早产儿照护者家庭护理知识掌握情况调查分析

目的 了解早产儿照护者对早产儿家庭护理知识的掌握情况及需求,为出院早产儿的健康教育提供依据.方法 采用自设问卷对108名早产儿照护者进行调查,内容为照护者早产儿相关护理知识、照护者现有护理知识获得的主要途径及希望住院期间健康教育的方式与出院后进一步获得健康知识的途径.结果 本次调查108名照护者护理知识测试总分13～46(27.79±5.36)分;对不同护理内容知晓率不同,早产儿的日常护理知识得分最高,生长发育知识得分最低;现有护理知识主要来源于孕妇学校、媒体及长辈、亲戚、朋友.住院期间希望的健康教育方式:首选护士个别指导(65.7%),次选医院提供教育资料或手册(59.3%);出院后希望进一步获得健康知识的途径:首选医院设立热线电话咨询.结论 早产儿照护者对早产儿家庭护理知识知晓率低,护士应针对不同人群采用不同形式的健康教育,不断改进健康教育模式,扩大护理服务范围,降低早产儿再就诊率和再住院率.     

脑卒中家庭照护者出院准备度现状调查及影响因素分析

[目的]了解脑卒中家庭照护者出院准备度现状及影响因素,为临床护理措施的制定提供相应的理论依据。[方法]采用自行设计的"家庭照护者基本情况调查表"以及中文版《家庭照护者出院准备度量表》对便利抽样的166名脑卒中家庭照护者进行问卷调查。[结果]8个条目中得分最高是照护活动准备情况,得分为(2.70±0.80)分,得分最低是面对照护压力准备情况,为(1.36±0.76)分,家庭照护者出院准备度量表总分为(16.35±7.38)分;不同年龄、文化程度、角色、酬金等相关因素的照护者对出院准备水平有影响,与年龄呈负相关,与文化水平、酬金呈正相关,雇佣角色比亲人角色出院准备水平高(P0.01)。[结论]脑卒中家庭照护者的出院准备度中照护压力准备处于最低水平状态,需采取护理干预措施扩大照护者的知识来源,对不同类型的照护者,进行针对性的健康教育以提高照护者的照护技能,并逐步完善相关体系,减轻照护者压力负担,确保病人生命质量。     

食管癌手术病人主要照护者照护能力及照护需求的调查分析

[目的]了解食管癌手术病人主要照护者的照护能力及照护需求,分析其影响因素,为制定针对性的干预措施提供依据。[方法]采用问卷调查法,应用自行设计的食管癌手术病人照护者照护能力自评问卷、食管癌手术病人照护者照护相关健康教育需求问卷对某三级甲等肿瘤专科医院食管癌手术病人及主要照护者各56例进行调查。[结果]食管癌手术病人主要照护者照护能力自评总分为67.09分±8.01分,其中手术相关知识、相关操作技术、行为态度、决策及自我效能自评得分分别为(20.11±2.93)分、(22.34±2.35)分、(15.59±2.55)分、(8.57±1.88)分。影响食管癌手术病人主要照护者照护能力的因素包括照护者与病人的关系、文化程度、家庭收入、照护经历、对医务人员指导理解程度、病人术后自理能力。出院前主要照护者对及时得知病情变化、了解住院费用、术后不适及应对方法、如何预防并发症的需求分别为94.6%、92.8%、92.8%、92.8%;出院后对病人复查、异常情况、用药的注意事项、健康等相关知识需求分别为98.2%、98.2%、94.6%、92.8%。[结论]医务人员应关注食管癌手术病人主要照护者出院前后的照护能力和照护需求,通过评估并给予个体化护理服务满足其照护需求,促进病人康复。     

