The contribution of psychologists to specialist palliative care

Current approaches to multidisciplinary working in specialist palliative care generally acknowledge the need for psychological care and the contribution of specialist psychological services. Embedded within an integrated approach to care, there has long been a recognition of the psychological needs of patients and their informal caregivers, although there has been less consensus on how these needs should be addressed. Confusion appears to exist regarding the boundaries between psychological support and psychological interventions, and which members of the multidisciplinary team are best qualified to provide them. This article aims to explore the contribution of psychologists and psychological services to specialist palliative care. It offers a conceptual model to help categorize psychological care in hospices and specialist palliative care services. It seeks to help define the boundaries between general psychological support and care that may be offered by nurses and other health care professionals, and the specialist expertise of psychologists.     

彝良地震伤员的支持性心理干预模式

在“9·7”彝良地震伤员集中救治的医院里,由国家卫生和计划生育委员会指派的彝良心理危机干预工作组发展了以支持性心理干预为核心的整体康复服务模式。该模式以病房心理护士作为联络者,立足于医学服务的整体性与连续性,在全面健康评估与重点评估心理创伤应激的基础上,以解决患者及照顾者的现实问题为重点,提供支持性心理干预,并借助社会心理支持服务内容量化的自评来激励心理护士对地震伤员提供的心理支持工作。在实践中,该模式能够得到医院管理者及医务工作者的积极配合,患者及家属普遍接受,具有连续心理服务的可操作性。     

Dimensions of informal care in Greece: the family's contribution to the care of patients hospitalized in an oncology hospital

Aims and objectives. This study aims to explore the kind and frequency of care provided to hospitalized cancer patients by relatives and the reasons for providing this care. Background. Informal care is a common phenomenon across many countries. In Greece, informal caring activities occur in most hospitals. Patients’ relatives stay by their bedside for long hours and assist with care. This phenomenon is highly correlated with the nursing staff shortage. Method. This study was carried out in a Greek oncology hospital. The sample consisted of 150 informal caregivers. We used a 37‐item questionnaire called In‐Hospital Informal Care Questionnaire Acute Care. Results. The participants provide substantial help to their patients daily. On average, they stay by their bedside for 20·23 hours in a 24‐hour period. Additionally, 104 participants stated that they hire a privately paid patient's helper. The relatives stay by their patients’ bedside for various reasons such as: (1) severity of the condition; (2) providing psychological support; (3) family tradition; (4) because they do not believe their patients are safe in the hospital without their supervision; or (5) the nursing staff shortage. Conclusions. The participants offer informal care that reflects specific nursing duties. We could argue that Greek hospitals ‘use’ relatives as unpaid labour to compensate for the nursing shortage. It is disquieting that usually someone from the hospital staff suggests to the relatives to stay at the patient's bedside even after visiting hours or to hire a private paid patient's helper. This implies that the staff considers such contribution necessary. Relevance to clinical practice. The findings show that relatives perform daily tasks that nurses should be performing. They indicate that the hospital should introduce specific staffing policies for reducing families’ burden. Our findings could influence future staffing plans of nursing managers, policy makers or health authorities.     

Caregivers’ morbidity in palliative care unit: predicting by gender, age, burden and self-esteem

Purpose

This study assesses psychological distress suffered by caregivers of patients with a disease at an advanced and terminal state admitted at a palliative care unit. Specifically, these areas were examined in how distress was perceived: the contribution of caregiving burden, caregivers’ self-esteem, caregivers’ age and gender.

Methods

The sample constituted of 159 caregivers. Measurements included the Hospital Anxiety and Depression Scale (HADS) to assess distress, the shortened version of the Zarit Burden Inventory and Rosenberg self-esteem scale.

Results

Approximately 77% of the caregivers reported probable significant distress (HADS ≥12), with a similar proportion with anxiety (76.1%) and depression (77.4%) within the caregivers’ symptomatology. Multiple regression analysis revealed that the caregivers’ self-esteem (p?<?0.01) and caregivers’ burden (p?<?0.01) were stronger predictors of caregivers’ distress than the socio-demographic characteristics, age or gender (p?<?0.05).

