以时机理论为基础的居家护理对中青年脑卒中病人自我护理及家庭照顾者照顾能力的影响

[目的]探讨基于时机理论(TIR)的居家护理对中青年脑卒中病人自我护理及其家庭照顾者照顾能力的影响。[方法]将109例中青年脑卒中病人及其家庭照顾者随机分为试验组55例和对照组54例,试验组在常规护理与随访的基础上采取以时机理论为基础的居家护理;对照组接受神经内科常规护理与随访,分别于病人干预前、出院时、出院3个月及6个月应用自我护理能力测定量表(ESCA)和家属照顾者照顾能力测量表(FCTI)评价两组病人的自我护理能力及其家庭照顾者的照顾能力。[结果]干预后试验组病人自我护理能力在各测量点均高于对照组(P0.05或P0.01),试验组家庭照顾者照顾能力在各测量点均低于对照组(P0.05或P0.01)。[结论]以时机理论为基础的居家护理,能更有效地提高中青年脑卒中病人的自我护理能力及其家庭照顾者的照顾能力。     

脑卒中照顾者健康教育路径的设计与应用

目的:探讨适合脑卒中照顾者的不健康教育路径,提高脑卒中照顾者疾病相关知识及康复护理技能.方法:将112例照顾者及其照顾的脑卒中患者分别分为实验组和对照组各56例,实验组照顾者按健康教育路径模式进行健康教育,对照组照顾者采用传统健康教育方法.结果:实验组照顾者对疾病相关知识、基础护理、康复护理知识掌握情况均明显优于对照组(P＜0.01);住院满意度调查满意率也显著高于对照组(P＜0.01),患者并发症发生率也显著低于对照组(P＜0.01);随访3个月后,实验组患者简化Fugl-Meyer运动功能评分及Barthel指数评定均显著高于对照组(P＜0.05).结论:健康教育路径应用于脑卒中患者的照顾者,能显著提高照顾者的护理知识及康复护理技能,提高照顾者的照顾能力及照顾质量,降低脑卒中患者并发症的发生率及残疾率,促进脑卒中患者的全面康复.     

老年股骨颈骨折43例围术期护理

目的：探讨适合脑卒中照顾者的不健康教育路径,提高脑卒中照顾者疾病相关知识及康复护理技能。方法：将112例照顾者及其照顾的脑卒中患者分别分为实验组和对照组各56例,实验组照顾者按健康教育路径模式进行健康教育,对照组照顾者采用传统健康教育方法。结果：实验组照顾者对疾病相关知识、基础护理、康复护理知识掌握情况均明显优于对照组（P〈0．01）;住院满意度调查满意率也显著高于对照组（P〈0．01）,患者并发症发生率也显著低于对照组（P〈0．01）;随访3个月后,实验组患者简化Fugl—Meyer运动功能评分及Barthel指数评定均显著高于对照组（P〈0．05）。结论：健康教育路径应用于脑卒中患者的照顾者,能显著提高照顾者的护理知识及康复护理技能,提高照顾者的照顾能力及照顾质量,降低脑卒中患者并发症的发生率及残疾率,促进脑卒中患者的全面康复。     

家庭访视对脑卒中患者照顾者照顾负担及积极体验的影响研究

目的探讨家庭访视对脑卒中患者照顾者照顾负担及积极体验的影响。方法将入选的80例脑卒中患者照顾者随机分为实验组和对照组,每组40例;实验组接受家庭随访式的护理干预,对照组接受常规护理指导。24周后,采用Zarit照顾者负担量表和照顾者积极感受量表评估脑卒中患者照顾者的照顾负担和积极感受情况。结果干预结束后比较,实验组的照顾负担明显低于对照组,实验组的积极体验高于对照组,差异均有统计学意义(P0.01)。结论采用家庭访视的干预模式对脑卒中患者照顾者进行指导和干预可降低照顾者照顾负担,增加其积极体验。     

基于时机理论以家庭为中心的护理模式对急性脑出血患者照顾者照顾能力的影响

目的 评价基于时机理论(timing it right,TIR))的以家庭为中心的护理模式(patient and family-centered care,PFCC)对急性脑出血患者照顾者的照顾能力、照顾负担影响.方法 将2018年3月至8月本院收治的脑出血患者33例及其照顾者33名设为对照组,给予常规康复健康教育指...     

