to code and categorise emerging themes. Results. Poststroke, spousal relationships altered significantly in terms of sexuality, sexual desire and sexual functioning. Within their role of husband or wife, stroke survivors described a lack of control and dramatic changes in their perception of self. Conclusions. Survivors of stroke experience profound, complex and multi‐faceted difficulties in many areas of their spousal relationships, which are distressing to both them and their spouses. These have a significant impact on each individual’s quality of life particularly in the longer term. Relevance to clinical practice. Health care professionals and service providers need to understand and recognise the subjective experience of stroke and the complex difficulties that stroke survivors experience within their spousal relationships. It would appear that current service provision does not adequately address the range of needs that the stroke survivors described in this study.     

护士组织支持感与组织支持需求的调查

目的了解护士组织支持感现状及护士对组织支持的需求情况,为提高护士组织支持感提供理论依据。方法采用组织支持感量表,对山西省5所三级甲等医院的442名护士的护士组织支持感与组织支持需求进行调查。结果护士组织支持感得分为（2.900±0.770）分,护士对组织支持需求得分为（4.359±0.607）分。护士组织支持感与组织支持需求在情感性支持、工具性支持及总分上比较,差异具有统计学意义（均P〈0.001）。不同医院护士组织支持感比较,差异具有统计学意义（P〈0.01）。同一医院护士组织支持感与组织支持需求比较,差异具有统计学意义（均P〈0.001）。护士对组织支持需求排在前3位为医院关心我的福利、医院重视我的贡献和当我在工作中遇到困难时医院尽力帮助我。结论护士组织支持感水平相对较低,护士对组织支持的需求非常强烈。医院应采取各种对策,提高护士组织支持感,从而调动护士工作积极性,促进护理工作的发展。     

脑卒中患者的社区健康指导

目的探讨脑卒中患者的社区键康指导。方法选取40例脑卒中患者,以每周1次家庭访视和电话访谈相结合,对患者进行健康指导,后进行生活质量评估。结果40例患者均能遵从良好的生活方式,加强了服药依从性,提高了康复训练护理技能,加强了自身健康管理,提高了生活质量。结论通过对患者进行健康教育,指导其遵医嘱正规服药,培养良好的生活方式。持续家庭康复护理训练及自我健康管理对患者起到了良好的干预作用。     

An investigation of family carers' needs following stroke survivors' discharge from acute hospital care in Australia

Purpose.?To expand understanding of informal stroke care-giving, validated tools previously used in Hong Kong and in the UK were used with Australian stroke carers to assess their stroke-related knowledge, perceived needs, satisfaction with services received and sense of burden after stroke patients' discharge home from acute hospital care.

Methods.?Record audit and telephone interviews with two cohorts of 32 carers recruited in Sydney and Brisbane 1 and 3 months post-hospital discharge, using validated scales and open questions in May–July 2006.

Results.?Female carers, those with prior care-giving responsibility, and those interviewed at three compared to one month post-discharge reported greatest needs and burden from the care-giving role; needs alone significantly predicted burden. Getting information and being prepared for life after discharge were central concerns. Some felt this was accomplished, but inadequate information giving and communication mismatches were apparent.

Conclusions.?Service providers need to develop partnership working with stroke families and provide a network of services and inputs that cut across conventional boundaries between health and social care, public, private and voluntary organisations, with care plans that deliver what they delineate. Stroke care-givers have common issues across countries and healthcare systems; collaborative research-based service development is advocated.     

A review of the information and support needs of family carers of patients with chronic obstructive pulmonary disease

Aims and objectives. The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers’ needs as reported in studies of patients living with COPD in the community. Background. Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital‐at‐home care and other models of community care to prevent or reduce re‐hospitalisations of people with chronic conditions. Understanding carers’ needs is important if health care professionals are to support carers in their caregiving role. Design. A narrative literature review. Methods. Thirty five papers were reviewed after searching electronic databases. Results. Few studies were identified which addressed, even peripherally, carers’ needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital‐at‐home/early discharge, self care and home management programmes were identified which included some information on patients’ living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer. Conclusions. This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research. Relevance to clinical practice. There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health.     

首发脑卒中患者延续性护理需求调查分析

目的调查首发脑卒中患者延续性护理需求,为制订护理对策提供依据。方法采用脑卒中延续性护理需求调查问卷对102例首发脑卒中患者在出院时进行调查;采用美国国立卫生研究院卒中量表（thenationalinstitutesofhealthstrokeseale,NIHSS）和生活自理能力Barthel指数（barthelindex,BI）量表分别评估脑卒中患者在人院和出院时神经功能缺损及生活自理能力情况,并分析患者延续性护理需求与其NIHSS、BI评分的相关性。结果首发脑卒中患者延续性护理需求排列前5位分别是‘脑卒中知识”、“安全用药知识”、“康复锻炼知识”、“血压控制及自我监测知识”、“饮食知识”,需求比例在94．11％～87．25％。首发脑卒中患者延续性护理需求评分与其NIHSS评分呈正相关（r=0．271,P〈0．05）,与BI评分呈负相关（r=-0．226,P〈0．05）。结论首发脑卒中患者对延续性护理需求普遍存在,内容是多方面的;首发脑卒中患者神经功能缺损越严重、生活自理能力越低,其对延续性护理需求越高。     

脑卒中患者整体护理中灵性需求的探讨

目的:探讨脑卒中患者在住院及回家康复阶段的灵性需求及其特质。方法:应用质性研究的现象学方法,访谈脑卒中患者15例,以主题分析法分析资料,描述脑卒中患者的生活经验。结果:在脑卒中患者的生活经验中,显示了3个灵性需求主题:①突发性身体残障牵动灵性困扰;②中国文化塑造的灵性需求;③"矛盾"的家庭及社会联系。结论:脑卒中导致突发性身体缺损,随之诱发心理及心灵困扰。研究显示了灵性需求的特质受中国文化的影响,它能赋予患者顺应、希望和内在平安。另外,家庭的参与和关爱能提升患者的灵性健康。落实整体护理,必须纳入中国化的灵性照顾内容和建立家庭参与模式。     

脑中风患者的高压氧治疗及护理

目的：探讨高压氧治疗对脑中风患者的疗效。方法：将80例脑中风患者分为高压氧治疗组与对照组,进行疗效比较及护理观察。结果：高压氧治疗组有效率达90％。结论：高压氧治疗脑中风可明显改善脑中风后脑损伤的预后,降低病死率;在高压氧治疗中,做好护理,对患者康复有重要意义。     

脑卒中患者39例心理状况分析及护理

目的　探讨脑卒中患者心理障碍对康复与生活质量的影响,探索有效的心理护理方法。方法　采用临床症状自评量表（ＳＣＬ—９０）对３９例脑卒中患者心理护理前后的心理状况进行对比研究。结果　发现其心理障碍发生频度依次为躯体化、抑郁、强迫、焦虑、恐怖,据此制定相应的心理护理措施和护理干预,除躯体化外,其余因子分明显降低。结论脑卒中心理障碍发生率较高,加强心理护理干预,有利于康复和提高生活质量。