老年人慢性疼痛自我管理策略及有效性的调查研究

目的探讨老年人慢性疼痛的临床特征和自我管理策略及有效性的现状，并分析之间的关系。方法对243名年龄≥65岁慢性疼痛老年人进行系列问卷调查，了解老年人慢性疼痛的临床特征及自我管理策略，并对结果进行分析。结果非麻醉性镇痛药、体育运动、冷热疗法和精神转移活动为4种最常使用的疼痛管理策略，不同年龄组的老年慢性疼痛患者间其所应用的疼痛管理策略比较差异无统计学意义。管理策略的有效性与疼痛强度，疼痛干扰日常生活程度及忧郁程度呈负相关，但与自我效能分数呈正相关。结论老年人愿意尝试各种不同的策略应对慢性疼痛，在今后的老年人慢性疼痛管理培训中应注重体育运动程序的规范化、对抗抑郁并增加自我效能以提高疼痛管理的效果。     

Use of the chronic pain coping inventory to assess older adults' pain coping strategies.

Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population. PERSPECTIVE: Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.     

老年人慢性疼痛自我管理策略及有效性的调查研究

目的 探讨老年人慢性疼痛的临床特征和自我管理策略及有效性的现状,并分析之间的关系. 方法对243名年龄≥65岁慢性疼痛老年人进行系列问卷调查,了解老年人慢性疼痛的临床特征及自我管理策略,并对结果进行分析. 结果非麻醉性镇痛药、体育运动、冷热疗法和精神转移活动为4种最常使用的疼痛管理策略,不同年龄组的老年慢性疼痛患者间其所应用的疼痛管理策略比较差异无统计学意义.管理策略的有效性与疼痛强度,疼痛干扰日常生活程度及忧郁程度呈负相关,但与自我效能分数呈正相关.结论 老年人愿意尝试各种不同的策略应对慢性疼痛,在今后的老年人慢性疼痛管理培训中应注重体育运动程序的规范化、对抗抑郁并增加自我效能以提高疼痛管理的效果.     

Recruitment and retention of students from minority groups

BACKGROUND AND PURPOSE: Studies have identified strategies used in physical therapist education to recruit and retain students from minority groups. However, physical therapist education has evolved since these studies were published. The purpose of this study was to examine current practice in recruiting and retaining students from minority groups. SUBJECTS: Seventy program directors of programs offering master's or doctoral degrees in physical therapy responded to a survey. METHODS: The survey questionnaire requested information on program demographics, numbers of applicants, students and graduates from minority groups, and recruitment and retention strategies utilized. The most frequently used strategies were identified. Wilcoxon rank sum tests were performed to determine which strategies were associated with better recruitment and retention of students from minority groups. RESULTS: Fifty programs made a special effort to recruit and retain students from minority groups. Nine recruitment strategies and 3 retention activities were associated with programs having higher proportions of minority applicants, students, and graduates. DISCUSSION AND CONCLUSION: The most frequently used strategies were incongruent with the strategies used by programs with higher proportions of applicants, students, and graduates from minority groups. This study provides information to help physical therapist educators determine which strategies help recruit and retain students from minority groups.     

Psychiatric consultation-liaison in the acute physical disabilities setting

This paper provides an overview of psychiatric consultation-liaison services in a general hospital setting. The patient most frequently referred for consultation-liaison services is the individual experiencing depression secondary to physical illness. The dimensions of occupational therapy intervention with this population is featured, including assessment, intervention strategies, and documentation guidelines useful in the treatment planning.     

Cambodian Refugee Adolescents: Cultural Factors and Mental Health Nursing

Cambodian adolescents in America are a high-risk group for physical, psychosomatic, and drug-related problems. Communication with the Cambodian community is a challenge to mental health nurses due to fundamental differences in American and Cambodian perceptions about parental roles and causation and treatment of illness. The authors focus on the Cambodian cultural theme of equilibrium in treatment of illness, management of stress, and patterns of parenting. Conflicts faced by Cambodian adolescents and nursing intervention strategies are identified.     

Living with heart failure; patient and carer perspectives.

Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome.     

Sexual Aggressors' Perceptions of Effectiveness of Strategies to Cope with Negative Emotions and Deviant Sexual Fantasies

The aim of this study was to investigate sexual aggressors' perceptions of effectiveness of strategies to cope with high-risk situations and their reasons for not using the adaptive coping strategies they learned in treatment. A total of 32 sexual aggressors, incarcerated in a maximum security psychiatric institution, filled out the Coping Strategy Report daily for 2 months. A lack of will, ignorance, and an emotional disturbance were the most frequently reported reasons for not using adaptive coping strategies to deal with a negative mood, whereas anticipation of failure and emotional disturbance were most frequently reported with interpersonal conflicts. For deviant sexual fantasies, child molesters most frequently reported a lack of will and an anticipation of failure as justification for not using adaptive coping strategies, whereas sexual aggressors of women most frequently reported a lack of will and emotional disturbance. For negative moods and interpersonal conflicts, behavioral strategies, such as social skills, were reported to be the most effective. Cognitive strategies, such as covert sensitization, were reported to be most effective for coping with deviant sexual fantasies. Theoretical and clinical implications of these results are discussed.     

