脑卒中患者的家庭护理与康复指导

目的探讨脑卒中患者家庭护理和康复训练指导方法。方法对34例首次发生脑卒中的患者于出院后进行家庭护理方法的指导,实施肢体、语言功能训练及日常生活康复训练,分别采用Fugl-m eyer与Barthel评分方法评定患者的运动能力和日常生活能力。结果通过家庭护理和康复训练指导,提高了脑卒中患者的运动和日常生活功能评分。结论家庭护理和康复训练指导相结合,能够有效改善脑卒中患者的生存质量。     

In-hospital social support for families of heart patients

Chronic illness in one family member influences all aspects of family life. Research has documented the positive contributions of social support in an unexpected and stressful event such as a family member's heart disease. The aim of the study was to describe in-hospital social support provided by nurses to families of heart patients and to identify factors related to social support. Data were collected using a mailed questionnaire to family members of heart patients (n = 161) receiving treatment on two medical wards of a university hospital in southern Finland. The results show that the family members were not very satisfied with the social support from nurses, because about 40% were dissatisfied with the concrete aid and affirmation they received and about 30% with emotional support. According to regression analysis the most important predictors of social support were family structure, patient's age, gender of family member and whether the patient had been hospitalized for cardiac symptoms. This report shows that supporting families of cardiac patients need development according to the family nursing practice.     

护理干预对肿瘤晚期病人及家属心理的影响

[目的]探讨护理干预对肿瘤晚期病人及其家属心理的影响。[方法]对50例肿瘤晚期病人及50名家属实施护理干预,采用症状自评量表（SCL-90）评定护理干预前后,肿瘤晚期病人及其家属心理。[结果]肿瘤晚期病人及其家属护理干预后,SCL-90总分低于护理干预前,病人主要表现在躯体化、抑郁、敌对、恐怖4个因子（P〈0.05）;病人家属主要表现人际关系、抑郁、焦虑、恐怖等4个因子（P〈0.05）。[结论]护理干预可以改善肿瘤晚期病人及其家属的心理健康状况。     

Nursing staff attitudes and behaviours regarding family presence in the hospital setting

Title. Nursing staff attitudes and behaviours regarding family presence in the hospital setting. Aim. This paper is a report of a study conducted to assess the attitudes and values of nursing staff towards family presence during routine nursing care. Background. Nursing staff attitudes are an important factor in the adoption of family‐centred care for children, and for all ages in the emergency room, special care units, and anaesthesia induction and recovery. Little is documented about nurse attitudes and behaviours related to family presence during day‐to‐day routine nursing care. Method. In 2006, primary data were collected with a convenience sample of 89 nursing staff using an 18‐item questionnaire developed by the authors and based on several family‐centred care instruments in the literature. Items assessed attitude and nurse behaviours related to family presence during routine nursing care. Findings. Nurses’ attitudes and behaviours towards family presence during routine nursing care were generally favourable. There was low agreement about family members being allowed to visit whenever the patient wished. Nursing staff attitudes were consistent with their self‐reported behaviours supporting family presence. Conclusion. Nursing staff who believe family presence is important are more likely to include families in daily care. The organization plays a key role in encouraging family‐centred care by providing appropriate education and support to nursing staff.     

Nursing Specialty Knowledge as Expressed by Standardized Nursing Languages

PURPOSE. To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages. METHODS. A cross‐sectional review of nursing records (N = 265) in four specialties. FINDINGS. The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty‐three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties). CONCLUSIONS. Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice. PRACTICE IMPLICATIONS. Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.     

特需病房的临终关怀服务

目的提高临终病人及家属的生活质量。方法建立家庭式临终关怀病房,控制癌症晚期病人的疼痛,制定个性化临终护理计划,做好基础护理和心理护理,给予临终病人家属心理支持,尊重其民族习俗和宗教信仰,遵照病人生前愿望进行尸体料理,帮助家属办理后续事宜。结果提高了临终病人生命质量,满足了病人的心理需要,病人及家属满意度较高。结论在特需病房实施的临终护理模式提高了服务质量和特需医疗服务信任度,扩大了特需医疗服务的影响力。     

