住院患者疾病不确定感的研究进展

论述了疾病不确定感理论、影响住院患者疾病不确定感的因素、疾病不确定感对住院患者的影响以及疾病不确定感的干预措施。提出疾病不确定感主要受患者受教育程度、社会支持、信息支持和应对方式四方面影响,并且影响到住院患者对治疗的依从性以及患者的生存质量。护理人员应当掌握疾病不确定感理论的相关知识,对住院患者进行评估,并且动员一切社会支持力量为患者提供全面的信息支持,从而降低其疾病不确定感。     

慢性病患者家属疾病不确定感与应对方式的相关性分析

目的探讨慢性病患者家属疾病不确定感、应对方式状况及二者之间的关系,以帮助患者家属有效应对患者的疾病状况。方法便利抽取149名慢性病患者的家属,应用中文版Mishel疾病不确定感家属量表和简易应对方式量表对其进行问卷调查。结果患者家属疾病不确定感总分为96.75±13.90,应对方式得分为33.08±9.19;年龄较高者应对方式得分较高,文化程度较高者积极应对方式得分较高,无职业者消极应对方式得分较高(均P0.05);疾病不确定感总分、复杂性维度得分与积极应对方式呈正相关,复杂性、信息缺乏性维度与消极应对方式呈负相关(均P0.05)。结论患者家属疾病不确定感水平较高,运用积极应对方式比消极应对方式多。疾病不确定感促进患者家属采取积极的应对方式面对患者的疾病。护理人员应向之提供信息支持,尤其是无职业、文化程度较低者,鼓励其有效地应对,以帮助患者康复。     

慢性阻塞性肺疾病患者疾病不确定感的影响因素分析

目的 探讨慢性阻塞性肺疾病(COPD)患者疾病不确定感状况及其影响因素.方法 便利抽取52例稳定期COPD患者为研究对象,应用疾病不确定感量表、COPD生存质量测评表测量其疾病不确定感和生存质量,同时测定其肺功能.结果 COPD患者的整体疾病不确定感评分为76.30±7.01,生存质量评分为84.17±6.13;病程、疾病分期、婚姻状况、文化程度、生存质量与疾病不确定感有相关(P＜0.05,P＜0.01).结论 COPD患者的疾病不确定感属于中等程度,其不确定感主要来自不明确性;COPD患者的病程、疾病分期、婚姻状况、文化程度、生存质量对疾病不确定感有一定影响.应采取针对性措施改善患者疾病不确定感,提高其生存质量.     

慢性阻塞性肺疾病患者疾病不确定感的影响因素分析

目的探讨慢性阻塞性肺疾病（COPD）患者疾病不确定感状况及其影响因素。方法便利抽取52例稳定期COPD患者为研究对象,应用疾病不确定感量表、COPD生存质量测评表测量其疾病不确定感和生存质量,同时测定其肺功能。结果COPD患者的整体疾病不确定感评分为76．30±7．01．生存质量评分为84．17±6．13;病程、疾病分期、婚姻状况、文化程度、生存质量与疾病不确定感有相关（P〈0．05,P〈0．01）。结论COPD患者的疾病不确定感属于中等程度,其不确定感主要来自不明确性;COPD患者的病程、疾病分期、婚姻状况、文化程度、生存质量对疾病不确定感有一定影响。应采取针对性措施改善患者疾病不确定感,提高其生存质量。     

脑卒中患者疾病不确定感与社会支持的纵向研究

目的 了解脑卒中患者疾病不确定感和社会支持状况,分析其纵向变化趋势及两者间的相关性.方法 采用疾病不确定感量表(MUIS)和领悟社会支持量表(PSSS)对86例脑卒中患者于出院前,出院后1个月、3个月、6个月进行调查.结果 患者疾病不确定感在出院前及出院后1个月最高,出院后3个月、6个月有所下降(P＜0.01);领悟社会支持在出院前最低,出院后随时间的推移呈上升趋势(P＜0.01);在这4个时期,患者的疾病不确定感与社会支持均呈显著负相关(均P＜0.01).结论 护理人员应加强对脑卒中患者的健康教育和心理支持,以提高其社会支持水平,降低疾病不确定感,促进身心健康.     

