Psychosocial adjustment following MI: current views and nursing implications.

Psychosocial adjustment following myocardial infarction (MI) has received significant research attention during the past 20 years. This article highlights research addressing the relationship of anxiety, depression, and denial in influencing specific outcomes following MI. Additional research describing patterns of emotional response to MI is also included. Based on reported research, specific nursing interventions, in a care plan format, are suggested to foster positive psychosocial outcomes in the post-MI patient. Even though a significant amount of research has been completed on this subject, definitive conclusions regarding patient management supportive of positive outcomes are not possible. Suggestions for future research focus on this topic area are identified.     

The relationship of hospital process variables to patient outcome post-myocardial infarction

This study examined the hospital process variables of nursing care, medical care, information, and hospital environment, as evaluated by patients, in relation to their outcome post-myocardial infarction (MI). The sample included 68 hospitalized men and women, aged 29–92, who were diagnosed with an MI. At the time of discharge, they responded to four subscales of the Patient Judgment of Hospital Quality Questionnaire, which measured the hospital process variables, and the Revised Haussman and Hegyvary Outcome Criteria Instrument for Acute Myocardial Infarction, which measured patient outcome post-MI. Data also were collected from patient charts and nurses. Correlational analyses revealed statistically significant relationships between nursing care and patient outcome, and between hospital environment and patient outcome; neither medical care nor information correlated appreciably with patient outcome post-MI. Regression analysis indicated that nursing care was the only significant predictor of patient outcome post-MI.     

Postgraduate Medical Imaging Nursing Curriculum: Development and Indications for Nursing Practice

Medical Imaging (MI) nurses require advanced education to increase their ability to positively influence patient care, leading to improved patient outcomes. The MI nursing field has been a neglected specialty with regard to postgraduate tertiary education programs, where the eminent skills, knowledge, and expertise of other specialist nursing fields have been recognized and sought after, such as critical care environments. Postgraduate tertiary education incorporates the application of evidence-based theory to clinical practice and can address the theory-practice gap and improve the critical thinking, confidence, and competence of MI nurses. Postgraduate tertiary education can contribute to improved patient outcomes and reduced mortality. A postgraduate tertiary MI nursing program was developed to support the clinical practice and critical thinking of nurses in radiology departments.     

Nursing Care of Hospitalized Medical Patients with Addictions

The purpose of this study is to discuss the literature regarding the development of a clinical pathway for substance abuse screening and brief intervention in an acute care facility for medical patients using Motivational Interviewing (MI). We reviewed the literature on the use of brief Motivational Interviewing for adult substance abuse treatment in hospitalized patients and we looked at the design and implementation of a clinical pathway that involves the screening and brief intervention for adult patients with substance abuse problems. Our research supports brief Motivational Interviewing techniques on adult hospitalized patients with substance abuse. The nursing literature identifies brief Motivational Interviewing as an evidence based approach to patients with substance abuse.     

Myocardial infarction: Part 1

Informed nursing care is crucial in effective treatment and rehabilitation of the patient following MI. The National Service Framework for Coronary Heart Disease should be integrated into nursing practice.     

Fatigue after myocardial infarction: Relationships with indices of emotional distress,and sociodemographic and clinical variables

Alsén P, Brink E, Brändström Y, Karlson BW, Persson L‐O. International Journal of Nursing Practice 2010; 16 : 326–334
Fatigue after myocardial infarction: Relationships with indices of emotional distress, and sociodemographic and clinical variables Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.     

A randomized, controlled trial of a patient/caregiver symptom control intervention: effects on depressive symptomatology of caregivers of cancer patients

In this study, we investigated whether a clinical nursing intervention focusing on teaching family caregivers and their cancer patients skills to better manage the patients' symptoms would reduce caregiver depressive symptomatology. Two hundred thirty-seven patient/caregiver dyads were recruited for the study. These dyads were randomized into either the 10-contact, 20-week experimental intervention group (n=118), which focused on assisting the patient and caregiver in managing patient symptoms and reducing emotional distress, or to a conventional care control group (n=119). A longitudinal random effects regression analysis did not indicate that the clinical nursing intervention was effective in decreasing caregiver depression over the 20-week course of the study. The relationship of the intervention to caregiver depressive symptomatology seems to be a complex one. We recommend further research to explore whether a lengthened intervention and/or delayed follow-up might reveal delayed positive effects of such interventions.     