Conclusions

A high prevalence of morbidity was noticed in caregivers of patients admitted at the palliative care unit. The early provision of psychological support to caregivers by healthcare staff may indeed help to decrease comorbidity symptoms.     

Experiencing Missing Contact With Professionals and Long Term Bereavement Outcome

ContextThe Danish health care system provides palliative care for terminally ill patients and their family caregivers. However, initiatives to support family caregivers are not systematically organized.ObjectivesWe aimed to examine the association between self-reported experience of missing contact to health care professionals involved in palliative care, and symptoms of grief and depression three years post-loss.MethodsWe conducted a prospective population-based survey of 3635 family caregivers to terminally ill patients. At six months follow-up, the caregivers reported whether they missed contact to the general practitioner, home care nurse, hospital staff, and/or palliative care team. Associations between missing contact and symptoms of prolonged grief (Prolonged-Grief-13) and depression (Beck Depression Inventory-II) three years after bereavement were analyzed with multivariable logistic regression analysis.ResultsWe found that an experience of missing contact with health care professionals six months after bereavement was significantly associated with symptoms indicative of prolonged grief disorder and depression after three years. The strongest association was found for missing contact with the general practitioner with an adjusted OR = 4.0 (95%CI: 1.9;8.3) for prolonged grief and an adjusted OR = 5.2 (95% CI: 3.4;7.9) for depression.ConclusionExperiencing missing contact with health care professionals shortly after bereavement was associated with adverse psychological reactions. Family caregivers may benefit from bereavement support to prevent further complications. A proactive approach with assessment of support needs and risk of complications early during the patient's illness trajectory may target support at those who needs it.     

Development process and qualitative evaluation of a program to promote the mental health of family caregivers

The purpose of this study was to develop and evaluate, through a participatory approach, an intervention program to promote the mental health of women caregivers in institutions. Focus groups were first organized to explore sources of stress for daughter and spousal caregivers. Workshops in which caregivers developed the content of a group program were then organized. The aims of the program were to increase empowerment and self-efficacy and to decrease stress and psychological distress of caregivers. Experimentation and qualitative evaluation of the program led to 10 weekly meetings covering the following topics: how to feel good with my relative, how to discuss with staff, how to appraise my experience differently, coping with my relative's losses, how to reorganize my life, and how to identify and ask for social support. This study provides a structured program to support family caregivers and a research method empowering families.     

Discharge of the older person from the emergency department - the perceptions of health professionals

Aims of study. This study aimed to examine the management of the older person in preparation for discharge home from an emergency department by exploring the perceptions of health professionals on procedures undertaken particularly in relation to the planned support, supply of medications, dressings, and contact information given to patients. An additional aim related to the perceived satisfaction levels of older patients and their carers. Background. It is imperative that older patients are adequately prepared for discharge home from the emergency department so as to avoid unnecessary anxiety, increase in health problems and possible re‐attendance or admission to hospital. Design. The sample in this study comprised the total population (n = 222) of all medical and nursing staff in both the emergency department and the primary care area. Methods. The method adopted was a survey approach which employed the use of standardized questionnaires comprising both open and closed questioning styles. Results. The data obtained identified results similar to previous research in that a discrepancy exists between hospital and community staff in relation to the procedures undertaken when discharging older people from the emergency department, such as arranging follow‐up care and appointments and giving the patient relevant contact numbers and dressings. Conclusion. The findings of this study support previous research in that there is a need to provide patients with planned support, aids and appliances, clear instructions and relevant contact numbers on discharge from the emergency department. Relevance to clinical practice. Good quality discharge planning is essential for a continuum of care for older people discharged from the emergency department. While patient education is often difficult in the busy emergency department, the provision of relevant information to older patients prior to discharge is essential particularly in relation to prescribed medications and wound care.     

