照顾技能培训对脑卒中患者照顾者照顾压力及生活质量的影响

目的:探讨照顾技能培训对脑卒中患者照顾者照顾压力及生活质量的影响。方法:将150例脑卒中患者照顾者按入院时间先后次序随机分为实验组和对照组各75例,实验组对照顾者实施个体化、系统性照顾技能培训,对照组按常规护理方法进行干预。采用脑卒中照顾者综合照顾能力评估问卷评价照顾者脑卒中相关知识认知,以照顾者压力量表和SF-36量表评价两组干预3个月后照顾压力与生活质量。结果:实验组脑卒中相关知识平均得分高于对照组(P0.01),实验组总压力平均得分低于对照组(P0.01),实验组PF、RP、MH、VT、GH得分均高于对照组(P0.05,P0.01)。结论:住院期实施个体化、系统性照顾技能培训,能有效地提高照顾者脑卒中相关知识和照顾技能,缓解居家照顾压力和提高生活质量。     

社区护士家庭访视对失智老人居家照顾者照顾负荷及生活质量的影响

[目的]探讨社区护士家庭访视对失智老人居家照顾者照顾负荷及生活质量的影响。[方法]选择上海市浦东新区南码头社区失智老人居家照顾者78人,随机分为干预组和对照组各39人,对照组实施社区常规管理,干预组按照本研究设置的社区护士家庭访视方案实施护理干预,包含照顾者培训、发放《失智症照顾者手册》及电话随访等,为期3个月。观察两组照顾者干预前后照顾负荷及生活质量得分的变化情况。[结果]干预后干预组照顾负荷得分明显低于对照组(P0.01),生活质量得分高于对照组(P0.01)。[结论]社区家庭访视能够减轻失智老人居家照顾者的照顾负荷,提高他们的生活质量。     

居家护理干预对脑卒中患者导尿管相关尿路感染的预防效果

目的:探讨居家护理干预对脑卒中患者导尿管相关尿路感染(CAUTI)的预防效果。方法:选取2018年12月1日～2019年12月1日收治的80例留置导尿管的脑卒中患者为研究对象,随机分为对照组和观察组各40例,对照组给予常规干预,观察组给予居家护理干预。采用自制的照顾者照顾行为问卷评估照顾者的照顾行为,并比较两组留置导尿管维护合格率、CAUTI及并发症发生率。结果:干预后,两组照顾者照顾行为得分高于干预前(P0.01),且观察组高于对照组(P0.01);观察组留置导尿管维护合格率(卫生情况除外)高于对照组(P0.05);干预后14、21、28 d,观察组CAUTI发生率低于对照组(P0.05);观察组导尿管堵塞、尿液外漏及导尿管脱落发生率均低于对照组(P0.05)。结论:居家护理干预能改善患者的照顾者照顾行为,提高留置导尿管维护合格率,降低脑卒中患者CAUTI、并发症发生率。     

工作坊模式对喉癌气管切开男性患者居家护理培训效果和并发症研究

目的 探索工作坊模式对于提高喉癌气管切开患者居家护理效果。方法 选取安徽省立医院南区耳鼻咽喉头颈外科首次行喉癌气管切开的73例患者及其各指定的一名主要照顾者为研究对象。2019年4—12月收治的37例患者及主要照顾者纳入观察组，2018年6月至2019年3月收治的36例患者及主要照顾者纳入对照组。观察组予以工作坊护理，对照组接受常规护理，对比两组喉癌气管切开患者居家护理效果和并发症。结果 观察组主要照顾者干预后套管居家护理知识知晓率、套管居家护理技能得分和自我效能得分明显高于对照组（P＜0.05）。观察组患者气切居家护理并发症（套管堵塞和造瘘口感染率）明显低于对照组（P＜0.05）。 结论 临床应用工作坊模式对喉癌气管切开患者进行居家护理培训能够有效提高患者自我护理知识和技能，明显降低居家护理并发症发生率，提高自我护理效能，值得推广。     

脑卒中主要居家照顾者照顾负荷与照顾者需求研究

[目的]了解脑卒中主要居家照顾者的照顾负荷与照顾者需求现状,分析照顾者照顾负荷与照顾者需求之间的关系.[方法]对180例社区脑卒中病人及其主要照顾者进行问卷调查.[结果]脑卒中主要居家照顾者照顾负荷总分为48.83分±8.05分,其中生理负荷最重.脑卒中主要居家照顾者需求总分为34.62分±9.93分,家庭访诊、康复锻炼方法、预防常见并发症、疾病基础知识、饮食指导和电话咨询服务排在需求列表的前5位.照顾者照顾负荷与照顾者需求总分及各维度得分呈负相关(P＜0.01或P＜0.05).[结论]脑卒中主要居家照顾者承受着较重的负荷,了解照顾者需求,制订和实施针对性的干预措施将有助于减轻照顾者的照顾负荷.     

