How Family Caregivers of Persons with Alzheimer Disease Achieve Mental Breaks: Preliminary Analysis from a Qualitative Study

There has been growing awareness that respite for family caregivers of persons with Alzheimer Disease can be conceptualized as a positive inner psychological experience as well as a service to provide a physical break. Little is known, however, about the specific activities and strategies caregivers use to achieve therapeutic mental breaks from caregiving concerns. This study examined the strategies and circumstances identified by 15 adult primary caregivers as providing mental breaks. Caregivers participated in two qualitative interview sessions and follow up member checks. Case-by-case and cross-case analyses, and structural synthesis were conducted to develop a working model describing mental breaks. This paper overviews the model, presents two cases illustrating model components, and provides preliminary implications for practice to stimulate therapists' thinking about applications for helping caregivers achieve mental breaks.     

Cultural competence: Development of a conceptual framework

Purpose. To describe the development of a conceptual framework for cultural competence that could help and guide the training of rehabilitation practitioners, students and researchers.

Method. A systematic review of the literature yielded 259 usable documents that were further reviewed by two independent readers to identify 32 publications that described cultural competence conceptual models.

Results. After eliminating redundancy, 18 unique cultural competence models were identified. A synthesis model was first developed which included four components. After an empirical validation of the model, a new model with only three components emerged.

Conclusion. The empirically validated conceptual framework is a promising tool for training and evaluation of cultural competence.     

晚期肝癌患者家属照顾者承受压力与应对方式的相关性研究

目的 描述晚期肝癌患者家属照顾者的压力水平、应对方式情况,并探讨两者之间的关系。方法 采用描述性相关性研究设计,调查70名晚期肝癌患者家属照顾者,并在相同医院调查80名中期肝癌患者家属照顾者作为对照。结果 晚期肝癌患者家属照顾者的总体压力水平为中度,明显高于中期肝癌患者家属照顾者（P〈0．01）;两组应对压力的方式无统计学差异;晚期肝癌患者家属照顾者的积极应对与其压力水平呈负相关（P〈0.05）,消极应对与其压力水平呈正相关（P〈0．01）。结论 晚期肝癌患者家属照顾者普遍存在中度水平压力,积极应对有助于降低其压力,消极应对则可加重家属照顾者的压力。     

Developing a comprehensive framework of community integration for people with acquired brain injury: a conceptual analysis

Purpose: Despite increasing emphasis on the importance of community integration as an outcome for acquired brain injury (ABI), there is still no consensus on the definition of community integration. The aim of this study was to complete a concept analysis of community integration in people with ABI.

Materials and methods: The method of concept clarification was used to guide concept analysis of community integration based on a literature review. Articles were included if they explored community integration in people with ABI. Data extraction was performed by the initial coding of (1) the definition of community integration used in the articles, (2) attributes of community integration recognized in the articles’ findings, and (3) the process of community integration. This information was synthesized to develop a model of community integration.

Results: Thirty-three articles were identified that met the inclusion criteria. The construct of community integration was found to be a non-linear process reflecting recovery over time, sequential goals, and transitions. Community integration was found to encompass six components including: independence, sense of belonging, adjustment, having a place to live, involved in a meaningful occupational activity, and being socially connected into the community. Antecedents to community integration included individual, injury-related, environmental, and societal factors.

Conclusion: The findings of this concept analysis suggest that the concept of community integration is more diverse than previously recognized. New measures and rehabilitation plans capturing all attributes of community integration are needed in clinical practice.

• Implications for rehabilitation

• Understanding of perceptions and lived experiences of people with acquired brain injury through this analysis provides basis to ensure rehabilitation meets patients’ needs.

• This model highlights the need for clinicians to be aware and assess the role of antecedents as well as the attributes of community integration itself to ensure all aspects are addressed in in a manner that will enhance the recovery and improve the level of integration into the community.

