医务人员对晚期癌症患儿尊严维护的质性研究

目的 了解医务人员对晚期癌症患儿尊严维护的认知及实践体验,为改善晚期癌症患儿尊严维护实践提供参考。 方法 采用描述性质性研究方法,对13名从事晚期癌症患儿治疗和照护工作的医务人员（8名护士、3名医生、2名安宁疗护志愿者）进行半结构式深入访谈,运用内容分析法对资料进行分析并提炼主题。 结果 提炼出4个主题：晚期癌症患儿尊严维护影响因素的复杂性,患儿尊严维护现存的多重困境,患儿尊严维护的重要意义,尊严维护实践的推进过程和基本要素。 结论 医务人员应了解晚期癌症患儿尊严维护影响因素的复杂性,动态持续关注患儿病程阶段和家属的医疗决策,并坚持个体化、充分沟通、尊重和人文关怀等尊严维护的基本要素,进一步推动儿童安宁疗护中尊严维护的临床实践。     

癌症患者主要照顾者家庭尊严干预的研究进展

从家庭尊严干预的相关概念、实施方案及其应用效果进行综述，旨在提高医务人员对家庭尊严干预的意识，维护癌症患者的尊严，提高照顾者生活质量，改善癌症患者及照顾者的身心健康水平，为今后对癌症患者开展家庭尊严干预提供参考，以推动我国安宁疗护的发展。     

脑卒中患者尊严研究进展

尊严是人的基本权利和基本信仰,尊重和维护患者尊严是护理实践的基本要求。脑卒中患者因躯体功能、吞咽及语言功能障碍等,容易出现尊严受损。本文总结脑卒中患者尊严的评估方法、影响因素、干预措施,以期有效维护脑卒中患者尊严,提高生活质量。     

尊严护理干预对晚期住院癌症患者尊严水平及焦虑抑郁的影响

目的探讨尊严护理干预对晚期住院癌症患者尊严水平及焦虑抑郁的影响。方法将2所三级甲等医院肿瘤科的100例住院晚期癌症患者分为干预组和对照组各50例。对照组接受常规护理,干预组在此基础上接受4周尊严护理干预。结果干预后两组尊严及焦虑抑郁评分比较,差异有统计学意义(P0.05,P0.01)。结论尊严护理干预能有效改善住院晚期癌症患者尊严水平,减轻焦虑抑郁情绪。     

分娩尊严内涵的扎根理论研究

目的 探讨分娩尊严内涵，以维护产妇分娩尊严，改善分娩结局，提高产妇分娩幸福感。方法 采用扎根理论研究方法，对江苏省4所医院的13名助产士、18名产妇进行深度访谈，通过开放式登录、关联式登录、核心式登录分析访谈资料。结果 析出分娩尊严内涵包括安全感维护（生理安全、心理安全）、自主权的体现（知情同意、共同决策）、社会网络和谐（家庭关系、社会关系）3个方面。结论 分娩尊严 内涵的确立有助于理解孕产妇分娩选择及期望，为促进医疗保健提供者和产妇之间沟通提供理论依据，对提供高质量助产护理服务的相关研究及实践具有指导意义。     

住院患者尊严现状及影响因素分析

目的 了解住院患者尊严期望现状,为针对性干预提供参考.方法 采用普通话版住院患者尊严量表对442例住院患者进行问卷调查.结果 住院患者尊严期望值为48.00(40.00,53.00)分,尊严满意度为71.00(61.00,75.00)分;回归分析结果显示,性别、家庭人均月收入、住院科室是住院患者尊严期望值影响因素(均P＜0.05);近年住院经历、经济负担、文化程度是住院患者尊严满意度影响因素(均P＜0.05).结论 住院患者尊严期望值处于中度水平,满意度较高.临床护士应根据不同尊严期望值和尊严满意度患者提供个性化和针对性干预,满足其尊严期望和尊严满意度.     

尊严疗法对肝癌患者自尊相关压力和希望水平的影响

目的探讨尊严疗法对姑息治疗肝癌患者自尊相关压力和希望水平的影响,为晚期癌症患者的临终护理提供依据。方法选择住院并接受姑息治疗的肝癌患者28例,通过个体化的尊严疗法,观察患者干预后1个月自尊相关压力和希望水平的改善情况。结果患者的自尊相关压力降低,希望水平和各维度水平提高,干预前后比较,差异有统计学意义(均P<0.01)。结论尊严疗法能较好地改善患者由自尊引起的压力水平,提高患者对生活的希望水平,从而提高患者生命临终阶段的生活质量。     

家庭尊严干预对乳腺癌患者照顾者的影响

目的 探讨家庭尊严干预对乳腺癌患者照顾者照顾感受、创伤后成长及照顾能力的影响.方法 将220名乳腺癌患者照顾者随机分为观察组和对照组各110人.对照组给予常规干预,观察组在此基础上实施家庭尊严干预.两组出院时及出院后3个月分别采用照顾者负担量表、创伤后成长评定量表及中文版照顾者能力量表进行调查.结果 观察组照顾负担显著低于对照组,创伤后成长及照顾能力评分显著高于对照组(均P＜0.01).结论 家庭尊严干预能有效降低乳腺癌患者照顾者的照顾负担,提升其创伤后成长水平及照顾能力.     