专项培训对居家鼻饲老人照护者护理能力的影响

目的：探讨专项培训对老年鼻饲患者照顾者护理能力的影响效果。方法选择住院治疗老年鼻饲患者的照顾者63名,按患者住院时间分为对照组（n＝32）和干预组（n＝31）,对照组给予常规鼻饲护理健康教育,干预组给予专项鼻饲护理培训。比较两组照顾者护理能力得分及受照顾者出院3个月内脱管和并发症发生情况。结果干预前两组照顾者鼻饲护理能力得分比较,差异无统计学意义（P＞0．05）;出院时干预组鼻饲护理能力得分为（71．45±10．99）分,高于对照组的（56．79±7．31）分,差异有统计学意义（t＝5．288,P＜0．01）。受照顾者出院后3个月,干预组胃管脱管2例,鼻饲并发症10例,均低于对照组的9,20例,差异有统计学意义（χ2分别为5．132,5．773;P＜0．05）。结论专项培训能提高居家鼻饲老人照护者护理能力。     

脑卒中照顾者健康教育路径的设计与应用

目的:探讨适合脑卒中照顾者的不健康教育路径,提高脑卒中照顾者疾病相关知识及康复护理技能.方法:将112例照顾者及其照顾的脑卒中患者分别分为实验组和对照组各56例,实验组照顾者按健康教育路径模式进行健康教育,对照组照顾者采用传统健康教育方法.结果:实验组照顾者对疾病相关知识、基础护理、康复护理知识掌握情况均明显优于对照组(P＜0.01);住院满意度调查满意率也显著高于对照组(P＜0.01),患者并发症发生率也显著低于对照组(P＜0.01);随访3个月后,实验组患者简化Fugl-Meyer运动功能评分及Barthel指数评定均显著高于对照组(P＜0.05).结论:健康教育路径应用于脑卒中患者的照顾者,能显著提高照顾者的护理知识及康复护理技能,提高照顾者的照顾能力及照顾质量,降低脑卒中患者并发症的发生率及残疾率,促进脑卒中患者的全面康复.     

脑卒中主要居家照顾者照顾负荷与照顾者需求研究

[目的]了解脑卒中主要居家照顾者的照顾负荷与照顾者需求现状,分析照顾者照顾负荷与照顾者需求之间的关系。[方法]对180例社区脑卒中病人及其主要照顾者进行问卷调查。[结果]脑卒中主要居家照顾者照顾负荷总分为48.83分±8.05分,其中生理负荷最重。脑卒中主要居家照顾者需求总分为34.62分±9.93分,家庭访诊、康复锻炼方法、预防常见并发症、疾病基础知识、饮食指导和电话咨询服务排在需求列表的前5位。照顾者照顾负荷与照顾者需求总分及各维度得分呈负相关（P〈0.01或P〈0.05）。[结论]脑卒中主要居家照顾者承受着较重的负荷,了解照顾者需求,制订和实施针对性的干预措施将有助于减轻照顾者的照顾负荷。     

以时机理论为基础的居家护理对中青年脑卒中病人自我护理及家庭照顾者照顾能力的影响

[目的]探讨基于时机理论(TIR)的居家护理对中青年脑卒中病人自我护理及其家庭照顾者照顾能力的影响。[方法]将109例中青年脑卒中病人及其家庭照顾者随机分为试验组55例和对照组54例,试验组在常规护理与随访的基础上采取以时机理论为基础的居家护理;对照组接受神经内科常规护理与随访,分别于病人干预前、出院时、出院3个月及6个月应用自我护理能力测定量表(ESCA)和家属照顾者照顾能力测量表(FCTI)评价两组病人的自我护理能力及其家庭照顾者的照顾能力。[结果]干预后试验组病人自我护理能力在各测量点均高于对照组(P0.05或P0.01),试验组家庭照顾者照顾能力在各测量点均低于对照组(P0.05或P0.01)。[结论]以时机理论为基础的居家护理,能更有效地提高中青年脑卒中病人的自我护理能力及其家庭照顾者的照顾能力。     

脑卒中照顾者照护结局量表中文版的信效度研究

[目的]检验脑卒中照顾者照护结局量表(BCOS)中文版的信度和效度.[方法]引进并翻译BCOS英文版,使用BCOS中文版对147位脑卒中主要照护者进行评估.[结果] BCOS总的Cronbach's α系数为0.857,重测信度总的相关系数为0.878(P＜0.001).内容效度指数为0.968.经分析得到4个公因子,累积方差贡献率为64.180%.BCOS与脑卒中照顾者压力量表中文版呈负相关(r=-0.319,P＜0.01),证实了其效标关联效度.[结论] BCOS中文版具有良好的信度和效度,可行性高,可用于脑卒中主要照顾者照顾负担的测评.     