Intervention to promote recognition of the rights of families of an elderly relative with dementia living in a long-term care facility

The rights of families of an institutionalized elderly relative with dementia have yet to be recognized. The results of our pilot study based on a participatory approach show, among other things, that family caregivers, women for the most part, have little input in the decisions regarding their relative's care and are uneasy to express their opinions to health care staff. As part of the pilot study, caregivers developed a group intervention program entitled "Taking Care of Myself" geared, among other things, towards increasing their competence in expressing their viewpoint to health care staff and in taking part in care-related decisions. According to an efficacy study conducted after the pilot study, the program produced successful outcomes in terms of caregiver competence in dealing with the health care staff and of perceived challenge of the caregiver situation. Recommendations are made aimed at giving caregivers recognition, that is their due.     

新型冠状病毒肺炎流行期间一线护理人员心理状况调查与干预措施

目的探讨新型冠状病毒肺炎(COVID-19)流行期间一线护理人员心理状况和干预措施。方法抽取我院一线护理人员133名为研究对象,采取一般资料问卷调查和症状自评量表(SCL-90)对护理人员心理状态进行评价,将量表总分与中国常模进行对比,并对影响一线护理人员心理状况的相关因素进行分析,总结心理干预措施。结果133名护理人员有115名SCL-90量表总分>160分,占比86.47%;有117名阳性项目数>43项,占比87.97%。性别、学历、婚姻状态、是否有公共突发事件应对工作经验是影响COVID-19流行期间一线护理人员心理状况的独立危险因素(P<0.05)。结论COVID-19流行期间,本院一线护理人员普遍存在焦虑、危机反应和心理障碍,需重点给予一线护理人员特殊照顾和心理干预,建立紧急重大疫情背景下护理人员快速心理调节机制和干预模式,维护护理人员心理健康。     

新型冠状病毒肺炎定点医院医务人员心理健康与社会支持、应对方式相关性分析

目的:了解新型冠状病毒肺炎定点医院医务人员应对突发公共卫生事件的心理健康、社会支持和应对方式现状,探讨心理健康与社会支持、应对方式的相关性。方法:采用一般情况调查表、突发性公共卫生事件心理问卷、社会支持评定量表和简易应对方式量表对四川省某市新型冠状病毒肺炎定点医院的1326名医务人员进行调查。采用描述性分析、单因素分析、Spearman相关性分析等分析相关资料。结果:共回收有效问卷1267份,回收率95.55%。定点医院医务人员突发公共卫生事件心理评估总分为0.407(0.481)分、社会支持总分为41.00(13.00)分、应对方式总分为26.00(14.00)分,医生、护士、医技人员组间比较差异有统计学意义(P<0.05),心理评估总分与社会支持量表总分、客观支持、主观支持、社会支持利用度均负相关(P<0.05),与应对方式总分、消极应对均正相关(P<0.05)。结论:定点医院医务人员心理健康与社会支持、应对方式密切相关,在应对突发公共卫生事件时,医务人员容易出现恐惧、神经衰弱、抑郁等心理问题,需引起重视。社会支持对定点医院医务人员心理应激起保护作用,但部分医务人员应对方式消极,需要有效干预。     

Male caregivers' use of formal support

The purpose of this study was to explore male caregivers' perceptions of formal support. The men were caregivers of adults with cognitive impairment. The study involved secondary analysis of interview data on perceptions of support that had not been previously analyzed from the perspective of formal support. Techniques of data analysis used in grounded theory were applied to 62 guided interactive interviews conducted with 24 male caregivers during a period of 18 months. The men experienced a process of making concessions for care in the following four sequential stages: resisting, giving in, opening the door, and making the match. Personal barriers deterred the caregivers from seeking help, and once the caregivers engaged formal help the influence of characteristics of the health care system and individual staff members had both enabling and disabling effects. For caregivers whose use of formal support involved admitting their relative to a long-term care facility, the phase of making the match was followed by redesigning their caregiver role.     

