Caregivers' perceptions of dementia patients' functional ability

Dementia patients' caregivers often provide information about patients' daily functioning, but little is known about factors influencing caregivers' perceptions. Baseline data from an intervention trial were used to compare caregiver estimates of dementia patients' performance with their actual performance of instrumental activities of daily living (IADLs) and to assess relationships between measures of caregiver responses to caregiving, self-perceived sense of self-efficacy, and depression. We also assessed patient cognition, overall function and behavioral disturbance, and caregivers' perceptions of their patients' behavior as manipulative or deliberate. Disparities between these estimates and actual patient performance on structured IADL tasks were unrelated to any caregiver, patient, or relationship factor that we measured     

A comparison of USA and New Zealand psychiatric patients' requests and clinicians understanding of patients' requests

This study compares USA and New Zealand psychiatric patients' requests at the initial psychiatric interview and examines clinician's accuracy in estimating patients' treatment request preferences. Eighty-five of the 146 consecutive nonacute patients to the psychiatric unit of a public New Zealand hospital completed a 14-item Patient Request Form before their initial interview and their clinician completed an equivalent form at the end of the interview. Patients' treatment request preferences were similar in the USA and New Zealand samples as were clinician's tendency to underestimate the importance their patients placed on requests. The results are discussed in relation to effective treatment planning.     

为照料者实施干预对老年痴呆患者BPSD症状的影响

目的 探讨为照料者实施综合干预对稳定老年痴呆患者精神行为(BPSD)症状的影响.方法 对100例住院老年痴呆患者的照料者实施为期6个月的综合干预,于干预前、干预3,6个月末采用AD病理行为评分量表(BEHAVE-AD)、总体衰退量表(GDS)分别对患者的BPSD症状及痴呆衰退程度进行评定、比较.结果 干预3,6个月末患者BEHAVE-AD总分及除妄想、幻觉外的各因子分均较干预前显著降低;其中尤以攻击行为、焦虑恐惧、行为紊乱因子分值降低最明显.而GDS评分干预前后均无明显变化,差异无统计学意义.结论 为照料者实施综合干预,可有效改善老年痴呆患者BPSD症状,稳定患者病情,利于护理.     

The relationship between staff members' working conditions and patients' perceptions of the treatment environment

BACKGROUND: The psychosocial climate of inpatient units has proved to be related to both patient satisfaction and outcome. AIMS: The aims of the study were twofold: to study the relationship between patient and staff satisfaction, and to study the relationship between the patients' perception of the treatment environment and the perceived working conditions of the staff. METHOD: A total of 129 different patients completed the Ward Atmosphere Scale (WAS) and a General Satisfaction Index (GSI) at 11 time points between 1981 and 2000. Staff members completed the Working Environment Scale-10 (WES-10) and the GSI. Z-scores were calculated to describe the fluctuations in the WAS, WES-10 and the GSI subscale scores. RESULTS: The study revealed a strong correlation between patient satisfaction and staff satisfaction. Staff satisfaction correlated significantly with the WAS subscales of Practical orientation and Staff control. Furthermore, the study revealed a significant correlation between patient satisfaction and staff members' perception on the WES-10 subscale of Self-realization. CONCLUSION: This exploratory study revealed that the working conditions of staff are related to both patient satisfaction and the patients' perceptions of the treatment environment. A satisfactory working environment for psychiatric staff members seems important for the quality of care perceived by patients.     

Accuracy of therapist perceptions of patients' alliance: Exploring the divergence

Abstract

Objective: The therapeutic alliance is a well-established predictor of psychotherapy outcome, yet much research has shown that therapists' and patients' views of the alliance can diverge substantially. Therapists systematically underestimate their patients' perceived level of alliance, and the correlation between therapist and patient estimates of patient alliance is only moderate. The present study explored the divergence between therapists' and patients' perspectives on patients' alliance experience, and its relations to therapists' concurrent work involvement and session process experiences. Method: Data from 98 patients treated by 26 therapists with psychodynamic psychotherapy were analyzed. Results: Therapist-patient divergence was significantly related to therapists' case-wise work involvement, but not to therapist's views of session process. The best predictor of therapist-patient divergence was therapists experiencing a “distressed practice” work involvement pattern. Conclusion: Although therapists' work involvement experiences are not commonly investigated, they can be a relevant predictor of therapy processes.     