维持性血液透析患者主要照顾者负荷水平和社会支持的相关性研究

目的探讨维持性血液透析（maintenancehemodialysis,MHD）患者主要照顾者负荷水平、社会支持及其相关性。方法采用照顾者负荷量表（caregivers’burdenscale）和社会支持评定量表（SocialSupportRatingScale,ssRS）,对62名MHD患者主要照顾者进行问卷调查并作统计分析。结果MHD患者主要照顾者的照顾负荷程度偏重,总负荷平均分为（54．71±20．322）分,3个负荷维度中社交功能负荷稍高于心理功能负荷,身体功能负荷程度较轻。MHD患者主要照顾者的社会支持水平较低,其总分为（31．44±9．623）分,3个社会支持维度中主观支持得分最高,其次为社会支持利用度和客观支持。MHD患者主要照顾者总负荷和社会支持之间呈负相关（P〈0．01）;其身体功能负荷、心理功能负荷及社交功能负荷均与主观支持之间呈负相关（P〈0.01）;社交功能负荷与社会支持利用度之间也呈负相关（p〈0.05）。结论MHD患者主要照顾者群体需引起社会的广泛关注,有关医疗服务机构应考虑采取有效措施,帮助提高其社会支持水平,减轻其照顾负荷。     

Bakas照顾结果量表评估脑卒中主要居家照顾者负荷的适用性研究

目的 探讨Bakas照顾结果量表评估脑卒中居家照顾者负荷的适用性.方法 用Bakas照顾结果量表对上海市区180名脑卒中主要居家照顾者进行问卷调查,从内部一致性、结构效度和效标关联效度对量表进行适用性评估.结果 各条目与Bakas照顾结果量表总分的相关系数0.408-0.725(P＜0.01);量表总的Cronbach's α值为0.877;用因子分析检验量表的结构效度,提取3个公因子累积贡献率达到60.93%,每个条目的因子负荷0.510～0.875;以负荷可视化标尺作为标准,Bakas照顾结果量表的效标关联系数为-0.461(P＜0.01).结论 Bakas照顾结果量表用于评估脑卒中居家照顾者负荷有较好的适用性.     

Effectiveness of a strength-oriented psychoeducation on caregiving competence,problem-solving abilities,psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial

BackgroundFamily caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.ObjectivesTo evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver’s depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors.DesignA prospective multi-centre and single-blinded randomised controlled trial stratified by survivors’ history of stroke.Setting and participantsAdult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong.MethodsThe design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests.ResultsWe recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers.ConclusionsFindings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors.     

A social skills training program for adult caregivers

A model for family caregiving was developed that linked social support and caregiving burden. A component of the theoretical model suggests that caregivers with high social skills will be able to mobilize social support in their environments more effectively, resulting in a decrease in their perceived caregiving burden. A pilot intervention study explored whether there was any difference in caregiving burden for subjects receiving social skills training and subjects in a control group. Results at pretest revealed no significant differences between the groups. Results at posttest revealed that a significant decrease in both objective and subjective burden occurred for the treatment group. These results indicate that further investigation about how best to support the caregivers who regularly care for and assist their elderly members is of prime importance.     

Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care

BACKGROUND: Family caregivers are often responsible for providing significant support to relatives who require palliative care at home. However, evidence suggests that family caregivers have limited information, resources or support to prepare them for such a role. Furthermore, family caregiving can be associated with negative physical, financial and psychosocial outcomes. PURPOSE: This project sought to examine the utility of a group family caregiver psycho-educational programme focused on preparing primary family caregivers for the role of supporting a relative with advanced cancer at home. METHOD: The education programme consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria (Australia). Participating caregivers were required to complete a set of self-report questionnaires measuring caregiver competence, preparedness, optimism, rewards, social support, burden and information needs, at three time points: commencement of the programme (T1), upon completion (T2) and 2 weeks later (T3). Caregivers were also asked to report on the relevance, acceptability and content of the programme, as well as any barriers to access. RESULTS: Sixteen education programmes were conducted, with 74 caregivers attending the first session. Forty-four caregivers completed all three data collection sets. Following the intervention, a significant positive effect was found for the following outcomes: preparedness for the caring role, caregiving competence, caregiving rewards and having information needs met from T1 to T2. These improvements were maintained at follow-up (T3). Feedback on the individual sessions and entire programme was favourable and the overwhelming majority of participants reported that the programme had a positive impact on their lives. CONCLUSIONS: This study demonstrated that a group education programme to prepare family caregivers for the role of supporting a dying relative at home was accessible, applicable and effective.     