长沙市某区失能老人家庭照护者照护知识和技能现状及需求研究

目的了解长沙市某区失能老人家庭照护者照护知识和技能现状及需求。方法 2016年12月,采用滚雪球法选取长沙市某区失能老人家庭照护者96名为研究对象,采用中文版Barthel指数量表评定失能老人的日常生活能力,同时使用失能老人照护知识问卷和照顾者所需知识与技能表对照护者进行调查。结果家庭照护者照护知识平均得分为(17.87±6.92)分。不同年龄、文化程度以及与失能老人亲属关系不同的家庭照护者,其照护知识的掌握情况差异均有统计学意义(均P0.05)。家庭照护者对照护知识和技能需求的平均得分为(62.76±12.15)分。高中及以下人员、失能者的配偶及子女和照护的失能者Barthel指数较低者,其照护知识的需求得分较高,与其他照护者相比,差异有统计学意义(P0.05)。家庭照护者对照护知识技能的需求排在前5位为疾病知识、康复、用药、身体不适和预防处理褥疮知识。结论长沙市某区失能老人的家庭照护者照护知识和技能亟待加强,学习需求强烈,应对其开展照护知识和技能培训。     

新生儿监护室医护人员早产儿互动知识调查

[目的]了解新生儿监护室医护人员早产儿互动知识掌握状况.[方法]采用早产儿互动知识量表及方便取样方法,调查上海市4所三级医院新生儿监护室的60名医生和68名护士对早产儿互动知识的掌握情况.[结果]医护人员早产儿互动知识得分为14.21分±2.03分,正确率为71.1%.医生组早产儿意识状态知识得分(3.53分±0.93分)显著高于护士组(2.99分±0.82分)(P<0.05).[结论]新生儿监护室医护人员对早产儿互动知识的掌握有待提高,医护人员应更加重视与早产儿互动,促进早产儿发育支持性照护和开展以家庭为中心的照护.     

微信健康教育对早产儿出院家庭准备度的影响

目的探讨微信健康教育在提高早产儿出院家庭准备度中的应用效果。方法将180名早产儿主要照顾者作为研究对象,按早产儿入院时间分为对照组和观察组,2015年7—12月入住新生儿科的早产儿主要照顾者90名为对照组,2016年1—6月入住新生儿科的早产儿主要照顾者90名为观察组。对照组接受常规的早产儿照护健康教育,观察组在对照组的基础上接受微信健康教育。比较2组干预前和出院当天的一般自我效能量表得分、早产儿出院家庭准备度得分及护理满意度。结果干预前2组早产儿主要照顾者一般自我效能量表得分、早产儿出院家庭准备度各维度得分及总分比较差异均无统计学意义(P0.05);出院当天观察组的一般自我效能量表得分、早产儿出院家庭准备度各维度得分及总分均高于对照组(P0.05);出院当天观察组的护理满意度得分及满意率均高于对照组(P0.05)。结论微信健康教育可以提高早产儿主要照顾者的自我效能和对早产儿照护知识的掌握程度,提高早产儿出院家庭准备度,并提高护理满意度。     

小群体式健康教育对提高早产儿照护者照护知识的影响

目的:建立以小群体为基础的早产儿照护者健康教育课程,探讨其对早产儿照护知识和课程满意度的影响。方法:本研究纳入50名早产儿照护者采用方便取样法分成4个小群体组,每组10~15名,建立合理喂养、呼吸管理、预防感染、发育照顾护理4项内容的健康教育方案。用自行设计的"早产儿照护知识"试卷和"课程满意度"问卷收集受教育早产儿照护者知识得分及对课程的满意程度。结果:早产儿照护者知识得分从教育前的(43.92±14.82)分提高到教育后的(61.72±13.89)分,教育前后差异有统计学意义(P0.01);对组织形式和课程设置的总体满意度均为100%,满意度最高的前两项内容是发育照顾护理和预防感染。结论:以小群体为基础的早产儿照护者健康教育课程具有提高早产儿照护知识水平的近期效果,其教学组织形式和内容设置得到早产儿照护者的一致好评。     

早产儿照护者实施基于赋能授权理论干预的效果探析

目的探讨对早产儿照护者实施基于赋能授权理论干预的效果。方法选择2017年6月至2019年6月在江阴市人民医院住院的早产儿照护者108名，按照随机数字表法分为对照组和观察组，各54名。对照组照护者出院后行常规健康教育，观察组照护者行基于赋能授权理论干预。对比两组照护者出院前后连续护理认知水平、负性情绪变化及护理满意度。结果出院前3 d，两组照护者连续护理认知水平、焦虑、抑郁评分差异无统计学意义（P＞0.05）。出院3个月后观察组照护者连续护理认知水平总分及各条目得分（疾病防护相关知识与技能、日常照护相关知识与技能、社会服务相关知识、康复相关知识与技能）均高于对照组（P＜0.05）；焦虑、抑郁评分均低于对照组（P＜0.05）；观察组照护者对护理工作满意度高于对照组（P＜0.05）。结论对早产儿照护者实施基于赋能授权理论干预可显著提升照护者护理认知水平，减轻其负性情绪，提高其对护理工作的满意度，值得推广。     