• The finding that community integration is a non-linear process also highlights the need for rehabilitation professionals to review and revise plans over time in response to a person’s changing circumstances and recovery journey.

• This analysis provides the groundwork for an operational model of community integration for the development of a measure of community integration that assesses all six attributes revealed in this review not recognized in previous frameworks.

     

Delineation of brain tumor margins using intraoperative sononavigation: implications for tumor resection

PURPOSE: Sonography has been employed for real-time intraoperative delineation of tumor boundaries during resection of brain tumors. However, the variably hyperechoic appearance of brain edema or gliosis surrounding the brain may interfere with accurate depiction of tumor margins. The goal of the present study was to use sononavigation, which provides coregistration between real-time sonograms and MRI scans, to assess the accuracy of sonographic determination of tumor margins. METHODS: Sononavigation was performed on 12 brain tumors (7 metastatic brain tumors, 2 meningiomas, 1 anaplastic oligodendroglioma, 1 anaplastic pilocytic astrocytoma, and 1 anaplastic astrocytoma). Sonograms of tumor margins were categorized into 1 of 3 types: in type 1, the tumor margin was clearly visualized and corresponded to the margin of the enhanced lesion on MR scan in all areas; in type 2, the tumor margin was clearly seen in some areas but was obscure in others due to hyperechoic edema; and in type 3, the tumor margin was indistinguishable from surrounding tissues in all areas. RESULTS: Three metastatic brain tumors and 1 meningioma were categorized as type 1. Three metastatic brain tumors, 1 meningioma, and 1 anaplastic oligodendroglioma were categorized as type 2. The anaplastic pilocytic astrocytoma, 1 metastatic brain tumor (which consisted mainly of necrotic tissue), and the anaplastic astrocytoma were categorized as type 3. These data assist in determining whether the sonographic appearance of tumor margins is accurate and whether to rely on information from either sonography (type 1) or the sononavigation system when resecting tumor types 1, 2, and 3. CONCLUSIONS: Sononavigation can help categorize the sonographic tumor margins into 3 different patterns, and this categorization can assist in determining which imaging modalities are needed to better delineate the tumor margins for subsequent resection.     

VEGF在小鼠活体移植脑肿瘤生长过程中的表达研究

目的通过连续测定血管内皮生长因子（ⅥⅪF）在小鼠Lewis肺癌活体移植脑肿瘤生长过程中的表达变化，分析其变化的规律和特点，探讨这些规律和特性与肿瘤生长的相互作用。方法采用小鼠kwis肺癌皮下移植肿瘤组织悬液，经直接穿破颅骨注入法建立小鼠脑移植瘤模型。荷瘤鼠分别选取实施肿瘤移植手术后第6，7，8，9，10，11，12,13日时处死，取脑。对各日龄组标本进行以下测定：（1）HE染色和免疫组织化学染色检测VEGF的表达：（2）逆转录-聚合酶链方法（RT-PCR）与定量PCR检测VEGFmRNA的表达；（3）测定VEGF的蛋白含量。结果10日龄前区间VEGF的表达符合肿瘤血管形成期的生长特点，10日龄后区间VEGF的表达符合肿瘤血管生长期的生长特点。10日龄可以作为肿瘤血管形成期和生长期的分界点。10日龄前区间内VEGF的表达呈缓慢上升趋势。自10日龄始，VEGF的表达显著上调，并伴随肿瘤的生长呈爆发性指数增长趋势。结论VEGF的表达强度和蛋白含量作为肿瘤新生血管多少的判定指标与肿瘤生长的时间存在密切关联性和规律性。其表达伴随肿瘤的生长逐渐增强，且存在一个显著上调的分界点。此分界点对肿瘤生长阶段的诊断判定具有重大的意义。     

Family-directed approach to brain injury (FAB) model: a preliminary framework to guide family-directed intervention for individuals with brain injury

Purpose: This article proposes a theoretical framework to help professionals include family as active members in brain injury rehabilitation. A trend towards greater family involvement has lead to the development of family-collaboration models. However, current models appear to focus on information sharing rather than increasing the capability of family members. This article introduces a family-directed approach to brain injury model, which provides a theoretical framework for supporting family as facilitators of change.

