急性脑卒中患者入院时迁移应激的现象学研究

目的 了解急性脑卒中患者入院时迁移应激的感受。方法 采用现象学研究方法,对15例急性脑卒中患者进行访谈。结果 急性脑卒中患者入院时存在迁移应激,入院前感受表现出思绪与行为紊乱,不信任感;入院时体验为解决问题的迫切感、危机隐患（高度关注环境改变、过分关注医疗仪器噪音）、角色行为冲突及寻求关注与支持（渴望获得家庭支持、对恢复健康的需求增加）。结论 急性脑卒中患者入院时普遍存在迁移应激症状,且症状表现多为负性体验,医护人员应协助患者加强家庭支持,降低危机隐患,提高急性脑卒中患者的自我应对能力及身心健康。     

青少年癫痫患者疾病感受和体验的质性研究

目的 了解青少年癫痫患者的疾病感受和体验,旨在为青少年癫痫患者护理干预策略的制订提供参考依据。 方法 采用现象学研究法,选取2019年10月—12月在郑州市某三级甲等综合医院住院的13例青少年癫痫患者,对其进行半结构式深入访谈,并采用Colaizzi 7步分析法对访谈资料进行分析、归纳及提炼主题。结果 青少年癫痫患者的疾病感受和体验可归纳为4个主题:①疾病自我管理能力不足;②生活质量下降;③自我感受负担明显;④期待理解与社会支持。 结论 青少年癫痫患者在生理、心理、社会等方面存在诸多负担和需求,护士应密切关注此类患者的情绪反应和心理感受,给予有针对性的心理疏导和多维度的社会支持。     

肝豆状核变性患者婚育观念的质性研究

目的 探讨肝豆状核变性患者基于遗传特点对婚育的观念和想法。方法 本研究采用质性研究的半结构访谈法,对12例肝豆状核变性患者根据半结构访谈提纲进行访谈,随后用Colaizzi七步法对访谈资料进行分析。结果 通过对访谈资料的分析,提取出4个主题,分别是：（1）婚姻的压力与渴望;（2）男女不同的生育矛盾心理;（3）社会支持需求增加;（4）悦纳自己,接受生活。结论 肝豆状核变性患者普遍存在负面的婚育观,护理人员应针对性地做好心理护理,对患者婚育过程中存在的问题和不正当行为及时给予指导,帮助患者树立积极正向的婚育观,进而改善患者生活质量。     

老年医学科低年资护士对临终患者死亡事件体验的质性研究

目的 探讨老年医学科低年资护士面对临终患者死亡事件的内心体验,为临床干预提供依据。方法 采用目的抽样法,选取北京市五家三级甲等医院老年医学科12名低年资护士进行个人面对面半结构式深度访谈,运用Colaizzi现象学研究法,对访谈资料进行整理分析。结果 共提炼出4个主题：产生负性情绪体验（恐惧感、莫名的难受、无能为力后的失落感）;死亡观念的改变（回避死亡、反思死亡、接纳死亡）;护士自身内在支持系统不足;全方位外在支持系统需求（死亡教育专业培训、临终关怀护理技能、专业的心理疏导途经）。结论 应关注老年医学科低年资护士护理死亡患者时的负性情绪、死亡观念、支持系统等状况,积极开展死亡教育和临终关怀服务,建立有效的支持系统,使其积极应对死亡事件,缓解心理压力。     

乳腺癌患者女性一级亲属照顾者真实体验质性研究

目的 探讨乳腺癌患者女性一级亲属在照顾乳腺癌患者过程中的真实体验,为该群体提供针对性支持和构建干预方案提供参考依据。方法 采用描述性质性研究方法,对16例乳腺癌患者女性一级亲属照顾者进行半结构式深入访谈,采用内容分析法分析资料。结果 本组对象的照顾体验可归纳为4个主题：情绪体验（负性情绪体验,正性情绪体验）,对自身及子女的风险认知（感知到自身风险、关注下一代健康）,健康相关行为（积极行为、消极行为）,意志力（直面挑战、忽视与逃避）。结论 乳腺癌患者女性一级亲属在照顾体验中,经历对亲属的负性、正性情绪;表现出对自身及子女患病风险的担忧,并转化为积极获益的健康管理认知和行为;在意志力方面表现为面对或退缩等。     