赋权教育在脑卒中患者家庭照顾者中应用状况的范围综述

目的 对赋权教育在脑卒中患者家庭照顾者中的应用进行范围综述,为其临床推广应用和未来研究提供参考。方法 对发表于建库至2022年2月20日的万方、中国知网、维普、中国生物医学文献数据库、Pubmed、Embase、Web of Science、CINAHL、Cochrane Library进行检索,并提取文献信息,进行资料汇总和讨论。结果 最终纳入18篇文献,纳入文献的赋权教育形式主要归纳为个体化教育、小组讨论、以健康管理手册为基础的教育、同伴支持教育、电话随访、家庭访视和在线随访。赋权实施流程为明确照顾问题、表达情感、设立照顾目标、制定切实可行性方案、实施照顾方案和效果评价。结局类别主要对脑卒中患者家庭照顾者干预效果和可行性进行总结与分析。结论 赋权教育有助于对脑卒中患者家庭照顾者产生积极效果,从而直接影响患者的健康结局。未来可多深入探讨赋权教育对脑卒中患者及其家庭照顾者二元教育的相关促进和阻碍因素,并结合“互联网+医疗健康”发展以家庭为基础的精准化远程照顾干预。     

脑卒中偏瘫患者主要照顾者出院准备教育的实践研究

目的探讨出院准备教育对脑卒中偏瘫患者主要照顾者的照顾能力和患者并发症发生率、肢体肌力恢复的影响。方法采用便利抽样法将脑卒中患者的主要照顾者87人分成对照组40人和观察组47人。对对照组照顾者实施常规健康教育和出院指导,对观察组照顾者实施出院准备教育。出院前比较两组主要照顾者的护理知识及技能考核得分情况;出院后3月比较两组患者并发症的发生率和偏瘫侧肢体肌力恢复情况。结果观察组主要照顾者的护理知识及技能考核得分明显优于对照组;观察组脑卒中患者并发症发生率低于对照组、偏瘫侧肢体肌力恢复优于对照组。结论对脑卒中主要照顾者实施出院准备教育,能有效提高照顾能力,提高家庭护理质量,降低脑卒中患者并发症的发生率。     

健康教育路径在脑卒中患者主要照顾者中的应用研究

目的探讨健康教育路径在脑卒中患者主要照顾者中的应用效果。方法将73例脑卒中患者的主要照顾者按照患者入院时间随机分为试验组和对照组,试验组主要照顾者按自行拟定的健康教育路径表进行健康教育,对照组主要照顾者采用传统健康教育方法。比较两组主要照顾者对疾病相关知识和护理技能掌握的程度。结果试验组主要照顾者掌握的ADL训练知识和主要技能均明显优于对照组,差异有统计学意义(P﹤0.05),试验组的患者ADL得分的提高明显优于对照组,在出院时及出院后三个月比较差异均有统计学意义(P﹤0.05)。结论应用健康教育路径对脑卒中患者主要照顾者实施健康教育,能显著提高照顾者的疾病知识及康复护理技能,提高照顾者的照顾能力及照顾质量,提高脑卒中患者的自理能力。     

照顾技能培训对脑卒中患者照顾者照顾压力及生活质量的影响

目的:探讨照顾技能培训对脑卒中患者照顾者照顾压力及生活质量的影响。方法:将150例脑卒中患者照顾者按入院时间先后次序随机分为实验组和对照组各75例,实验组对照顾者实施个体化、系统性照顾技能培训,对照组按常规护理方法进行干预。采用脑卒中照顾者综合照顾能力评估问卷评价照顾者脑卒中相关知识认知,以照顾者压力量表和SF-36量表评价两组干预3个月后照顾压力与生活质量。结果:实验组脑卒中相关知识平均得分高于对照组(P0.01),实验组总压力平均得分低于对照组(P0.01),实验组PF、RP、MH、VT、GH得分均高于对照组(P0.05,P0.01)。结论:住院期实施个体化、系统性照顾技能培训,能有效地提高照顾者脑卒中相关知识和照顾技能,缓解居家照顾压力和提高生活质量。     