Methods: Family-collaboration models and literature regarding family experiences following brain injury and support needs are reviewed to identify the driving forces behind family engagement in rehabilitation, including effective professional–family relationships, and important factors in the delivery of education underpinned by evidence-based practices.

Results: The family-directed approach to brain injury model is based on principles of hope, family expertise, education/skill building, and family-directed intervention.

Conclusions: The family-directed approach to brain injury model provides a theoretical framework for educating and training family members as facilitators in the management process: promoting competence rather than dependency on service systems. Guiding recommendations encourage professionals to reflect on the importance of their therapeutic relationships and their capacity to positively impact rehabilitation outcomes beyond the technical aspects of health care and treatment.

• Implications for Rehabilitation

• Training family members as facilitators in the rehabilitation process is suggested to reduce dependency on the service system, address families’ unmet support needs, and to optimize rehabilitation outcomes for individuals with brain injury.

• The family-directed approach to brain injury model is proposed to guide the increased involvement of family as active members in the rehabilitation team and to define potential active ingredients in this process.

     

Meaning and purpose: A conceptual model for speech pathology terminology

Within speech pathology, one term is sometimes used to cover a range of different constructs, or sometimes several terms refer to one construct. This leads to the high level of inconsistency which characterizes our professional terminology. The speech pathology profession is impeded on several fronts due to this inconsistent terminology. There is an urgent need to develop more appropriate and more consistent terminology to allow the profession to advance in both professional and public forums. This article aims to initiate a debate about how to improve the current situation by exploring the impact of inconsistency on the profession and its clients, and highlighting some of the factors contributing to inconsistency. These factors are the reason the profession has not developed universal and straightforward terminology. Work on improving consistency in speech pathology terminology must first focus on understanding, resolving or minimizing the impact of these underlying factors. This article then proposes the development of a conceptual model based on the purposes of terminology. Such a conceptual model could be developed if the profession investigated the various purposes of terminology, and developed a framework which included definitions and parameters of these purposes, and only then looked at examples of appropriate terms to meet these purposes. A proposal for a conceptual model is presented as a provocation to the profession.     

The measurement of self-efficacy in persons with spinal cord injury: psychometric validation of the moorong self-efficacy scale

Purpose. The factorial and concurrent validity of the Moorong Self-Efficacy Scale (MSES) was examined using a sample of Americans with spinal cord injury.

Methods. One hundred sixty-two participants were recruited with the assistance of the Florida Brain and Spinal Cord Injury Program and the Florida Spinal Cord Injury Resource Centre. Mean age of participants was 45.8 years (SD = 13.4), and 68.5% were men. The participants completed a survey containing a demographic questionnaire, the MSES, the Satisfaction with Life Scale (SWLS), the Personal Resources Questionnaire – 2000 (PRQ-2000), and the Centre for Epidemiologic Studies Depression Scale – 10 item version (CES-D-10).

Results. Factor analysis yielded two factors (Interpersonal Self-Efficacy and Instrumental Self-Efficacy) similar to the original MSES. In addition, the MSES factors and total score in the present study were significantly correlated in the predicted directions with specified psychosocial variables, as well as hours of paid employment.

Conclusions. The results of this study support the factorial and concurrent validity of the MSES as a self-efficacy measure in Americans with spinal cord injury.     