老年乳腺癌患者乳房重建决策体验的质性研究

目的 了解我国老年乳腺癌患者乳房重建手术决策过程的体验。方法 采用目的抽样法选取2021年4月—2022年5月在天津某三级甲等医院就诊的乳腺癌患者进行半结构式访谈。运用Clolaizzi 7步分析法对资料进行整理分析,进行主题描述。结果 提炼出4个主题：内心感知的痛苦;决策的困境;决策的动机;期待决策支持。结论 本研究深入探索我国老年乳腺癌患者乳房重建决策体验,为向老年乳腺癌患者开展更具有针对性决策辅助干预措施提供理论依据。     

临时性肠造口患者还纳术后居家生活体验的质性研究

目的 探讨临时性肠造口患者还纳术后居家生活体验,为制定干预方案及促进居家康复提供依据。方法 采用质性研究中的现象学研究方法,对12例造口还纳后的患者进行半结构式访谈,按照Colaizzi七步分析法对获得的资料进行编码、分析、整理和归纳。结果 对访谈内容进行分析提炼3个主题：疾病发展的不确定性;肠道症状伴生的生活困扰;疾病应对的情感调节。结论 造口还纳后肠道功能的改变,给患者身心带来极大的困扰,影响了患者的生活。医护人员应根据患者的认知和需求,及时给予护理干预,提高患者的生活质量。     

老年慢性心力衰竭患者居家期间灵性照护需求及照护体验的研究

目的 深入探讨在延续护理模式下老年慢性心力衰竭患者居家期间的灵性照护需求及照护体验,为临床护理提供依据。方法 应用质性研究中的现象学方法,对12例老年慢性心力衰竭患者进行访谈,运用Colaizzi现象学分析法进行资料分析,并提炼主题。结果 灵性照护需求主题：（1）找回选择权力;（2）回归角色统一;（3）提升尊严;（4）重拾生命意义。照护体验主题：（1）渴望开通24 h家庭访视和电话访问服务;（2）期待护理协调员的动态支持;（3）向往志愿帮扶活动。结论 老年慢性心力衰竭患者居家期间应该满足其灵性照护需求,医护人员应提供24 h动态咨询服务,充分发挥护理协调员作用,并激活社会支持系统,共同助力老年慢性心力衰竭患者健康养老,安度晚年。     

ICU护士照护长期昏迷患者真实体验的研究

目的 深入了解神经外科ICU护士照护长期昏迷患者的真实体验。方法 采用现象学研究法,对11名神经外科ICU护士进行半结构式深入访谈,并用Colaizzi 7步法对访谈资料进行分析。结果 神经外科ICU护士照护长期昏迷患者的真实体验共提炼出5个主题：形成多种情感体验（爱伤与共情共存;失望与希望交织）、领会职业素养必要性（慎独躬行,提高护理质量;视患犹亲,体现护理人文性）、感知重症思维重要性（批判性思维是应用专业知识的关键;病情预判为成功抢救提供有效保障）、获得自我价值认同感、审视血脉伦理与临床决策（坚持源于亲情血脉相连;放弃源自不忍生命质量低下）。结论 神经外科ICU护士对照护长期昏迷患者的体验呈多维度,提示护理管理者应培养神经外科ICU护士职业素养、强化护士专业思维、提升护士自身价值、权衡血脉与伦理进行临床决策,进而为长期昏迷的神经重症患者提供更好的照护。     