Comparing Perceived Burden for Korean and American Informal Caregivers of Stroke Survivors

Little is known about the burden of cross‐cultural care for stroke patients. This article compares the perceived burden for caregivers of stroke survivors in Korea and the United States. A brief interview was conducted to determine specific problem areas for caregivers. Caregiver burden (using the Sense of Competence Questionnaire) and social support (using the ENRICHD Social Support Inventory) also were measured. The overall‐sense‐of‐burden‐from‐caregiving score was significantly higher in the Korean cohort than in the American cohort, as was the scale regarding satisfaction with the relationship with the recipient of care. The primary predictors of overall burden for the combined sample were caregiver and patient depression and insufficient social support. Lower perceived social support among Korean caregivers was strongly related to caregiver depression, while it was more strongly related to increased hours of caregiving in the American sample. These findings can help rehabilitation nurses plan supportive interventions that incorporate cultural values for stroke survivors and their caregivers.     

Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale

BACKGROUND: Family caregivers of stroke survivors experience a variety of negative social, emotional, and health-related outcomes as a result of providing care. OBJECTIVES:: To psychometrically test the revised 15-item Bakas Caregiving Outcomes Scale (BCOS) measuring life changes specifically resulting from providing care. The original 10-item BCOS was improved by adding five items addressing financial well-being, level of energy, role functioning, physical functioning, and general health. METHODS: Psychometric testing of the revised 15-item BCOS using a sample of 147 family caregivers of stroke survivors approximately 4 months after stroke was conducted to determine the quality of the items, internal consistency reliability, test-retest reliability, construct validity, and criterion-related validity. Most caregivers were women (78.9%), White (68.0%) or African American (29.9%), and either spouses (60.1%) or adult children (31.3%). RESULTS: Satisfactory evidence of internal consistency (alpha = .90) and 2-week test-retest reliability (intraclass coefficient [ICC] = .66; 95% confidence interval [CI] = 0.42-0.81) was provided, with item-to-total correlations ranging from .41 to .74. Unidimensionality was supported by confirmatory factor analysis with indices, indicating a good fit. Using hierarchical multiple regression, 36% of the BCOS variance was explained by constructs in the conceptual model [F(11,132) = 6.72, p < .001]. Criterion-related validity was supported by correlations with the 36-item Short Form (SF-36) General Health Subscale (r = .32, p < .001) and a criterion variable measuring how caregivers' lives had changed overall (r = .67, p < .001). DISCUSSION: The revised 15-item BCOS has evidence of satisfactory reliability and validity in family caregivers of stroke survivors. The BCOS is a valuable measure in research and can be used to identify priority areas for nursing interventions designed to improve caregivers' outcomes.     

Vigilance. Evolution and definition for caregivers of family members with Alzheimer''s disease

The language of caregiving relies heavily on terms that are frequently negative such as caregiver stress and burden, but these are not universally accepted phenomenon. The purpose of this article is to report on the development of caregiver vigilance and to suggest it offers both neutral terminology and a means to include caregivers' perceptions of their supervisory role. The concept of vigilance emerged from a qualitative study of caregivers of family members with Alzheimer's disease. Vigilance is defined as the caregivers' continual oversight of their care recipients' activities. The five key components of vigilance were watchful supervision, protective intervening, anticipating, always on duty, and being there. Vigilant caregivers saw themselves as "on duty" even when they were not "doing things." The findings of this study support caregivers' perceptions of 24-hour-a-day responsibility. Nurses need to realize that caregiver vigilance is not necessarily diminished when professional caregivers intervene or institutionalization occurs. Debriefing caregivers about their unique family caregiving knowledge and incorporating it into caregiving is a key strategy for nurses to use to build caregiver trust and reduce their vigilance time.     

居家痴呆病人照料者负担及其相关因素

[目的]了解居家痴呆病人照料者的负担及相关因素。[方法]采用问卷及访谈相结合的方法进行调查。用于照料者的问卷包括:Zarit照料者负担问卷、社会支持问卷、简易应对方式问卷、自行设计的知识技能问卷;用于病人的问卷有:痴呆临床分级量表、日常生活能力量表、简易智能状态量表、加利福尼亚痴呆行为问卷。[结果]居家痴呆病人照料者主观感受的负担较重,中度、重度负担者占67.5%。影响照料者负担的因素有痴呆严重程度、病程、行为和心理症状、认知功能及日常生活能力、照料者同病人之间的关系质量、已照料病人时间、应对方式、社会支持、痴呆知识和照料技能掌握情况。[结论]痴呆病人照料者负担是病人、照料者和社区或社会总体反应的结果,应进行综合干预。