家庭护理干预对腹膜透析患者生活质量的影响

目的探讨家庭护理干预提高腹膜透析（PD）患者生活质量的效果.方法选择2002年7月至2005年7月在中国医科大学附属第一医院肾内科出院的腹膜透析患者（n=80）,用随机数字表法分为实验组40例和对照组40例.对照组按常规定期复查,实验组在此基础上以定期家访和电话访问的形式进行家庭护理干预,包括为患者及家属提供心理咨询、健康教育、护理指导等,每周1次,每次30～60 min,持续时间为3个月.干预前后采用WHO推荐的健康调查简易量表Mos SF-36测评两组患者的生活质量.结果80例患者均进入结果分析.实验组患者干预后生理机能、角色生理、心理健康状况、角色心理状况、活力、躯体疼痛、主观健康状况得分分别明显高于干预前（t=2.1922～6.0236,P＜0.05）,亦高于对照组（t=2.0364～5.0622,P＜0.05）,差异有统计学意义.两组社会机能无统计学差异（P＞0.05）.结论家庭护理干预有效地提高了患者的生活质量.     

The experiences of Chinese family members of terminally ill patients - a qualitative study

Aim. To describe and understand the experiences of Chinese family members of terminally ill patients during the end of life process in a palliative care unit. Background. Palliative care aims to provide care to dying patients and their family members. Skillful interventions are necessary to help family members cope with the impending death of the patient and maintain their emotional equilibrium. Hence, it is important to understand the experiences of family members of palliative care. Design. A phenomenological study was conducted. Data were collected by semi‐structured interviews. We interviewed a purposive sample of 20 family members of terminally ill patients in a palliative care unit in Hong Kong. The data were analysed following Colaizzi's phenomenological methodology. Results. Family members experienced anticipatory grief, with reactions that included anger, unease, sadness and helplessness. This was particularly acute when the patient was first admitted to the palliative care unit. However, the family members quickly accepted the reality and committed themselves to the care of the patient, seeking informational and emotional support from the nurses. The families wanted to be assured that the patient had been offered good care and suffered no pain. It was considered important to be with the patient during the dying process. Conclusion. This study demonstrated that Chinese family members were committed to the care of the patients in the palliative care unit. Cultural beliefs played a part in influencing family emotions and concerns. Relevance to clinical practice. This study offers a direction for family interventions that acknowledge the reactions of family members to the admission of a patient to a palliative care unit. It highlights that families need active informational and emotional support from nurses.     

尿毒症患者家属负性心理反应调查与护理干预

目的探讨对尿毒症患者家属负性心理反应的相关因素及护理干预的作用。方法采用组间对照,将57例尿毒症患者分成观察组和对照组,观察组给予健康教育及心理辅导等护理干预,对照组实施常规护理;运用心理健康状况自评量表（SCL-90）进行2组家属心理健康状况的评估。结果尿毒症家属负性心理反应与疾病知识缺乏,昂贵的医疗费用、长期的治疗及各种并发症的出现等关系密切,采用护理干预后观察组家属的抑郁、焦虑、恐惧心理明显低于对照组（P〈0.05）。结论针对尿毒症患者家属负性心理进行护理干预,不仅可以减少家属的抑郁、焦虑及恐惧心理,而且可以提高家属及患者的生活质量。     

Resilience in families with a member with chronic pain: a mixed methods study

Aims and objective. To measure and explore between 2007–2010 measure and explore the nature of family resilience in the context of families with a member with chronic pain. Background. Chronic pain impacts on the entire family. The literature suggests that it is possible to strengthen resilience in individuals with chronic conditions, but little is known about the impact of chronic pain on family resilience. Design. A explanatory sequential mixed method study was undertaken. Methods. In the initial quantitative phase, assessment measures were administered using the Connor‐Davidson Resilience Scale, Family Impact of Pain Scale, Medical Outcomes Study Short Form 36 and Medical Outcomes Study Social Support Survey. Data were collected and analysed from 31 family cases (n = 67 participants). In the second, qualitative phase, follow‐up semi‐structured interviews were undertaken with 10 families to help explain the quantitative results. Results. The impact of pain on the family was high overall, but the perceived impact was greater for the person with pain. Resilience scores were above average for both the person with pain and other family members. However, the person with pain scored lower on the resilience scale than other members of the family. The families scored high for social support overall, while the person with pain perceived they had greater support than their family members. Conclusions. Identifying the strengths or resilient properties inherent in families and using those strengths in the planning and implementation of care, especially of chronic conditions such as chronic pain, is pivotal to quality health outcomes. Relevance to clinical practice.  It is important that nurses and healthcare professionals include family members when planning and delivering care for persons with chronic pain. Identification of strengths within families can help tailor nursing interventions to meet family needs.     