Coping and stress: a conceptual analysis

BACKGROUND: Much work has been done towards the classification of clinical concepts in nursing. However, there is a comparative lack of analysis of non-technical terms, which nevertheless bear closely on professional practice in nursing. Within nursing classifications, the term 'coping' functions as an element in more complex conceptual structures, the term itself being left relatively undefined. The case is similar for the term 'stress'- the set of circumstances with which the individual is attempting to cope. AIMS: The aim of this paper is to arrive at grounds for consensus over the use and meaning of the widely used terms 'stress' and 'coping'. METHODS: A conceptual analysis of the terms 'stress' and 'coping' was carried out, looking at etymology, ordinary usage and theoretical contingencies, in order to generate paradigmatic cases. A range of nursing and non-nursing literature was examined in order to illustrate further the range of the terms. CONCLUSIONS: 'Stress' and 'coping' are terms which are widely used in nursing; their significance has varied overtime and in the literature, and there continues to be lack of clarity over their precise meaning and use.     

Traumatic brain injury resiliency model: a conceptual model to guide rehabilitation research and practice

Abstract

There is a growing trend in traumatic brain injury (TBI) rehabilitation, and research, to focus on the processes of adaptation following the injury. Resiliency is an umbrella term describing the range of personal protective factors, environmental supports and resources, as well as self-regulatory processes, engaged in response to adversity. An affective, cognitive, and behavioural self-regulatory process model of resiliency in the workplace was adapted to suit the TBI context. Through a narrative review of the literature pertaining to brain injury rehabilitation, participation, and resilience, we substantiated the model, and explained how resiliency can frame research on life experiences following the injury. TBI represents a cascading adversity as the injury and subsequent life experiences (e.g., job loss) shape adaptation. Resiliency is shaped by: personal characteristics (e.g., hope, social functioning, self-awareness, memory, spirituality, coping, and self-efficacy), environmental resources/supports (e.g., services and social support), and self-regulatory processes that lead to the resiliency-related outcomes, which we suggest involve re-engaging in activities, adapting participation, and reconstructing identity. This conceptual model outlines and defines the factors and processes operating and contributing to resiliency following TBI. Recommendations for future research are outlined.

• Implications for rehabilitation

• Investigating resiliency processes can move the traumatic brain injury field beyond examining individual traits and protective factors, to transactional processes that influence participation experiences and opportunities over time.

• The Traumatic Brain Injury Resiliency Model can be used to frame the targets and desired outcomes of rehabilitation interventions, such as self-regulatory processes or environmental supports known to enhance resiliency.

• Studying resiliency will help to shift the paradigms of traumatic brain injury research, and rehabilitation practice, to a focus on life experiences and adaptation, helping individuals, clinicians, and families consider processes of positive change, rather than focusing solely on adversity.

     

Alone together: A grounded theory study of experienced burden,coping, and support needs of spouses of persons with a bipolar disorder

Bipolar disorder is a chronic and severe mental disorder. Little is known about the experiences of the spouses of such patients. A grounded theory study was undertaken to examine the burden for spouses living with a partner with a bipolar disorder and to explore how they cope and what support they need. Fifteen spouses and ex‐spouses were interviewed; they experienced heavy burden and found themselves to be ‘alone together.’ Their coping process is found to involve appraisal of the situation and attempts to achieve a balance between self‐effacement and self‐fulfilment. While support can clearly reduce experienced burden, the spouses surprisingly receive virtually no professional support. A theory is developed that constitutes a starting point for the development of adequate support for spouses.     

脑转移瘤射波刀治疗的临床护理

目的探讨射波刀治疗脑转移瘤的有效的护理措施。方法对23例脑转移瘤患者实施射波刀治疗前的宣教、治疗中护理、治疗后的并发症的观察与相应的护理。结果23例患者均顺利完成治疗,经过治疗后第1周J临床症状改善率95．6％：治疗后第3个月的治疗有效率为74．3％,局部控制率为88．6％。无护理并发症的出现。结论精心的护理为射波刀成功治疗提供了有效的支持和保汪。     

脑肿瘤卒中发病机制分析

目的　探讨脑肿瘤卒中的发病机制。方法　对 72例脑肿瘤卒中病例的病理类型 ,发病机制 ,诊断及治疗进行回顾性分析。结果　脑肿瘤卒中以脑转移瘤、恶性胶质瘤、脑膜瘤较易发生 ,CT及MRI有助于确诊。手术治疗效果明显。结论　脑瘤卒中的内因在于血管结构的异常 ,外因在于肿瘤浸润 ,压迫引起的出血     

Collaborative childcare health consultation: a conceptual model.