护士疾病不确定感认知程度的调查分析

目的了解临床护士对疾病不确定理论的认知程度。方法使用自制调查问卷对301名临床护士进行问卷调查。结果12.62%护士了解疾病不确定感理论,8.97%了解疾病不确定感测量工具,7.31%了解疾病不确定感干预措施,59.47%认为自己对疾病相关信息的掌握程度会影响到患者的疾病不确定感,87.71%期望通过举办培训班来了解疾病不确定感理论。结论临床护士对疾病不确定感理论了解程度低,应加大对疾病不确定感理论的宣传教育,提高其在患者疾病不确定感中的干预作用。     

护士疾病不确定感认知程度的调查分析

目的了解临床护士对疾病不确定理论的认知程度。方法使用自制调查问卷对301名临床护士进行问卷调查。结果12．62％护士了解疾病不确定感理论，8．97％了解疾病不确定感测量工具，7．31％了解疾病不确定感干预措施，59．47％认为自己对疾病相关信息的掌握程度会影响到患者的疾病不确定感，87．71％期望通过举办培训班来了解疾病不确定感理论。结论临床护士对疾病不确定感理论了解程度低，应加大对疾病不确定感理论的宣传教育，提高其在患者疾病不确定感中的干预作用。     

患者病耻感的干预研究进展

病耻感是一个涉及医学、社会学、心理学等众多学科的复杂问题。通过阐述病耻感的概念及其公众病耻感和自我病耻感两个层面之间的关系,并归纳总结国内外应对病耻感的干预方法,旨在为护理专业人员应对患者病耻感提供参考。     

高危妊娠患者疾病不确定感及其影响因素分析

目的调查高危妊娠住院患者的疾病不确定感状况,并探讨其影响因素。方法采用疾病不确定感量表(MUIS-A)及自编个人资料和影响因素问卷,对90例高危妊娠患者进行调查,分析其影响因素。结果共发放问卷90份,回收有效问卷90份,有效回收率为100%;90例患者的疾病不确定感总分为53~117分,平均(89.20±12.30)分,其中79例(87.8%)患者得分为77~117分,属于中度疾病不确定感;疾病不确定感各维度条目平均得分:不明确性(2.90±0.55)分、信息缺乏(2.67±0.58)分、复杂性(2.35±0.43)分、不可测性(3.27±0.54)分;多元回归分析结果显示,孕周[OR1.404,95%CI(6.169,15.039)]、学历[OR1.435,95%CI(4.410,11.720)]、合并内科疾病[OR1.307,95%CI(8.757,35.774)]、治疗方法[OR1.267,95%CI(1.814,9.852)是疾病不确定感的主要影响因素(P均0.05)。结论高危妊娠患者的疾病不确定感处于中等水平,主要受孕周、学历、合并内科疾病及治疗方法等影响。对于小孕周、低学历、合并内科疾病、采用相关药物治疗的患者,护理人员应有针对性提供信息支持,给予必要的护理干预措施,降低患者疾病不确定感水平。     

慢性阻塞性肺疾病患者疾病不确定感与生存质量的相关性研究

目的探讨慢性阻塞性肺疾病（COPD）患者疾病不确定感、生存质量状况以及两者之间的关系。方法便利抽取住院治疗的稳定期COPD患者38例．应用Mishel疾病不确定感量表和慢性阻塞性肺疾病生存质量测评表测量其疾病不确定感及生存质量。结果COPD患者的疾病不确定感呈中等强度，评分为87．30±13．22；生存质量评分为84．17±6．13；COPD患者的疾病不确定感与生存质量评分呈显著正相关（均P〈0．05）。结论对COPD患者需加强健康教育和心理支持，提高其心理调节能力和社会适应能力，从而降低疾病不确定感，提高生存质量。     