Experiences of undergraduate nursing students with faculty incivility in nursing classrooms: A meta-aggregation of qualitative studies

Faculty-to-student incivility can have detrimental impacts on both the individual students and the nursing profession. This study synthesized the current qualitative research evidence on the experiences of undergraduate nursing students with faculty incivility in nursing classrooms. A meta-aggregation approach was applied in a systematic review of qualitative studies based on the guideline of the Joanna Briggs Institute. The analysis of 11 qualitative studies identified four synthesized findings: (1) faculty incivility included a wide range of uncivil behaviors from disruptive to threatening behaviors, (2) pedagogical incompetence, including ineffective teaching, unresponsiveness, and unfairness, was perceived as uncivil, (3) faculty incivility negatively impacted on psychological well-being and learning, and (4) adaptation efforts included seeking support from family and friends and voicing the need for an official support system. Nursing faculty members need to be aware of the malicious impacts of faculty incivility, have formal teaching preparation, and develop pedagogical competency. The students and faculty members should be empowered by establishing official support systems for students and training faculty members to be role models for civility, respectively. Faculty perspectives of their incivility to students, interventions for cultivating faculty civility, and the long-term effects of faculty incivility are suggested as areas for further research.     

Nursing Diagnoses of Burned Patients and Relatives' Perceptions of Patients' Needs

PURPOSE.  The aims of this study were to identify the nursing diagnoses of burn patients in the period 1 week before hospital discharge and to determine whether their relatives had similar perceptions of the patients' problems.
METHODS.  A qualitative case study was conducted with 10 burn patients and 10 family members. One week before hospital discharge, the nursing diagnoses of the patients and the relatives' perceptions of the patients' were identified and compared.
FINDINGS.  Thirty different diagnoses related to physical and psychosocial aspects were identified. The family members reported concerns mainly related to physical care, specifically wound care and prevention of infection, and psychosocial aspects, while patients were primarily concerned with the latter.
CONCLUSIONS.  Nursing diagnoses for these patients and their relatives' perceptions frequently overlapped; however, the emphasis of the families' attention was on the physical aspects.
IMPLICATIONS FOR NURSING PRACTICE.  Anticipating family members' perceptions about the patients' problems is important in order to promote strategies that will improve patient care after hospital discharge.     

Social support and networks in health promotion of older people: a case study in Brazil

Aim.  This research aimed at identifying social support for older people and their families.
Background.  The Brazilian National Policy for Older People's Health, created in 1998, is based on the promotion of healthy ageing, aiming at encouraging older people to remain in their environment and independently exert their functions in society. Nursing has engaged in this process, seeking to provide integrated care to the older person and family.
Method.  A case study with multiple participants was carried out. The inclusion criteria were families of older people over 70 years old who attended a Family Health Unit in the interior of the State of Minas Gerais, Brazil. Data were collected between April and June, 2007. In-depth interviews, genograms and ecomaps were used to collect data, which were categorized by thematic content analysis.
Results.  Three families participated in this study, totalling seven participants.
Conclusions.  The older people's families depend on institutional networks for their health maintenance. Spirituality and religion are mixed and are very expressive sources of support.
Relevance to clinical practice.  Assessing social support and networks can favour nursing interventions in order to intensify social interactions, promote leisure and help the families of older people to cope with life changes.     

Staff-family relationships in nursing home care: a typology of challenging behaviours

Aim.  This paper draws on data from a study which investigated how Australian nursing home staff constructed staff–family relationships.
Background.  Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy which espouses holistic care. The quality and enjoyment of the experience however, is frequently fraught with problems and challenges for both the staff and the family involved.
Design.  A qualitative constructivist design as described by Guba and Lincoln [ Fourth Generation Evaluation . Sage Publications, London.] was used.
Method.  Thirty paid caregivers drawn from eight nursing homes were interviewed about their experiences of working with residents' families. A constant comparative method of data analysis was used to arrive at the findings.
Results.  This paper reports on seven themes under the category of 'unacceptable behaviours'. These themes describe a range of attitudes and behaviours exhibited by families which staff members found undesirable.
Conclusions.  Staff members found a number of family behaviours challenging. Nursing home staff perceives the family as subordinate to their needs and want to retain control of the work environment.
Relevance to clinical practice.  Nursing home staff need to move away from custodial models of care focused on 'getting the work done' and develop more family friendly work practices that are inclusive of the needs of the family and view them as equal partners in care.     