脑卒中后尿失禁患者疾病体验质性研究的系统评价

目的 系统评价脑卒中后尿失禁（post-stroke urinary incontinence,PSUI）患者的疾病体验,为医护人员开展精准化干预提供参考。方法 计算机检索Cochrane Library、PubMed、EMbase、CINAHL、Web of Science、PsyINFO、CBM、中国知网及万方数据库关于PSUI患者疾病体验的质性研究,检索时限为建库至2019年5月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准对文献质量进行评价,采用汇集性整合方法对结果进行整合。 结果 共纳入5篇文献,提炼34个研究结果,归纳形成7个新类别,合成2个整合结果：①PSUI患者负性情绪较重、人际关系紧张,并伴有日常生活活动受限;②PSUI患者存在护患沟通不畅、信息获取不足而导致自我应对欠佳,希望得到家庭和社会的支持。 结论 医护人员应高度重视PSUI患者疾病体验和信息需求,及时给予心理疏导、医疗支持和人文关怀,帮助患者提高应对疾病的信心,改善其生活质量。     

国内痴呆症患者照顾者照护体验质性研究的Meta整合

目的 评价我国痴呆症患者照顾者的照护体验。方法 运用CNKI、VIP、WanFang Data、PubMed、EBSCO、EMBase、CINAHL Complete、Cochrane Library检索有关国内痴呆症患者照顾者照护体验的文献,采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价纳入文献质量,按照Meta整合方法对结果进行汇总。结果 共纳入11篇质性研究,总结出28个结果,概括为4个类别,最后提炼出2个整合结果。整合结果1：照顾者通过自我调节,角色适应能力逐渐增强。整合结果2：照顾者渴望得到家庭-医院-社区-社会的帮助和支持。结论 建立家庭-医院-社区-社会为一体的全面支持系统对于提高痴呆症患者及其照顾者的生活质量具有重要意义。     

The influence of caregiver burden on patients' management of Parkinson's disease: implications for rehabilitation nursing.

In this study, we examined how the perceived burdens of caregivers influence how people with Parkinson's disease (PD) manage their condition. Burden has previously been defined as the extent to which caregivers perceive that their health, social life, and financial status are being adversely affected because of their care giving. We hypothesized that when caregivers perceive that their burden is increasing, the level of management by PD patients of their disease decreases. A purposive sample of 41 couples in which one spouse or partner had PD was obtained through physician referrals, PD educational programs, and support groups in six Midwestern states. Twenty-eight of the PD patients were men and 13 were women; their spouses or partners included 28 women and 13 men. How patients managed the disease was measured with the Management of Parkinson's Disease Instrument, developed by the first author. The Zarit Perceived Burden Inventory was used to measure the caregivers' perceived burdens. A significant path (p < .02) was noted between the spouse or partner's perceived burden of care and the patient's management of the disease (beta = -.067). A path coefficient of beta = -365 was obtained. The role of the rehabilitation nurse in the relationship of caregiver and care recipient is that of counselor, educator, and supporter.     

When CPR is not an option

What is to be learned from this situation? First, although Mr. Lockwood's consent for the DNR order is not needed, there is an obligation to communicate openly and clearly with the family and ensure that Mrs. Lockwood's advance directive is respected. This might mean a DNR order needs to be written. Also, there is an obligation to discuss goals of care with the family. The second lesson is that you should reflect on your employer's CPR policies and practice, and ask the following questions: Do the policy and/or practices support saying "no" in a situation such as Mrs. Lockwood's? Also, how does the policy support staff when there is a request for futile CPR, either from a competent patient or from a patient's family? What are the expectations about communication with the family when there is an advance directive and/or when CPR is found to be futile? Knowing what you ought to do for patients is not sufficient. Often you cannot act on these decisions because of the environment. If the policies are not in accord with the CNA Statement on Resuscitative Interventions, you should collaborate with colleagues to revise the CPR policy and practices. By doing so, you will be meeting your obligation to help foster and support a practice environment that promotes ethical, competent and compassionate nursing care.     

