罗伊适应模式在鼻咽癌放疗患者康复护理中的应用

本文介绍了如何运用罗伊适应模式作为一个系统的理论框架指导鼻咽癌放疗患者的康复护理;并从生理功能、自我概念、角色功能和相互依赖4个方面分析患者的适应问题、刺激因素并探讨相应的护理措施,为促进鼻咽癌放疗患者的康复和生活质量的改善提供参考。     

Roy适应模式在甲亢患者围手术期中的应用

目的:探讨Roy适应模式在甲亢患者围手术期中的应用效果.方法:选择2010年3月～2012年3月在我科手术治疗的甲亢患者87例作为干预组,围手术期利用Roy适应模式对患者进行护理,同时选择2008年1月～2010年1月在我科手术治疗的甲亢患者71·例作为对照组,比较两组患者对手术的认知程度、心理状态和对护理工作的满意度.结果:干预组患者对手术及麻醉知识五道题的回答正确率均高于对照组,差异有统计学意义(P＜0.05).SCL-90量表显示,干预组患者的心理状态更好,与对照组比较差异有统计学意义(P＜0.05).干预组患者对护理工作的满意度也高于对照组(P＜0.05).结论:运用Roy适应模式能有效提高甲亢患者围手术期的护理质量,促进患者康复.     

Roy适应模式对不孕症患者的心理干预

目的运用经典护理模式加强不孕妇女心理护理,提高护理质量和不孕症的治疗效果。方法将1615例接受不孕治疗的患者按实施心理干预前后分为2组,比较2组护理效果及临床治愈率。结果实施Roy适应模式对不孕症患者的心理干预,显著提高了治疗不孕症的有效率和治愈率。使患者的依从性增加,满意度提高。结论Roy适应模式对不孕症患者的心理干预在发扬经典护理理论的同时,更新现代护理理念,有助于不孕症患者的临床治疗。     

罗伊适应模式对急性心肌梗死恢复期患者护理的效果评价

目的探讨应用罗伊适应模式对急性心肌梗死恢复期患者护理的效果。方法将89例急性心肌梗死恢复期患者随机分为实验组48例和对照组41例。实验组在常规治疗的同时应用罗伊适应模式护理,而对照组在常规治疗的同时采用一般护理。采取护理措施后,应用90项症状自评表(SCL-90)测定患者的心理状况,同时采用社会功能评定量表(SDSS)进行社会功能评定,并进行比较。结果采取护理措施后,实验组SCL-90评定总分、总均分和阳性项目数、躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执等因子分均低于对照组;SDSS评分明显低于对照组,差异均有非常显著性意义(P<0.01)。结论应用罗伊适应模式对急性心肌梗死恢复期患者进行护理是较好的护理模式,能增强患者治疗的信心,从而促进康复,达到最大限度地维护患者健康的目的。     

Maturing Responsibility in Young Teens Participating in an Asthma Camp: Adaptive Mechanisms and Outcomes

PURPOSE: The purpose of this study was to describe adolescent adaptation in the four adaptive modes of the Roy Adaptation Model in campers attending a Young Teen Asthma Camp and relate that adaptation to the acquisition of asthma responsibility. DESIGN AND METHODS: The camp experience included asthma education and an opportunity to grow socially. A quasi-experimental design investigated ratings of self-efficacy and responsibility from before to after camp. RESULTS: Improvements in self-efficacy supported adaptation in self-concept and role function. Adolescents demonstrated maturing responsibility in asthma management in interdependence mode. PRACTICE IMPLICATIONS: Asthma camps are effective for delivering asthma education, enhancing maturation, and assisting with normalizing life experiences. Nurses can be instrumental in facilitating adolescents' participation.     

