卒中病人居家照顾者疾病相关知识认知情况调查

[目的]了解居家照顾者卒中相关知识认知情况。[方法]采用问卷调查形式了解103名居家照顾者对卒中诱发因素、卒中发作症状、家庭急救措施的认知情况。[结果]居家照顾者对卒中诱发因素认知欠佳,尤其是对A型行为、生活压力会诱发卒中。50%以上居家照顾者对卒中发作时"说话困难""头痛难忍""突然有眩晕感"症状缺乏认知。50%以上居家照顾者对相关卒中家庭急救措施缺乏认知。不同照顾时间及工作类型的居家照顾者对卒中诱发因素及院前延误因素认知力比较差异具有统计学意义(P<0.05)。[结论]卒中病人居家照顾者对卒中诱发因素、卒中发作时症状及卒中院前家庭急救措施的认知欠佳,因此在延伸护理服务中应针对居家照顾者开展适宜有效的健康教育具有必要性。     

Changes in life-style,needs and difficulties faced by caregivers of AIDS patients in home care

This study aimed at delineating the social and demographic profile of 17 home caregivers for AIDS patients, identifying the alterations occurring in their life style and detecting the main needs and doubts presented by them when assisting a person living with AIDS at home, as well as the difficulties stemming from the disease and the care given by them. We identified that the introduction of HIV/AIDS within the family generates a crisis situation and awakens many negative feelings in caretakers. An alteration in life routine takes place and there is also an overload of tasks to be carried out. The main difficulties of caretakers are related to taking care of the patient at home in addition to financial and emotional difficulties. We have shown the need for more effective orientation as to protection measure while caring for the patient. We have also pointed out the importance of orientation and educational actions to be given by health professionals, during which nurses' participation in home assistance/visits is essential.     

脑卒中患者照顾者负担的常用评估工具

脑卒中具有发病率高、病死率高以及致残率高的特点。目前,随着医疗技术的进步,脑卒中的病死率在逐步下降,但同时脑卒中患者照顾者数目庞大,并呈不断增长的趋势[1]。调查显示,大约80%的脑卒中患者出院后由家人完成家庭康复及护理活动[2]。自上世纪90年代以来越来越多的研究开始关注照顾者,对照顾者的研究提示,评估他们的负担状况并采取有针对性的干预措施是现实的帮助途径,而评估工具的准确性、适用性直接影响到评估效果及进一步的干预研究。Knapp[3]指出,一些用于减轻脑卒中患者照顾者负担的干预措施之所以效果欠佳,很可能在于所使用的评估…     

The home care experience as perceived by the caregivers of Chinese dialysis patients

The caring issues perceived as crucial by caregivers in home-based dialysis, have never been systematically studied in any depth in Hong Kong. This research aimed to explore various characteristics of the home care experience perceived by caregivers. Thirty caregivers of home dialysis patients were interviewed using a phenomenological approach. Selection was by convenience. The interviews were conducted in the outpatient clinic following receipt of the informant's consent. The instrument consisted of two aspects designed to elicit the phenomena. The caregivers' responses seemed to indicate that caregiving is likely to have financial, emotional, social and health-related implications.     

Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke

Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended.     

脑卒中后患者及陪护者抑郁发生因素的1年后社区随访

目的分析影响脑卒中发病后产生抑郁的因素。方法将脑卒中患者及其陪护者(照料患者日常生活的人)分成4组(总数为1048例)。其中423例幸存者中的321例患者和195例陪护者在脑卒中发生后3个月和12个月时以接受和不接受康复活动分组。390例幸存者中的311例患者和184名陪护者于12个月时仍以是否接受康复活动分组。接受为康复组,不接受为对照组。追踪调查2年。结果3个月时康复组患者出现抑郁者少于对照组(差异率0.59),12个月时仍保持差异(差异率0.55);3个月时康复组与对照组的陪护者之间没有明显差异,12个月时结果相同。然而12个月时在对照组中,有比康复组患者更明显的严重抑郁陪护者。结论脑卒中幸存者及其陪护者在3个月时普遍存在抑郁,它的几率在以后的1年中没有下降,康复组比对照组抑郁的发生率低,由此可见参加康复活动是降低脑卒中后抑郁发生率的有效方法。     

Down to the fundamentals of telehealth and home healthcare nursing

Many changes have taken place in the field of home healthcare. Because of these changes, home health agencies must be creative and implement various tools that help improve quality of care for their patients. Starting with the most basic intervention definitely can lend a hand in improving patient outcomes. Phone monitoring, the most basic form of telehealth, can be an important aspect in a patient's plan of care.     

Perceived home care needs of cancer patients and their caregivers

The purpose of this study was to identify perceived home care needs of outpatients receiving treatment for cancer and their caregivers. The purposive subsample consisted of 16 subjects, 8 patients receiving treatment as outpatients and their 8 caregivers. Two interview guides, one for the patients and the other for their caregivers, were based on the Neuman Systems Model to assess patient and caregiver stressors The data were analyzed in relation to intrapersonal stressors (within the individual), interpersonal stressors (between the individual and others), and extrapersonal stressors (between the individual and the environment) Several stressors within each category were identified by both the patients and caregivers. Intrapersonal stressors included treatment uncertainty and role change, the interpersonal stressor of lack of social support, and the extrapersonal stressors of lack of transportation and limited finances. In addition, patients identified specific intrapersonal stressors in relation to their situation. These included assistance in coping with physical restrictions resulting in subsequent anger and depression. On the other hand, intrapersonal stressors identified by the caregivers included support in coping with the added responsibilities in relation to patient care, the fear of being alone, guilt, and the interpersonal stressor of limited knowledge regarding the patient situation. The stressors identified by both the patients and caregivers can serve as a beginning means to explore the needs encountered by this population group.     