长期护理保险制度下家庭赋权方案在脑卒中患者居家照护中的应用

目的 探讨长期护理保险制度下,家庭赋权方案在首发脑卒中出院患者居家照护中的应用效果。方法 采用前瞻性研究方法,便利抽取80例首发脑卒中患者作为研究对象,试验组40例,对照组40例。试验组接受家庭赋权方案干预,对照组接受住院期间的健康教育、出院指导及延续护理,应用中风自我管理行为评定量表、Zarit照顾者负担量表及家庭照顾者照顾能力测量表(FCTI)评价干预效果。结果 干预前,两组患者及家庭照顾者的一般资料差异无统计学意义,且两组患者的中风自我管理行为评定量表评分、两组患者家庭照顾者的Zarit照顾者负担量表评分及FCTI量表评分比较,差异均无统计学意义(P>0.05)。干预后,两组患者的中风自我管理行为评定量表评分、两组患者家庭照顾者的Zarit照顾者负担量表评分及FCTI量表评分比较,差异有统计学意义(P<0.05)。结论 长期护理保险制度下,家庭赋权方案能有效改善首发脑卒中患者的自我管理行为,减轻家庭照顾者的照顾负担,提高家庭照顾者的综合照顾能力,从而提高脑卒中患者的家庭照护质量。     

Influence of stroke survivor characteristics and family conflict surrounding recovery on caregivers' mental and physical health

BACKGROUND: Stroke recovery is a dynamic process for stroke survivors, and shorter lengths of stay in healthcare settings shift the care of the survivors to family caregivers. The physical and mental sequelae after stroke and the family's response to this catastrophic event may have deleterious effects on caregivers. OBJECTIVE: To examine the influence of stroke survivors' motor function, their memory and behavior changes, and the family conflict surrounding stroke recovery on the mental and physical health of caregivers during the subacute recovery period. METHODS: This cross-sectional, correlational study used baseline data from family caregivers (n = 132) and first-time stroke survivors enrolled in a larger multisite study. RESULTS: The caregivers were primarily White (71%), female (74%), college-educated (73%) spouses (80%) of survivors. Most of the caregivers (66%) reported family conflict. The caregivers from families with lower family functioning scores reported worse mental health.The caregivers reported lower mental health when they were caring for stroke survivors with a combination of high memory/behavior changes and low motor function (R =.30). Family conflict appears to exacerbate the impact of memory and behavior changes on caregiver mental health. Higher caregiver education and no major health problems were associated with better caregiver physical health (R =.36). Caregiver physical health was not associated with family functioning or stroke survivor memory and behavior changes. CONCLUSIONS: These results indicate that memory and behavior changes of stroke survivors and family conflict surrounding stroke recovery are important considerations for assessment during the poststroke recovery period.     

授权教育对脑卒中患者照顾者准备度及照顾行为的影响

目的 探讨授权教育对脑卒中患者照顾者准备度及照顾行为的影响。 方法 选取84例脑卒中患者照顾者作为研究对象,采用随机数字法将其分为观察组和对照组各42例,观察组采用授权教育法,对照组采用传统的健康教育方法,比较2组患者照顾者准备度及照顾行为。 结果干预后,观察组照顾准备度总分及照顾行为总分均高于对照组(t=2.243,P=0.028; t=2.693,P=0.009)。 结论 授权教育可以提高脑卒中患者照顾者准备度及照顾行为水平。     

A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers

Aims. To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan. Background. Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families. Design. A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers. Methods. The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver‐oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale. Results. Caregivers in the experimental group had significantly better nurse evaluation and self‐evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self‐evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs. Conclusions. This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge. Relevance to clinical practice. This caregiver‐oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers’ preparation and the satisfaction of their needs during the discharge transition.     