Therapists' and chronic pain patients' perceptions of treatment outcome

Pain is a complex phenomenon which is influenced by multiple factors; likewise, assessment of chronic pain patients' response to treatment is influenced by many variables. A physician, psychologist, physical therapist, and occupational therapist rated the extent of recovery of 40 chronic pain patients who had spent 4 to 6 weeks in an inpatient chronic pain treatment program. Each patient also rated his/her own degree of improvement. In addition, therapists and patients reported which factors were the primary determinants of their outcome ratings. Although therapists rated the patients as significantly more improved than the patients rated themselves, there was still a high degree of similarity between therapists' and patients' view of recovery. Therapists and patients were in high agreement concerning which patients were classified as treatment successes or failures. Furthermore, activity level and ability to cope with pain were frequently endorsed by therapists and patients as important determinants of recovery rating. Contrary to a previous report, the results of this study suggest that pain patients are not necessarily poor judges of (their own) treatment results. Perhaps more importantly, this study supports the use of a broad-based multidimensional approach to assessing treatment outcome for chronic pain patients.     

The influence of Chinese one-child family status on Developmental Coordination Disorder status

We conducted a population-based study on Developmental Coordination Disorder (DCD) in mainland China to explore the influence of one-child status in Chinese families on DCD. A total of 4001 children selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children assessed motor function. The prevalence of DCD in Chinese one-child families (8.7%) was higher than that in multi-child families (5.9%). Chinese one-child family status (compared with younger children in multi-child families) were negatively related with total score (−1.793), Manual dexterity (−0.228), Aiming and catching (−1.145), Balance (−0.433) of MABC-2 and DCD (OR = 2.294) when adjusted for the children's and family's characteristics, and perinatal factors (each p < 0.05). As one of the studies in this Chinese context, it provides a platform for future intervention programs in one-child families in preventing children's developmental disorders.     

A qualitative study of patients' perceptions of a 'minimal' psychological therapy

BACKGROUND: Access to psychological therapy is often difficult. Problems with access may be overcome through 'minimal interventions' (such as books and computer programs), which encourage self-help for mental health problems and are less dependent on the availability of specialist therapists. However, to be effective, such interventions must be acceptable to patients. AIMS: To use qualitative methods to explore patient attitudes, by examining patient expectancies of psychological therapy and their experiences with a 'minimal intervention' (guided self-help). METHODS: Qualitative interviews (N = 24) were conducted with patients after they had received guided self-help for depression as part of a randomised controlled trial. RESULTS: There were important gaps between patients' expectancies of psychological therapy and their experience of the guided self-help. These gaps related to the process of therapy (e.g. time, professional expertise) and outcomes. Particularly salient was a theme relating to explanatory models. Patients were often seeking insight into the 'cause' of their current difficulties, whereas the minimal intervention was largely focused on symptom resolution. CONCLUSIONS: The effective implementation of 'minimal interventions' requires an understanding of the expectancies of patients concerning psychological therapy, in order to provide a basis for effective communication and negotiation between professionals and patients.     

Interferon-beta treatment for patients with multiple sclerosis: the patients' perceptions of the side-effects

The aims of this study were to investigate (i) the self-reported frequency and intensity of systemic side-effects and their impact on the daily lives of patients suffering from Multiple Sclerosis (MS) and undergoing interferon-beta therapy and (ii) the self-reported frequency and perceptions of any local-tissue reactions. Forty patients aged 22 - 59 years (27 females) with relapsing/remitting MS were consecutively recruited for the study (17 on interferon-beta-1a and 23 on interferon-beta-1b). Two self-administered questionnaires were used before and after 1, 4, 8 and 16 weeks of therapy. The interferon therapy was found to be associated with flu-like symptoms. Most systemic side-effects were reported to be mild and to have little impact on the patients' daily lives. Asthenia and fatigue were more often rated as moderate or severe. The most frequently reported local-tissue side-effects were redness and local pain at the injection sites. A considerable inter-individual variation was found among patients regarding the perceptions of both the systemic and local side-effects. This suggests that it is of importance to identify early those patients who may need more support or other interventions to maintain a successful compliance. Multiple Sclerosis (2000) 6 349 - 354     

Spouse caregivers' perceptions of influence of dementia on marriage

OBJECTIVES: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. DESIGN: Semistructured telephone interviews of spouse caregivers of demented patients. SETTING: Community-living demented patients and their spouse caregivers in eastern Finland. PARTICIPANTS: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. RESULTS: A statistically significant decline had occurred in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). CONCLUSIONS: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.