Coping with uncertainty and ambivalence while awaiting a cadaveric renal transplant

A qualitative approach was used to identify concerns of candidates awaiting cadaveric renal transplant and to identify coping strategies used during the wait. Patients who were within 10 days postrenal transplant were interviewed and asked to recall their concerns during the wait. Two major concerns were identified through the analysis--uncertainty and ambivalence. The problems are presented with supporting vignettes and strategies used by the subjects to cope with the problem.     

Exercise dependence: a problem for sports physiotherapists

Twenty-four postgraduate-trained sports physiotherapists were interviewed to investigate their experiences with exercise dependent patients. The respondents identified exercise dependent patients as likely to continue physical activity when injured. They were described in terms such as anxious, obsessive, overachieving and addicted to feelings. The majority of physiotherapists (71 per cent) reported problems in communicating with and gaining compliance from exercise dependent patients. Treatment approaches listed by the respondents included education, prescribing reduced or alternative activities, referral and psychological strategies. Most physiotherapists reported that they used combinations of these strategies. Within the limits of generalising from the present sample, it appears that sports physiotherapists are aware of the difficulties of managing exercise dependent patients and have developed specific techniques to cope with the problems of treating them.     

Job stress and coping strategies in health care professionals working with cancer patients.

The aim of this study was to determine the factors influencing stress in health care professionals working with cancer patients and the strategies used to cope with stress. The data was collected by self-report questionnaires, the Job Stress Inventory and Ways of Coping Inventory. Overall 109 health care professionals (physicians n = 52, nurses = 57) employed in five Oncology Hospitals in Ankara, Turkey, between January 2001 and July 2001 were involved in the study. It was identified that the mean job stress score of health care professionals was 30.76 (physicians = 30.53, nurses = 31.00) (range = 0-50). This stress level indicated that there were signs of physical and psychological stress. It was determined that variables influencing stress scores were marital status, age, professional career, unfairness in promotion opportunities, imbalance between jobs and responsibilities, conflict with colleagues, lack of appreciation of efforts by superiors, responsibilities of role, long and tiring work hours, inadequacy of equipment, and problems experienced with patients and their relatives. It was also determined that health care professionals utilize similar strategies in order to cope with stress. The most common strategy used by physicians and nurses was a self-confident approach (x = 1.89 and 1.82 respectively), and the strategy least used was a submissive approach (respectively, x = 1.03 and 0.85). Programmes directed towards reducing job stress and enhancing motivation and job satisfaction were recently considered by health institutions. It is thought that the findings of the study could be taken into account in preparing programmes (coping with stress, training) for health care professionals working with cancer patients.     

Physical therapists should integrate illness perceptions in their assessment in patients with chronic musculoskeletal pain; a qualitative analysis

In the past decade, scientific evidence has shown that the biomedical model falls short in the treatment of patients with musculoskeletal pain. To understand musculoskeletal pain and a patient's health behavior and beliefs, physical therapists should assess the illness perceptions of their patients. In this quantitative study, we audiotaped the assessments of 19 primary care physical therapists on 27 patients and analyzed if and how illness perceptions were assessed. The Common Sense Model was used as the theoretical framework. We conclude that some of the domains of the Common Sense Model were frequently asked for (identity, causes and consequences), while others (timeline, treatment control, coherence, emotional representation) were used less frequently or seldom mentioned. The overall impression was that the assessments of the physical therapists were still bio-medically oriented in these patients with chronic musculoskeletal pain.     

Spousal perspective of Parkinson's disease in middle life

An interpretive study in America explored the experience of living with a partner who has Parkinson's disease (PD) in middle life. Challenges experienced by eight spouses and their ways of coping with these challenges were examined. The convenience sample of five wives and three husbands were 44-58 years and had been married 4 months to 30 years. Spouses described the most significant challenges as watching their partner struggle and be frustrated; and renegotiating their lives. The coping strategies most frequently used were maintaining their own life, encouraging their partner to stay active and involved, and seeing the challenges they experienced as secondary. The context of living with a partner with Parkinson's disease is illuminated and strategies that spouses find most effective in coping with their partners illness are identified.