早产儿出院后对家庭护理需求的调查研究

目的 调查早产儿家庭照护者对出院后的需求现状,探讨其影响因素.方法 选取我院211例早产儿为研究对象.采用自行设计调查问卷进行家庭护理需求调查分析.结果 照护者对出院后家庭护理有较高需求,随访方式希望采用电话随访,占比62.5％.生活中对喂养知识需求较高,占比67.3％.出院后照护者希望能对其心理进行照护,特别是照护压力方面.结论 早产儿照护者对家庭照护需求迫切,需求内容包括:喂养知识、小儿抚触、疾病护理,对知识和后续长期的护理需求,亟待建立健全完善早产儿家长中心式照护体系,完善院前、院后的护理.     

早产儿出院后父母居家照护需求调查分析

目的了解早产儿出院后父母的居家照护需求,探讨有效延续家庭护理的对策,为提高早产儿生存质量提供实证依据。方法自行设计调查问卷,采用方便抽样对105名出院初期早产儿父母的居家照护需求进行横断面问卷调查。结果早产儿父母的居家照护需求总得分为（3．30±0．81）分,各项照护需求依次为获得再保证需求（3．46±0．75）分、医疗信息需求（3．39±0．71）分、照护能力需求（3．29±0．86）分、社会支持需求（3．08±0．92）分。在22个单项需求中,早产儿父母认为接近非常重要的需求有10项,其余12项需求内容为重要和接近重要。结论出院后早产儿父母的居家照护需求较高,其照护需求呈现多层次、多方面,应根据早产儿父母的照护需求特点进行健康教育,实施以家庭为中心的护理,建立从医院过渡到家庭护理的健康管理模式。     

Early Palliative Care Initiation: Role of the Primary Care Clinician

Palliative care provided to patients with chronic life-limiting illnesses shows improvement in symptom management, quality of life, and caregiver support while reducing cost of care. Early initiation of palliative care faces a multitude of barriers in the primary care setting, including provider confidence, coordination and implementation, education, and family and patient misconceptions. A team-based approach along with additional education, clear referral triggers, and resources for advanced-care planning discussions allows providers to overcome many of these barriers. With the population’s advancing age, it is essential that primary care providers are properly prepared for early initiation of palliative care.     

Advance care planning in Belgium and The Netherlands: a nationwide retrospective study via sentinel networks of general practitioners

Context

Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe.

Objectives

To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors.

Methods

A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present.

Results

Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient’s family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4-6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6-4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7-4.1), died of cancer (OR 1.46; 95% CI 1.1-2.0), or died at home (OR 2.16; 95% CI 1.5-3.0).

Conclusion

In these countries, ACP is done with approximately one-third of the studied terminally ill patient population. Most agreements are made only verbally, and care also is often planned with family only. ACP relates strongly both to patient factors and to health care measures performed at the very end of life.     

Sheltered housing compared to independent housing in the community

Background:  With elderly people desiring to live independently as long as possible, traditional homes for the elderly are increasingly being transformed into sheltered accommodations. In order to assess the importance of housing for frail elderly people, elderly people at risk for institutionalization were studied in two living conditions: sheltered accommodation and living independently in the community.
Methods:  A total of 317 elderly people at risk for institutionalization [91 men and 240 women, mean age = 83.3 (SD = 6.0)] were interviewed using a structured questionnaire with questions regarding home care and social service use, quality of life, subjective well-being, life satisfaction, autonomy, functional status, feelings of insecurity and loneliness.
Results:  Exactly 56.5% of the respondents were living in sheltered accommodation (n = 179) and 43.5% (n = 138) were living in regular houses. Although both groups were similar in demographic details and functional status, those in sheltered accommodation had a higher perceived autonomy, sense of security and quality of life. No differences were found with regard to subjective well-being or feelings of loneliness. Elderly people in regular houses needed more hours of housekeeping assistance. Those in sheltered accommodation participated more frequently in services like social activities and social restaurants, but made less use of day care facilities.
Conclusions:  Affordable, decent and suitable noninstitutional housing with service provision play a vital role in the lives of elderly people. Compared with independent living in the community, sheltered accommodations provide added value. Sheltered housing should therefore be an integral part of long-term care policy.     