社区精神分裂症患者家属心理感受的质性研究

目的了解社区精神分裂症患者家属在看护期间的心理感受，以探索促进患者家属身心健康的相关因素。方法质性研究采用现象学研究法，通过深度访谈法收集了12例个案资料，采Edmund Husserl（1964）观点构成的理论方法分析。结果通过对资料的分析、整理、反思、分类和提炼主题，得出6个主题：①复杂的心理负担；②照顾任务繁重；③来自疾病的压力；④来自治疗费用的压力；⑤对家庭结构的影响；⑥缺乏看护技能。结论精神分裂症患者家属所承担的沉重负担和相关问题不容忽视。社区工作者应该对其采取相应措施，提高其生活质量。     

精神分裂症患者家庭主要照顾者心理脱离在照顾者负担和连带病耻感间的中介作用

目的：探讨精神分裂症患者家庭主要照顾者心理脱离在照顾负担与连带病耻感间的中介作用,为缓解其连带病耻感制定相应干预措施提供依据。方法：采用便利抽样法选取132例精神分裂症患者家庭照顾者为研究对象。采用一般资料调查问卷、心理脱离量表（PD）、照顾者负担量表(ZBI)、贬低-歧视感知量表（PDD）进行调查,运用多元回归中介效应分析及Bootstrap法进行验证。结果：精神分裂症患者主要照顾者的照顾负担与心理脱离呈负相关（r=-0.540,P<0.05））;照顾负担与连带病耻感呈正相关（r=0.629,P<0.05）;心理脱离与连带病耻感呈负相关（r=-0.688,P<0.05）;中介效应分析显示,心理脱离在照顾负担与连带病耻感之间起完全中介作用,效应值为78.42%。结论：在精神分裂症患者家庭主要照顾者中,心理脱离是照顾负担与连带病耻感的中介变量。医护人员应多关注精神分裂症患者主要照顾者的心理情况,采取积极措施提高其心理脱离水平,使其从繁重的照顾工作中脱离出来,进而促进其身心健康。     

Health literacy,social support,and care ability for caregivers of dementia patients: Structural equation modeling

At present, the level of health literacy, social support, and care ability of dementia caregivers is not very high. Therefore, the purpose of this study was to construct a structural equation model to explore the relationship between health literacy, social support, and the care ability of dementia caregivers. It is hoped that the study will provide a theoretical basis for future intervention. We recruited 225 dementia patients and their caregivers from August 2018 to June 2019 at the Department of Geriatrics and Neurology. We issued a health literacy questionnaire, social support scale, and a care ability questionnaire. Statistical analyses were performed using SPSS 19.0 and SPSS Amos 23.0. The mean scores for health literacy, social support, and care ability were 13.93±4.18, 34.64±6.42, and 44.44±9.31, respectively. Health literacy was directly related to social support (path coefficient = 0.454). Social support was directly related to care ability (path coefficient = 0.293). Furthermore, health literacy was directly related to care ability (path coefficient = 0.561), while health literacy had indirect associations with care ability via social support (path coefficient = 0.133). This study showed that improving the health literacy of caregivers effectively improved their care ability, and that social support was important for the link between health literacy and care ability. Medical staff and family members can provide appropriate health education and social support according to the characteristics of caregivers to improve the care ability of caregivers, improve the quality of life of patients, and delay the disease process.     

Emergency medical services: Brazil

Emergency medical services in Brazil have been created to offer first aid, primary medical treatment, basic life support, stabilization and rapid transfer to the closest appropriate hospital and advanced life support. Pre-hospital emergency care in Brazil is divided into permanent and mobile services. Permanent care is provided by the pre-hospital network (basic health units, family health program, specialized clinics, diagnosis and therapy services, non-hospital emergency care units). The mobile medical services include: mobile emergency care service, fire department and private services. Emergency hospital care units (emergency departments) are classified into general and reference units. Details of these services are described.     