Breast cancer: evaluation of the Common Journey Breast Cancer Support Group

Background. Most studies of cancer support groups have focused on the effects of groups established for research purposes, from the exclusive perspective of the group participants. Aim. This Roy Adaptation Model‐based programme evaluation project focused on identifying the experiences of both participants in and facilitators of a community hospital‐sponsored breast cancer support group. Design. Repeated measures survey methodology. Methods. Ten women with breast cancer and two Registered Nurse group facilitators participated in the programme evaluation project. Qualitative data were analysed using content analysis. Themes extracted from the data were categorized according to the Roy Adaptation Model modes of adaptation. The group participants completed Initial and End of Year Interview Guides and Group Voices Forms; the group facilitators completed the Facilitators’ Voices Form. The Institutional Review Committee of a community hospital approved the programme evaluation project. Results. The Common Journey Breast Cancer Support Group is a community hospital‐sponsored cancer support group established to meet the informational, emotional support, and social support needs of women with breast cancer who reside in a rural state in the New England region of the USA. Responses of participants and facilitators, which reflected all four of the Roy model modes of adaptation, indicated that the combination of information and emotional and social support was effective. Conclusions. Nurses and other health professionals who establish community‐based cancer support groups should consider formal evaluation of the outcomes, from the perspectives of both participants and facilitators, and should publish the results. The results of this programme evaluation project are limited to one breast cancer support group with a small number of female participants and two facilitators. Results cannot be generalized to support groups for other types of cancer or to cancer support groups for men. Relevance to clinical practice. Nurses and other health professionals should consider establishing and facilitating community hospital‐sponsored support groups for women with breast cancer, which have the potential to meet the women's informational, emotional support, and social support needs.     

Roy适应模式在介入治疗子宫肌瘤患者护理中的应用

目的 评价Roy适应模式在子宫肌瘤患者护理中的应用。方法 将Roy学说中的生理、自我概念、角色功能及相互依赖4种适应模式用于25例介入治疗子宫肌瘤患者角色适应性护理。结果 实施Roy护理程序后，患者情绪稳定。能愉快配合治疗与护理，顺利完成手术。结论 运用Roy适应模式能提高子宫肌瘤介入治疗患者的适应性。     

Increasing Perceptions of Self-Worth in Preadolescents Diagnosed with ADHD

Purpose: To test the effectiveness of a school-based, nurse-facilitated support group in increasing perceptions of scholastic competence, social acceptance, behavioral conduct, perceived athletic competence, perceived physical appearance, and perceived global self-worth in preadolescents diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).
Design: A quasi-experimental design with 65 preadolescents diagnosed with ADD or ADHD in an upper-middle class community in the United States.
Methods: Participants randomly assigned to either the control or experimental group completed Harter's Self-Perception Profile for Children instrument at the beginning of the study and 4 weeks later. Students in the experimental condition participated in a school-nurse facilitated support group which met twice weekly for 4 weeks.
Findings: Participants in the support group had increased scores on each of the six subscales, with significant increases on four of the subscales, including perceived social acceptance, perceived athletic competence, perceived physical appearance, and perceived global self-worth.
Conclusion: Participation in a school-based, nurse-led support group was positively associated with perception of self-worth in preadolescents diagnosed with ADD or ADHD.     

Testing a theory of chronic pain

BACKGROUND: Chronic pain is highly prevalent among older people with arthritis, with depression as its major outcome. The psychopathological process of chronic pain and its outcomes in older people with arthritis have not been the subject of extensive research. The purpose of this study was to test a middle-range theory of chronic pain derived from the Roy Adaptation Model, a nursing theory whose validity has not been tested in the context of chronic pain. METHODS: The study used a convenience sample of 71 older people with arthritis. Two subscales of the Arthritis Impact Measurement Scales were used to measure pain and physical disability. Social support was measured by Part II of the Personal Resource Questionnaire, and the Elderly Daily Stress scale was used to measure daily stress. Participants also completed the 10-item Center for Epidemiological Studies of Depression scale. Univariate analysis, correlation, and path analysis were used to analyse the data. RESULTS: Overall, the data supported the hypothesized model in which pain, disability, social support, age, and gender are predictors of daily stress and daily stress further predicts depression. The direct effects of chronic pain, disability, and social support accounted for 37% of the variance of daily stress, which in turn predicted 35% of the variance of depression. Age and gender had no influence on daily stress. The chi-square index suggested a fit between the data and the model, and therefore the current model is temporarily accepted. Other fit indices also showed a good fit of the model to the data. To simplify the model, a revised version was developed. CONCLUSIONS: This study validated a middle-range theory to explain the effects of chronic pain in older people with arthritis and highlights the importance of chronic pain in the development of depression.     