The challenges in adopting care pathways for the dying for use in care homes

An increasing number of older people are requiring palliative care within the care home setting. There are currently a number of initiatives that are generally gaining approval and being implemented within health care in general with the goal of improving standards of palliative care. These are the Integrated Care Pathway for the dying person, the Gold Standards Framework and the Preferred Place of Care document. The Liverpool Care Pathway is being used across a wide range of care settings to improve care in the last 24–48 hours of life and is being implemented in care homes as part of a national rollout programme. This article aims to explore some of the issues associated with the use of the care pathways in care homes, particularly without the input of additional resources and support for the care homes. It also questions the appropriateness of the pathway in its current format without further work on the specific palliative care needs of the residents dying in care homes.     

Is integrated nursing home care cheaper than traditional care? A cost comparison

Background

It is generally assumed that integrated care has a cost-saving potential in comparison with traditional care. However, there is little evidence on this potential with respect to integrated nursing home care.

Aims and objectives

• • 

  To portray the costs of traditional and integrated nursing home care.

• • 

  To explore the cost-saving potential of integrated care.

Design/methods/settings/participants

Between 1999 and 2003, formal and informal caregivers of different nursing homes in the Netherlands recorded activities performed for residents with somatic or psycho-social problems. In total, 23,380 lists were analysed to determine the average costs of formal and informal care per activity, per type of resident and per nursing home care type. For formal care activities, the total personnel costs per minute (in Euro) were calculated. For informal care costs, two shadow prices were used.

Results

Compared to traditional care, integrated care had lower informal direct care costs per resident and per activity and lower average costs per direct activity (for a set of activities performed by formal caregivers). The total average costs per resident per day and the costs of formal direct care per resident, however, were higher as were the costs of delivering a set of indirect activities to residents with somatic problems.

Conclusions

The general assumption that integrated care has a cost-saving potential (per resident or per individual activity) was only partially supported by our research. Our study also raised issues which should be investigated in future research on integrated nursing home care.     

Pediatric palliative care

Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included.     

Use of Care by Home-dwelling Stroke Patients during Three Years following Hospital Discharge

Of 82 stroke survivors who had been discharged from hospital, 49 were still living at home after a three-year period. Thirty-three of these patients formed the population of the present study of the use of care at home. Sixty-one percent had received professional care and 88% had received family care. Although their overall functional status indicated only mild handicaps, after three years patients still reported a large number of disabilities and problems. The average weekly amount of family care was 37 h, and many family carers experienced a high burden of care and had emotional problems coping with the patients' disabilities. Concerning factors related to the use of care, in spite of the relatively small number of study patients, some interesting hypotheses can be advanced.     

ICUs worldwide: an overview of critical care medicine in South Africa

South Africa has undergone rapid changes in the political and social arenas since 1994. With new policy-makers in the Department of Health, the distribution of health care resources are being rationalised and redirected to benefit the majority of the previously disadvantaged population of the country. The role and rationalisation of intensive care medicine has to be re-evaluated to ascertain that it is at a level appropriate for a developing country. Despite progress made, the subspecialty of intensive care medicine faces challenges from changing disease patterns and from lack of human and financial resources as these are redirected to primary health care and other priorities facing the country.     

Consensus of the Millennium Conference on Teaching High Value Care

Issue: Healthcare costs have spiraled out of control, yet students and residents may lack the knowledge and skills to provide high value care, which emphasizes the best possible care while reducing unnecessary costs. Evidence: Mainly national campaigns are aimed at physicians to reconsider their test ordering behaviors, identify overused diagnostics, and disseminate innovative practices. These efforts will fall short if principles of high value care are not incorporated across the spectrum of training for the next generation of physicians. Implications: Consensus findings of an invitational conference of 7 medical school teams consisting of academic leaders included strategies for institutions to meaningfully incorporate high value care into their medical school, residency, and faculty development curricula.