患者教育程序应用于抑郁症患者的效果

目的 探讨应用患者教育程序对抑郁症患者心理、行为状态等方面的影响.方法 将抑郁症患者46例,随机分为两组,分别实施医院常规治疗护理(对照组)和医院常规治疗护理联合实施患者教育程序(试验组).4周末或出院前,采用住院患者护士观察量表(NOSIE)、汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)3个量表进行评定.结果 试验组和对照组患者抑郁、焦虑情绪和行为障碍程度在入院4周末或出院前均有不同程度的改善,但试验组的焦虑、抑郁分值较对照组下降多,差异有统计学意义(P＜0.01)；试验组患者NOSIE量表测评社会能力、社会兴趣、个人整洁因子分均较对照组有所提高,迟缓、抑郁、激惹因子分较对照组有所下降,差异均有统计学意义(P＜0.01).结论 应用患者教育程序可以调动抑郁症患者维护自身健康的 潜能,调整患者的心理状态,提高患者的社会适应、生活自理等能力.     

A programme for developing nurses'' skills and nursing practice

In this paper we describe a programme for developing nursing care for patients with myocardial infarction (MI) and report some results of a study in which applicability and effectiveness of this programme were evaluated. To investigate how the programme influenced nursing practice, nurses' readiness (knowledge, skills, motivation, accountability) to provide care for MI patients was followed for 2 years. Data for the evaluation were collected by questionnaires from three categories of nurses, by analysing nursing documents before and 1 and 2 years after the programme started, and by keeping a continuous diary. This programme made an impact on many variables that measure changes in nursing practice and nurses' readiness to provide care. The implications of this programme for nursing practice, research, education and administration are discussed.     

老年期抑郁症住院患者系统性心理护理

目的 研究系统性心理护理在老年期抑郁症住院患者中的作用及意义.方法 将58例首次发病的老年期(＞60岁)单相抑郁症患者自新入院开始进行系统性心理护理,作为干预组,对照组为随机抽出已经住院治疗6个月以上的单相抑郁症患者58例(＞60岁).通过前后对比的方法,对照组应用一般常规护理;干预组在此基础上,由指定的医师和经过培训的主管护理师从首次住院开始,给予系统性的健康教育、精神鼓励、心理疏导等对症干预,并在社会及家庭的配合下进行.在入院时和治疗后6个月时记录抑郁症主要症状的分布情况,并在两组问进行比较.结果 干预组与对照组的主要症状言语减少、兴趣减退、睡眠障碍、能力减退感、偏执的差异有显著性(P＜0.05),心境抑郁、焦虑、自杀意念、自杀行为、疑病的差异有非常显著性(P＜0.01).结论 医生护士通过心理护理干预在老年期抑郁症患者康复中有明显效果.     

心理护理干预对抑郁症患者认知功能的影响

目的探讨心理护理干预对抑郁症患者认知功能的影响。方法将60例抑郁症患者随机分为两组,研究组29例,对照组31例,两组均口服舍曲林治疗并接受常规护理,研究组在此基础上给予心理护理干预,观察8周。于干预前及干预第8周末采用汉密顿抑郁量表、汉密顿焦虑量表和威斯康星卡片分类测验对两组进行测评分析。结果干预8周末两组汉密顿抑郁量表、汉密顿焦虑量表评分及威斯康星卡片分类测验错误数、持续错误数、非持续错误数评分较干预前有显著下降（P〈0．01）,分类数评分较干预前有显著升高（P〈0．01）;同期两组间比较,干预前除威斯康星卡片分类测验非持续错误数评分外,两组其他评分差异无显著性（P〉0．05）,干预8周末研究组汉密顿抑郁量表评分显著低于对照组（P〈0．01）,威斯康星卡片分类测验分类数评分显著高于对照组（P〈0．01）。结论对抑郁症患者在常规治疗的基础上进行心理护理干预,能更有效地改善其认知功能。     