Effectiveness of a strength-oriented psychoeducation on caregiving competence,problem-solving abilities,psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial

BackgroundFamily caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.ObjectivesTo evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver’s depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors.DesignA prospective multi-centre and single-blinded randomised controlled trial stratified by survivors’ history of stroke.Setting and participantsAdult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong.MethodsThe design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests.ResultsWe recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers.ConclusionsFindings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors.     

A comparison of working versus nonworking family caregivers of stroke survivors.

Because of the trend toward shorter hospital stays, family caregivers of stroke survivors are expected to accept more responsibility for helping survivors during the subacute recovery process. The caregiver role is associated with negative health outcomes, yet existing literature differs on whether work status is a contributor. The purpose of this secondary analysis was to examine how caregiving affects employment and to compare characteristics of working and nonworking caregivers. Baseline data of family caregivers (N = 132) caring for stroke survivors 3-9 months after stroke and enrolled in a national multisite study were used. Caregiver characteristics of physical health, depression, fatigue, family functioning, and family conflict were measured. A total of 36% of caregivers reduced their work hours, resigned, or retired from their jobs to care for their family member. A larger proportion (n = 25, 66%) of minority caregivers were employed (full time or part time) compared to white caregivers (n = 43, 46%). Caregivers employed full time were younger and in better physical health but were at higher risk for depressive symptoms than nonworking caregivers. Family function and conflict were similar between the groups, but working caregivers received more assistance from other family members. Healthcare professionals and employers can use these findings to assist them with recognizing the needs of employed caregivers and offering support measures to facilitate their dual role.     

对回肠造口患者主要照顾者实施家庭赋权的效果观察

目的 探讨家庭赋权在回肠造口患者主要照顾者中的应用效果。方法 选取2019年8月—2020年8月实施回肠造口手术患者的主要照顾者74例为研究对象,按随机数字表法分为观察组和对照组,每组各37例。对照组接受常规健康教育,观察组实施基于家庭赋权的健康教育。观察比较2组患者主要照顾者的照顾准备度、照顾负担及照顾能力情况。结果 经干预后,2组患者主要照顾者的照顾准备度评分较同组干预前上升,照顾负担和照顾能力评分较同组干预前均下降,且观察组的照顾准备度评分高于对照组,照顾负担及照顾能力评分低于对照组,差异均有统计学意义（P<0.05）。结论 家庭赋权护理应用于术后健康指导中,可有效帮助回肠造口患者主要照顾者提高照顾准备度、照顾能力及积极感受,减轻负担水平。     

Female caregivers of stroke survivors: coping and adapting to a life that once was

Despite the prevalence of women caring for stroke survivors, relatively little research has focused specifically on the experience and needs of informal female caregivers of stroke survivors. Therefore, the purpose of this study was to describe the experience of female caregivers who care for an adult family member who has experienced a stroke within the previous year using a qualitative methodology. A sample of 46 female caregivers of stroke survivors completed a demographic form and responded to open-ended written questions exploring their experiences as caregivers and how they coped with changes in their lives during the first year after the stroke. Four concepts emerged from the data: losing the life that once was, coping with daily burdens, creating a new normal, and interacting with healthcare providers. Findings suggest that female caregivers of stroke survivors grieve the life that they once shared with the stroke survivor and struggle to cope with multiple family and work demands while trying their best to interact with healthcare providers to attain the best possible care for their loved ones. Recognizing the unique challenges of female caregivers of stroke survivors may help nurses provide better support and resources to meet their needs.     

健康教育视频在脑卒中照顾者中的应用

目的探讨应用视频对脑卒中照顾者进行健康教育的方法及效果。方法收集并制作脑卒中健康教育及康复指导的视频,使用移动护理车车载电脑在床边护理过程中进行视频播放,对脑卒中照顾者实施健康教育。回顾性比较采用移动护理车车载视频系统结合传统方法进行健康教育的脑卒中照顾者和进行传统健康教育的脑卒中照顾者的照顾能力。结果在传统健康教育的基础上采用视频宣教,脑卒中照顾者的照顾能力高于以往传统健康宣教后的照顾者(P<0.05)。结论视频宣教方式调动了患者及照顾者接受健康教育的积极性,保证健康教育内容传递的准确性,提高了照顾者的照顾能力。