Mental health needs for providers of Emergency Medical Services for Children (EMSC): A report of a consensus panel*

On October 5, 2000, the select Consensus Panel on Mental Health Needs for Providers of Emergency Medical Services for Children (EMSC) was convened in Washington, DC, by the American Psychological Association. This paper reports the results of that two-day meeting. Major topics addressed by the consensus panel were the need for acute psychological support services for providers of EMSC, identification of especially stressful clinical stressors for emergency caregivers, stressors within the health care system, adverse psychological and behavioral reactions among EMSC providers, a review of intervention strategies, and recommendations for future directions. The select panel agreed that there exists an extraordinary need for acute psychological support services in venues that provide EMSC. The panel recommended the proliferation of state-of-the-art information to settings that provide EMSC in order to assist in the implementation of acute psychological support services to assist EMSC providers as well as the pediatric patients and their families. The Critical Incident Stress Management (CISM) crisis intervention program was viewed as one such system of psychological support services that should be pursued. PREHOSPITAL EMERGENCY CARE 2002;6:15-21     

Repeated use of the emergency department: qualitative study of the patient's perspective

Objective—To explore what lies behind repeated emergency department (ED) use, from the patients'' own perspectives. Methods—Qualitative study based on in depth interviews with frequent users of the ED at the Huddinge University Hospital, Sweden. Ten adult patients having visited the ED 6–17 times in the previous 12 months were interviewed. The personal meaning they attached to the symptoms and their encounters at the ED were inductively analysed, thereby relating patient behaviour to life conditions. Results—The frequent ED visitors perceive pain or other symptoms as a threat to life or to personal autonomy. Irrespective of whether or not the patients relate their health problems to a traumatic event, overwhelming anxiety compels them to seek urgent help. Clear cut diagnoses are seldom mentioned. Although none of the patients is homeless or totally lacking in means, the narratives reveal struggles with adverse life circumstances and medical, psychological and/or social problems, including alcohol or other substance misuse. Occasional referrals from the ED to a psychiatrist seem not to lead to any continuous treatment or to a change in the patients'' health seeking behaviour. Satisfaction with care becomes adversely affected when the patients perceive that the ED staff classifies their use of the ED as inappropriate or when their symptoms are belittled. Conclusions—From their own perspectives, frequent ED visitors are in need of urgent care. It is particularly important to these patients that the personal meaning they attach to their symptoms is attended to and respected by the ED staff.     

Determining emergency physicians' and nurses' views concerning older patients: a mixed-method study

The number of elderly patients presenting to emergency services is gradually increasing. Given that the needs of older patients differ from those of other patients, the quality of emergency care for this patient group also varies. This mixed-method study aimed to reveal the views of emergency service staff concerning ageing and elderly patients. Participants were 19 physicians and 17 nurses employed by the adult emergency service of a university hospital. Data were gathered using questionnaires and focus group interviews. Frequency and percentages were used to evaluate quantitative data. Open-ended questions used to gather quantitative data were analysed using thematic analysis and four themes (including understanding older patients' situations, good nursing care and medical treatment, affecting good nursing care and medical treatment, emotions experienced) were determined. Emergency department staff identified older patients as dependent individuals requiring health care. Nurses indicated that good care for older patients included ensuring that their physical, social, and psychological needs were met; whereas, physicians identified good treatment as improving the quality of life. Impediments to the care and treatment of older patients were identified as staff shortages, emergency service crowding, and lack of proper training for emergency department staff. Emergency department staff also indicated that they experienced weariness and exhaustion while providing health care for older patients. Emergency nurses and physicians were aware of older patients and their needs but experienced difficulties regarding patient density, physical settings, staff shortages, and a lack of training.     

Care planning in the emergency department

There are many demands placed on staff working in emergency departments such as the currently witnessed overcrowding, bed shortages and long waiting times for patients. Despite these demands nursing care needs to be carefully assessed, planned and documented. This study aimed to examine attitudes of staff towards the use of a nursing care plan in the emergency department. The sample comprised the total population (n = 38) of all nursing staff working in an emergency department at one regional general hospital in the Republic of Ireland. The method adopted was a survey approach which employed the use of standardised questionnaires comprising both open and closed questioning styles. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were manually analysed for themes. The data obtained in this study identified that care plans were valued by respondents, stating that they contribute to holism, increased nurse/patient contact time and better communication. The findings also identified that there is a need for continuing education, further research and a need to address issues in relation to specific patient groups, including paediatrics, minor injuries, mental health and the elderly attending the emergency department.