Restorative activities among bereaved caregivers of nursing home patients

This prospective study examined predictors and correlates of restorative activities in recently bereaved caregivers and their relation to post-bereavement adjustment, namely complicated grief. Participants included 89 caregivers (CGs) age 32–87 (M age – 63 years) whose care recipients recently died in a long-term care facility (M time since loss?=?107 days). Our findings show that being prepared prior to death enables CGs the opportunity to engage in restorative activities post death. Restorative activities partially mediated the relationship between preparedness prior to death and complicated grief, but this association was attenuated in multivariable models. It is possible that being prepared prior to death allows CGs to engage in restorative activities post-death, which in turn decreases complicated grief. More research is needed in diverse populations of CGs to determine how restorative activities may impact post-bereavement adjustment.     

Using home telehealth to empower patients to monitor and manage long term conditions

This article describes a pilot telehealth project in Swansea where patients with heart failure and chronic obstructive pulmonary disease were provided with telehealth monitoring equipment. While early evaluation points to some potential economic benefits, supporting patient empowerment was a significant outcome.     

Spirituality expressed by caregivers of stroke survivors

Thirty-six caregivers of stroke survivors who are new to that role participate in a Web-based support and education intervention over the course of a year. The authors use a secondary analysis of a total of 2,148 e-mail messages that these caregivers posted to the intervention's discussion group. Rigorous content analysis is used to analyze the narrative data coded to spirituality (n = 230 e-mails). Four themes emerge and are drawn to Friedemann's (1995) framework of systemic organization: (a) feeling the presence of a greater power, (b) practicing rituals, (c) being one with nature, and (d) interacting with family and friends. Spirituality gives these caregivers hope and sustenance, but it also helps them express themselves more fully during a difficult time of change. The e-mail discussion data presented here highlight the importance of increased awareness of addressing spirituality in nurse-client encounters and designing interventions to support the caregivers.     

脑卒中患者主要照顾者压力与护理对策的研究进展

脑卒中(stroke)又称脑中风或者脑血管意外(cerebrovas-cular accident),是一组以急性起病,局灶性或弥漫性脑功能缺失为共同特征的脑血管病,包括脑出血、脑梗死、蛛网膜下腔出血[1].流行病学调查表明:我国脑卒中患者数约500～600万,每年新发病例120～150万,年发病率120～180/10万,病死率60～120/10万,存活者75%以上留有不同程度的后遗症[2],包括肢体、语言、认知等方面的障碍,严重影响患者的日常生活能力.     

脑卒中患者主要照顾者的负担和应对方式及其相关性分析

目的探讨脑卒中患者的主要照顾者的负担水平与应对方式以及二者的相关性。方法采用Zarit照顾者负担量表和简易应对方式问卷调查120位脑卒中患者的主要照顾者。结果脑卒中患者的主要照顾者的负担总分（39．54±13．88）分,86．7％的照顾者负担处于轻、中度水平;照顾者多采取积极应对方式应对负担,偶尔也采取消极应对方式;负担与积极应对方式呈负相关,与消极应对方式呈正相关,差异均有统计学意义（P〈0．01）。结论脑卒中患者的主要照顾者普遍存在不同程度的照顾负担,脑卒中患者主要照顾者的负担与其应对方式密切相关,护理工作者应正确引导照顾者采取适当的应对方式,减轻照顾负担。     

The role of nurses in installing telehealth technology in the home

Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.     

Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm

We previously conducted a randomized controlled trial in which early supported discharge from the Department of Neurology at Huddinge Hospital in southwest Stockholm with continuity of rehabilitation at home (n = 41) was compared to routine rehabilitation services (n = 40) for moderately disabled selected stroke patients. No statistical significant differences were found in patient outcome at 3 or 6 months, but a moderately positive effect in the home rehabilitation group was suggested. In the present study we evaluated resource utilization of health and social care, impact on family caregivers during 6 months after acute stroke and patient satisfaction. A 50% reduction in total hospitalization (initial and recurrent) was observed, from 30 days in the routine rehabilitation group to 15 days in the home rehabilitation group (p < 0.001). After discharge, the mean number of home visits in the home rehabilitation group was 12. In total, the routine rehabilitation group had a higher frequency of therapy contacts and daycare in outpatient care. Seventy-eight percent received help from a family caregiver in activities of daily living, yet only 15% had formal home help service. No major differences were found in use of home help service or impact on family caregivers in the form of time devoted to helping the patient or subjective well-being of spouses as per Sickness Impact Profile. Patient satisfaction was in favour of the home rehabilitation group, but a significant difference was only found in active participation in rehabilitation programme planning. In conclusion, early supported discharge with continuity of rehabilitation at home, using goal-directed functional activities based on the patient's personal interests, should be the rehabilitation service of choice for moderately disabled stroke patients fulfilling certain criteria, provided that further evaluation during the first year after stroke reveals no great changes in outcome or resource use. More research into the effectiveness and cost implications of early supported discharge with continuity of rehabilitation at home is needed in other parts of Sweden and in other countries before it can be asserted that the conclusions drawn from this study are applicable elsewhere.