Falling in Parkinson's disease: the impact on informal caregivers

Purpose: The aim of this study was to explore the views and experiences of the informal caregivers of repeat fallers with Parkinson's disease. Method: Individuals were invited to participate in this study if they were the informal caregiver of a person with Parkinson's disease (PD) who had experienced more than one fall in the previous 12 months. Participants were interviewed about their experience of managing falls using a semi-structured interview schedule. Interview data were transcribed and analysed using thematic analysis. Results: Fourteen caregivers (11 female) participated in the study. All were marital partners of a repeat faller with Parkinson's disease. The average age of the participants was 69.9 years (44 - 79). Their partners had had PD for an average of 16.7 years. Six major themes emerged from the analysis of the interview data, four directly related to falls management (the falls; consequences of the falls for the person with PD; caregivers' experiences of falls; consequences of falls for the caregiver). The majority of caregivers were frightened about their spouse falling. They used a number of methods of getting their spouse up from the floor but often injured themselves as a consequence. Caregivers highlighted the high level of care they provided and the social and psychological impact of the condition on them. They received limited help in looking after their spouse and little information about falls or about the disease in general. Conclusion: Caregivers in this study felt unprepared for their role and expressed a need for more support and advice, especially about managing falls.     

Family caregiving in cancer pain management

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.     

Let's talk about sex

Do you ever find your patients sexually attractive? Have youever been sexually aroused while seeing a patient? Have youever prolonged a physical examination because you were enjoyingthe sight of someone's body? Have you ever had an enduring sexualfantasy about one of your patients? Have you at any time consideredinitiating a sexual relationship with a patient? Over the pastyear or so, I have become particularly interested in these questions.I have also become curious about why it seems impossible formost of us to discuss them. In ten years as a GP trainer, for example, I can remember     

The experience of hope for informal caregivers of palliative patients

This study explored the experience of hope for informal caregivers of palliative patients. Interviews were conducted with 10 caregivers living with and providing care to a palliative patient. The interview data were analyzed using grounded theory qualitative methods. "Eroding hope" was their main concern--a result of bad days, negative messages, and experiences with the health care system. The participants dealt with eroding hope by "hanging on to hope." Hanging on to hope had four subprocesses: a) doing what you have to do, b) living in the moment, c) staying positive, and d) writing your own story. The support of friends, family, and health care professionals, and spiritually connecting with something bigger and stronger were subprocesses. These findings have application for informal caregivers providing palliative care at home, as a basis for assessment and interventions. Health care professionals need to recognize and value the experience of hope for the informal caregivers of palliative patients.     

回族老年2型糖尿病患者主要照顾者照顾感受的质性研究

目的 了解回族老年2型糖尿病患者主要照顾者的照顾感受,旨在为制订符合回族文化特征的老年2型糖尿病患者护理方案提供借鉴。 方法 采用半结构深度访谈法,对15名回族老年2型糖尿病患者主要照顾者进行访谈。 结果 提炼4个主题：爱的体验、老年及女性照顾者负担较重、回族文化及生活习俗对疾病的影响、对社会支持系统的感恩与期望。4个主题中包括8个亚主题。夫妻的角度：感恩,照顾是一场修行;儿女的角度：反哺,爱的回馈;老年照顾者忽略自己的健康;女性付出较多;悲伤不是主旋律;习俗与健康的冲突;感恩国家,看病负担较轻;糖尿病知晓率低,希望获取专业的照顾支持。 结论 回族老年2型糖尿病患者主要照顾者负担感受较轻,老年和女性照顾者负担较重,照顾感受和照顾行为受到回族文化和生活习俗的影响;主要照顾者疾病相关知识缺乏、传统文化与健康饮食有冲突,希望得到符合其文化特征的护理支持。     

Burning the EMS candle. EMS shifts and worker fatigue

Has coffee become your best friend? Do you sleep only in your dreams? Is your bed merely an illusion? If so, you are not alone; sleep deprivation is a fact of life for many EMS personnel. Though widely accepted, isn't it time that we question the effects of those long days and nights?