应用心理护理对冠状动脉内支架术患者焦虑抑郁情绪的影响研究

目的探讨心理护理干预措施改善冠状动脉内支架术患者焦虑和抑郁情绪的效果。方法将2011年10月～2013年5月在我院接受冠状动脉内支架术治疗的60例患者,随机分为对照组和研究组,各30例。对照组接受常规护理。研究组接受常规护理并强化心理护理。于手术前、手术后第7d、手术后第14d、手术后第21d,分别采用Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）对焦虑、抑郁情绪进行评分。结果手术前、手术后第7d两组SAS评分、SDS评分比较无显著性差异（P〉O．05）。手术后第14d、手术后第21d两组SAS评分、SDS评分比较有显著性差异（P〈O．05）。结论心理护理干预可以显著改善冠状动脉内支架术患者的焦虑、抑郁情绪,从而使患者手术后保持一个良好的心态。     

Effect of a psychiatric diagnosis on nursing care for nonpsychiatric problems

This study was designed to test how patients' psychiatric diagnoses would affect nursing care for medical problems. Sixty nurses were randomly assigned to three groups in this posttest-only experiment. Control group nurses read a vignette describing a man admitted with a possible myocardial infarction (MI). Nonpsychotic group nurses also read that the person was on alprazolam. Psychotic group nurses read that the person was on haloperidol, benztropine, lorazepam, trazadone, fluoxetine, and lithium. Psychotic group nurses estimated a decreased probability that the patient was having an MI and were less likely to respond to additional possible MI symptoms. An increased awareness of the potential to stereotype medical patients with a history of psychosis might assist nurses when providing care.     

Predictors of quality of life in AIDS patients.

BACKGROUND: While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life. OBJECTIVE: This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS. METHODS: A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently. RESULTS: The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores. CONCLUSIONS: The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.     

A randomized controlled trial of in-hospital nursing support for first time myocardial infarction patients and their partners: effects on anxiety and depression

This study monitored and compared levels of anxiety and depression reported by first myocardial infarction (MI) male patients and their partners, throughout the patients' hospital stay. An independent variable of a programme of supportive-educative counselling provided by a coronary care nurse was introduced to determine whether it significantly affected reactions. Sixty couples were randomly assigned to one of two groups: (a) the treatment group (in which they received the systematic programme of nursing support in addition to routine care), or (b) the control group (in which they received routine care but no other intervention). Anxiety and depression were measured by the Hospital Anxiety and Depression (HAD) scale at 24 hours and 5 days after the patient's admission to hospital. At 5 days there were statistically significant differences between both groups with respect to the HAD scale mean scores. These findings strongly suggest that a simple programme of in-hospital couple counselling, provided by a coronary care nurse, statistically significantly reduces anxiety and depression in first MI male patients and anxiety in their partners.     

产妇产后抑郁应用时机理论指导的持续性护理干预的研究

目的探究时机理论指导的持续性护理对产妇产后抑郁的干预效果。方法依照护理方法不同将2018年1月至2018年12月在本院分娩的60例产妇分为两组,对照组行常规护理,研究组在常规护理基础上行时机理论指导的持续性护理,组间对比干预前后抑郁发生率;使用抑郁自评量表(Self-rating depression scale,SDS)对产妇产后负性情绪改善情况进行评价;使用科室自制自理能力评价问卷对产妇产后自理能力进行评价。结果干预前组间产妇抑郁发生率及SDS评分无明显差异(P>0.05),干预1个月及干预2个月后研究组抑郁发生率及抑郁评分均低于对照组(P<0.05);研究组自理能力评分高于对照组(P>0.05)。结论产妇应用以时机理论为指导的持续性护理干预模式,可有效改善产后负性情绪,降低抑郁发生率,提高自我护理能力,增强干预效果,该模式具有较高临床实用价值。     

呼吸科老年住院患者心理状态的质性研究

目的深入了解和研究在呼吸科住院的老年患者住院期间的心理状态。方法采用质性研究EdmundHusserl观点构成的现象学方法为指导，采用个人访谈法，深入访问在某三甲医院呼吸科住院的8例老年患者。结果呼吸科住院的老年患者心理状态包括5个主题：焦虑和忧郁心理；对疾病和治疗的恐惧；猜疑和依赖；自尊心强；孤独和失落心理。结论通过提出针对性的护理干预措施，确保呼吸科老年住院患者的健康心理状态，以配合治疗、检查、手术、护理的顺利进行，并且在痊愈出院后保持健康、积极向上的生活方式和高质量的老年生活。