Determinants of perceived health in families of patients with heart disease

BACKGROUND: Heart disease is a severe long-term illness, which often requires lifestyle changes and self-care and affects the life of the whole family. Perceived family health is highly complex. It combines people's values and everyday experiences, such as knowledge about their own health, what they do to promote their health, how their life progresses, and how they feel physically and emotionally. AIM: The aim of this paper is to report a study to describe the perceived health of families of patients with heart disease and to ascertain factors related to family health. METHODS: Data were collected by questionnaire with a convenience sample of 161 family members of patients receiving treatment on two medical wards of a university hospital in southern Finland. Data were analysed using means and medians and tested by parametric and non-parametric tests. A stepwise regression analysis was also used. RESULTS: The most important predictors of family health were family structural factors, effect of illness symptoms on daily life, and family relationships. The strongest predictor was family structural factors. It was found that the better the family structure and relationships, the better the family health. Similarly, the greater the effect of the illness on the patient's daily life, the worse the family health. CONCLUSION: The findings suggest that supporting family functioning in the families of people with heart disease is an important challenge for family nursing.     

Postdischarge nursing interventions for stroke survivors and their families

BACKGROUND: The physical, cognitive, and emotional sequelae of stroke underscore the need for nursing interventions across the continuum of care. Although there are several published studies evaluating community interventions for stroke survivors, the nursing role has not been clearly articulated. AIM: The aim of this paper is to report a study to describe, using a standardized classification system, the nursing interventions used with stroke survivors during the initial 6 weeks following discharge home. METHODS: In the context of a randomized controlled trial, two nurse case managers provided care to 90 community-dwelling stroke survivors who were assigned to the intervention arm of the trial. The nursing documentation was analysed, using the Nursing Intervention Classification (NIC) system, to identify and quantify the interventions that were provided. FINDINGS: Stroke survivors received, on average, six different interventions. There was a trend for those who were older, more impaired, and who lived alone to receive more interventions. The most commonly reported interventions included those directed towards ensuring continuity of care between acute and community care, family care, and modifying stroke risk factors. The study was limited to the nursing documentation, which may represent an underestimation of the care delivered. CONCLUSIONS: The NIC system was useful in capturing the interventions delivered by the nurse case managers. Nursing interventions are often not clearly articulated and less often use standardized terminology. Describing nursing activities in a standard manner will contribute to an increase in nursing knowledge and to evidence-based practice.     

首发精神病病人家庭关系调查及干预

目的 探讨首发精神病病人家庭关系对其病情的影响及护理干预措施。方法 选择首次发病的精神病病人78例,随机分为干预组和对照组,各39例。分别对两组病人的家庭关系进行调查,找出影响因素,然后对干预组家庭实施干预措施,对照组进行一般卫生宣教,于患者出院后半年,对两组病人病情及家庭关系再次进行调查。结果 干预组病人临床痊愈率、遵医服药率等均优先于对照组,且家庭关系更为融洽,病人的生活质量明显高于对照组。结论 对首发精神病病人家庭关系进行干预,可明显改善其家庭关系,改善照料者对患者的照护水平,减少复发,提高生活质量。     

Promotion of evidence-based practice by professional nursing associations: literature review

AIM: This paper reports a literature review examining the activities of professional nursing associations in the promotion of evidence-based practice. BACKGROUND: Professional nursing associations can play a role in the implementation and achievement of evidence-based practice as such associations aim to develop and further educate nurses professionally, build professional networks representing the interests of nurses and the nursing profession, influence the government and policymakers, and support and protect the basic values of nurses. The exact role of professional nursing associations in the promotion of evidence-based practice is as yet unclear, along with just how the role of such associations can be expanded and which strategies can be used to promote evidence-based practice among members. METHOD: A literature and Internet search was undertaken using the PUBMED, CINAHL, SCIRUS, INVERT, and the Cochrane databases using the terms evidence-based practice(s)* or EBP*, which were then combined with Nursing Society*, Nursing Organization*, Nursing Organisation*, Nursing Association* or Nursing Council*. Other sources included a Google search of the Internet, and the sites of various members of the International Council of Nurses. Publications in English, French or German from 1993 to 2004 were used, and the Internet search was conducted on 17 July 2003. RESULTS: Sixty nursing associations described the dissemination of evidence-based practice using one or more types of activities (179 activities in total). All of these activities were of a voluntary nature, with a predominant focus (132/179 activities) on intrinsic motivation of nurses. More specifically, most of the activities were aimed at nurses' competences and attitudes in relation to evidence-based practice. CONCLUSION: Professional nurses' associations are active in promoting evidence-based practice among their nurse members, but only those focusing on changing competences and attitude by addressing intrinsic motivation are well used. Other types of activities deserve to be explored, including behaviour-oriented approaches, approaches using structural, social or financial influence measures and perhaps methods based on 'involuntary involvement'.