PURPOSE: This study explored the nature of consultation between childcare providers and nurse childcare health consultants and identified factors that promote a collaborative relationship. DESIGN AND METHODS: A qualitative study using semistructured, individual interviews of five collaborative and five conflicted pairs of nurse childcare health consultants and childcare center directors. Data were analyzed following principles of grounded theory and applying the constant comparative method of analysis. RESULTS: Establishing a collaborative relationship was influenced by previous experiences and four themes in the relationship: open and active communication, commitment, respect, and congruent philosophies. PRACTICE IMPLICATIONS: Preparation in developing collaborative relationships should be incorporated into the education of nurse consultants and childcare directors and providers.     

精神分裂症照料者对精神分裂症患者病态行为应对方式及健康教育需求现状调查

目的探讨住院精神分裂症患者的照料者对患者主要病态行为出现时的应对方式、对常见精神卫生知识的了解程度及对健康教育知识的需求情况。方法对300名精神分裂症患者的照料者,采用自制的一般情况调查表(婚姻、与患者关系、与患者的感情及与患者的交流情况等)、照料者对患者病态行为应对方式调查表(病态应对方式、教育开导、继续服药、督促活动、强制就医、打骂惩罚及放任顺从等)、照料者健康知识知晓情况调查表(是否知道患者疾病的诊断与性质、精神分裂症复发的可能性、精神分裂症的不良影响、药物的常见不良反应、维持用药的时间、如何与患者进行沟通交流、疾病对后代的影响抢救等)及照料者健康教育需求情况调查表(教育途径及内容、出院后教育指导及教育形式、婚育指导内容等)进行现状调查。结果照料者在精神分裂症患者出现意志减退、幻觉妄想、消极行为、攻击行为、违拗拒药及反复外跑时,选择"强制就医"的比例分别为18.7%、34.0%、50.0%、42.0%、18.7%及25.3%。在出现锥体外系反应、消化道反应、镇静过度、心血管反应、体质量增加及睡眠障碍时,选择"及时就医"的比例分别为25.3%、28.7%、20.0%、34.0%、9.3%、16.7%。照料者在药物保管、婚育注意事项、疾病遗传影响及帮助患者回归社会方面缺乏了解,仅42.0%的照料者全部知道疾病诊断。70.0%的照料者希望通过医生、护士获取健康教育知识,25.7%的照料者希望通过网络获取。婚育指导内容中,48.0%及46.0%的照料者分别选择"后代遗传概率"及"患者可否结婚";出院后教育形式中,54.7%的照料者选择了"电话咨询医生"。结论精神分裂症患者照料者对患者病态行为常不能及时准确辨认,多选择不良应对方式,且对常见精神卫生知识缺乏了解,因此极有必要向他们提供有效而全面的健康教育指导,尤其是加强网络宣传普及的力度。     

Cigarette smoking, socioeconomic status, and psychosocial factors: examining a conceptual framework

Inequalities in cigarette smoking prevalence exist, with smokers more likely to be poor and less educated. Higher socioeconomic status (SES) is associated with higher quit rates. The overall relationship between low SES and poor health, as measured by morbidity and mortality, is well established. However, research indicates that inequalities in health are not explained by SES alone; other variables, such as psychosocial factors, may play a significant role. Williams has developed a conceptual framework to examine relationships among SES, psychosocial factors, and medical care related to health outcomes. According to Williams, the interrelationships among these factors have yet to be determined. As such, the pathways among the variables within psychosocial factors are explored and the authors discuss application to public health nursing practice and areas for future research. Further understanding of these relationships in the context of smoking may inform prevention and cessation strategies.