慢性阻塞性肺疾病患者疾病不确定感与生存质量的相关性研究

目的 探讨慢性阻塞性肺疾病(COPD)患者疾病不确定感、生存质量状况以及两者之间的关系.方法 便利抽取住院治疗的稳定期COPD患者38例,应用Mishel疾病不确定感量表和慢性阻塞性肺疾病生存质量测评表测量其疾病不确定感及生存质量.结果 COPD患者的疾病不确定感呈中等强度,评分为87.30±13.22;生存质量评分为84.17±6.13;COPD患者的疾病不确定感与生存质量评分呈显著正相关(均P＜0.05).结论 对COPD患者需加强健康教育和心理支持,提高其心理调节能力和社会适应能力,从而降低疾病不确定感,提高生存质量.     

系统干预对面颈部肿瘤放疗患者疾病不确定感的影响

目的 探讨系统干预对面颈部肿瘤放疗患者疾病不确定感的影响.方法 将确诊面颈部肿瘤行根治性放疗的80例患者随机分为对照组和观察组各40例.对照组接受常规护理和健康教育;观察组在此基础上按照护理干预流程表实施系统护理干预.采用疾病不确定感量表(MUIS)分别在患者入院第2天、出院前1d进行调查.结果 干预后观察组疾病不确定感下降幅度显著高于对照组(P<0.01).结论 对面颈部肿瘤接受放疗的患者进行系统干预,能明显降低疾病不确定感,改善患者的生活质量.     

Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

Background

Guidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients.

Purpose

Our facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program.

Methods

We conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques.

Results

Of 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home.

Conclusions

Inpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

     

Illness Uncertainty and Quality of Life of Patients with Small Renal Tumors Undergoing Watchful Waiting: A 2-year Prospective Study

Background

Few studies have examined factors associated with the quality of life (QOL) of patients with renal tumors. Illness uncertainty may influence QOL.

Objective

To prospectively examine the influence of uncertainty on general and cancer-specific QOL and distress in patients undergoing watchful waiting (WW) for a renal mass.

Design, setting, and participants

In 2006–2010, 264 patients were enrolled in a prospective WW registry. The decision for WW was based on patient, tumor, and renal function characteristics at the discretion of the urologist and medical oncologist in the context of the physician–patient interaction. Participants had suspected clinical stage T1–T2 disease, were aged ≥18 yr, and spoke and read English. The first 100 patients enrolled in the registry participated in this study.

Outcome measurements and statistical analysis

Patients completed questionnaires on demographics, illness uncertainty (Mishel Uncertainty in Illness Scale), general QOL (Medical Outcomes Study 36-item short-form survey), cancer-specific QOL (Cancer Rehabilitation Evaluation System–Short Form), and distress (Impact of Events Scale) at enrollment and at 6, 12, and 24 mo. Age, gender, ethnicity, tumor size, estimated glomerular filtration rate, comorbidities, and assessment time point were controlled for in the models.

Results and limitations

Among the sample, 27 patients had biopsies, and 17 patients had proven renal cell carcinoma. Growth rate was an average of 0.17 cm/yr (standard deviation: 0.35). Mean age was 72.5 yr, 55% of the patients were male, and 84% of the patients were Caucasian. Greater illness uncertainty was associated with poorer general QOL scores in the physical domain (p = 0.008); worse cancer-related QOL in physical (p = 0.001), psychosocial (p < 0.001), and medical (p = 0.034) domains; and higher distress (p < 0.001).

Conclusions

This study is among the first to prospectively examine the QOL of patients with renal tumors undergoing WW and the psychosocial factors that influence QOL. Illness uncertainty predicted general QOL, cancer-specific QOL, and distress. These factors could be targeted in psychosocial interventions to improve the QOL of patients on WW.