An Application of Beck's Cognitive Therapy to General Anger Reduction

Beck's cognitive therapy (CT) was compared to a no-treatment control in the reduction of anger in college students. CT lowered trait anger, anger reactivity to many potential provocations, anger in the individual's most angering ongoing situation, daily anger, anger-related physiological arousal, anger suppression, and outward negative expression. CT also enhanced positive forms of anger expression. Treatment effect sizes were medium to large, with many being quite large, and significantly more CT participants met an index of clinically significant change. Moreover, CT lowered trait anxiety and depression. Reductions of anger and trait anxiety were maintained at 15-month follow-up. CT was judged an effective, promising treatment for anger reduction.     

认知行为疗法联合协同护理干预在扩张型心肌病患者中的应用效果

目的探讨认知行为疗法(CBT)联合协同护理干预在扩张型心肌病(DCM)患者中的应用效果。方法选择我院收治的103例DCM患者为研究对象,依照入院时间不同将其分为对照组(51例)和联合组(52例)。对照组给予常规护理干预,联合组于常规护理基础上给予CBT联合协同护理干预。比较两组患者的干预效果。结果联合组总依从率为94.23%,高于对照组的70.59%(P<0.05)。干预后,两组社会功能、精神健康、生理机能、生理职能评分均提高,且联合组高于对照组(P<0.05)。干预后,两组SDS、SAS评分均降低,且联合组低于对照组(P<0.05)。联合组的满意度高于对照组(P<0.05)。结论 CBT联合协同护理干预应用于DCM患者,能缓解焦虑、抑郁情绪,改善其生活质量,提高患者依从性及满意度。     

Theory-guided interventions for adaptation to heart failure

Title. Theory‐guided interventions for adaptation to heart failure Aim. This paper is a report of a study to examine the effects of a Roy Adaptation Model‐based experimental education, exercise and social support programme on adaptation in persons with heart failure. Background. In the past 20 years, a large number of studies have evaluated heart failure. Several studies of other chronic diseases have been based on the Roy Adaptation Model and show that this approach is useful in promoting adaptation for patients. Method. A randomized, parallel, controlled clinical trial was conducted in 2005 with 43 patients (21 intervention and 22 control patients). A booklet for patient training was given to those in the intervention group. Participants received a patient identification form, assessment form for physiological data, the Minnesota Living with Heart Failure Questionnaire, Interpersonal Support Evaluation List and the 6‐Minute Walk Test. Results. Patients in the intervention group adapted well to their condition and the four adaptive modes of Roy Adaptation Model were interrelated. Patients’ quality of life was enhanced, their functional capacities increased and social support within the interdependence dimension improved in patients in the intervention group. Conclusion. This is the first study to use the Roy Adaptation Model in a study of patients with heart failure. Roy’s model is an effective guide for nursing practice when caring for patients with heart failure.     

Managing a Chronic Pain Patient in the Perioperative Period

ABSTRACT

The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients.

This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.     

以Roy适应模式为基础的健康行为训练对抑郁症患者的效果

目的 探讨Roy适应模式对抑郁症患者健康行为训练的效果.方法 将90例患者随机分为干预组（45例）和对照组（45例）.干预组以Roy适应模式为基础健康行为训练8周,对照组给予常规治疗护理,予Zung抑郁自评量表（SDS）、汉密尔顿抑郁量表（24项,HAMD）和简易应对方式问卷（SCSQ）评定患者抑郁状态,WHO生存质量测定量表简表（WHOQOL-BREF）评定生活质量满意度.结果干预组SDS、HAMD评分显著低于对照组（P〈0.01）,SCSQ（积极、消极）积极评分显著高于对照组,消极评分低于对照组,WHOQOL-BREF评分（心理、生理、社会关系领域）显著高于对照组（P〈0.05）.环境领域差异无统计学意义（P〉0.05）.结论 运用Roy适应模式进行健康行为训练,可以促进抑郁症的有效适应,改善应对方式和抑郁状态,提高生活质量.