晚期癌症患者家庭主要照顾者沟通模式现状及影响因素

目的 了解晚期癌症患者家庭主要照顾者沟通模式及影响因素，为制订沟通应对策略提供参考。方法 以方便抽样法选取晚期癌症家庭主要照顾者164人，使用一般资料问卷和家庭照顾者沟通模式问卷对患者照顾者及患者进行调查。结果 晚期癌症患者家庭主要照顾者中孤独型沟通模式103人(62.80%),承担型30人(18.29%),合作型20人(12.20%),主导型11人(6.71%)。无序多分类logistic回归分析显示，照顾者性别、照护时长、文化程度和患者心理痛苦程度是晚期癌症患者家庭照顾者沟通模式的主要影响因素(P<0.05,P<0.01)。结论 晚期癌症患者家庭主要照顾者以孤独型沟通模式为主，医护人员需针对相关影响因素制订晚期癌症患者家庭照顾者沟通应对策略，以改善晚期照护阶段家庭沟通模式。     

养老机构中老年人尊严的研究进展

综述尊严的起源、概念,总结归纳养老机构老年人尊严的测量工具、影响因素,维护尊严的措施,以及对我国养老机构维护老年人尊严的启示,希望能够增加医务人员对尊严概念的了解,将相关概念应用于对老年人的日常生活照护中,维护老年人的尊严,提高其生活质量,有尊严地安享晚年。     

重型狼疮性肾炎患者自我管理行为的质性研究

目的探讨重型狼疮性肾炎患者的自我管理行为,为完善重型狼疮性肾炎患者自我管理提供例证和启示。方法采用质性研究中诠释现象学研究法,对10例重型狼疮性肾炎患者进行深度访谈,收集资料,并采用Miles和Huberman内容分析法分析资料。结果通过资料分析,提炼出症状管理、情绪控制、服药意识、健康生活方式4个主题。结论重型狼疮性肾炎患者能根据自己的经验和知识以及疾病的症状采取适当的自我管理控制行为,但仍需进一步加强医护人员在重型狼疮性肾炎患者自我管理中的作用,同时督促和鼓励社会支持系统参与重型狼疮性肾炎患者的自我管理,提高其自我管理水平。     

An exploration of an ethics of care in relation to people with intellectual disability and their family caregivers in the Cape Town metropole in South Africa

People with intellectual disability (ID) are defined as a group by their need for lifelong support. For the most part, it falls to family caregivers to provide this support. This paper begins with a critique of a human rights perspective in dealing with family care and argues for an ethics of care in understanding the support needs for families and adults with ID. This perspective is then applied to a study that was undertaken in 2013 in the Cape Town metropole in the Western Cape Province of South Africa on the views of people with ID and their families on meeting care needs in this context. Sixteen adults with ID and 38 family caregivers were interviewed and the data was analyzed by means of a thematic analysis. The themes that emerged were: (a) the need for “another mother”, (b) protection from crime, violence and abuse, (c) maximizing independence, (d) accessing resources and (e) community integration. These themes are discussed in the light of an ethics of care, using Tronto's (1993) elements of care as an analytic tool to explore how care needs might be thought of in the study context.     

The process of patient education of cancer patients at a surgical clinic

In order to clarify the controversial issue of informing cancer patients of their condition, the following questionnaire was administered to 41 patients with cancer, and 106 patients with other conditions. The questions were: How often and in what form will cancer patients be informed about the nature of their illness? What types of reactions followed? How often did hopelessness and suicidal phantasies arise? What type of support system was the most helpful? The result showed that 90% of all patients wanted to be informed; 85% of the patients with cancer reacted with great anxiety: an increased loss of hope and risk of suicide was not encountered; the most important support system is the family and the patient's trust in the doctor.     

Comparison of the psychospiritual needs of Chinese heart transplant recipients at pre- and postoperative stages

Purpose

This project sought to compare Chinese heart transplant (HT) recipients' psychospiritual needs during the preoperative (PS) and the postoperative predischarge stage (PDS).

Methods

Thirty HT recipients from two leading medical centers in Taiwan were recruited for this research. Data collected by face-to-face interview were analyzed by content analysis.

Results

The patients' ages ranged from 23 to 45 years (mean [M] ± standard deviation [SD] = 28.5 ± 4.1); 90% were married. The subjects' cardiac disease history ranged from 4.2 to 12.3 years (M ± SD = 8.2 ± 2.3). The waiting time list for HT ranged from 1.2 to 6.4 years (M ± SD = 3.1 ± 2.6). The subjects had the following six psychospiritual concerns: death (PS), unfulfilled family responsibilities (PS and PDS), unaccomplished personal life goals (PS and PDS), poor body image (PDS), loss of significant others' support and love (PDS), and discrimination by others (PDS). The following seven needs of help were reported: comforting the fear of failure in heart transplantation (PS and PDS), meeting unfulfilled family responsibilities (PS and PDS), accomplishing personal life goal (PS and PDS), religious support (PS and PDS), establishing confidence in body image (PDS), establishing positive relationship with significant others (PS and PDS), and preparation for dying with dignity when necessary (PS and PDS).

Conclusion

The in-depth investigation on Chinese HT recipients' psychospiritual needs was first compared in PDS and PS. More distress and needs were found in PDS than PS. These findings were attributed by the dilemma of pursuing prospective future versus taking the risk of loss of life, valuing families' and health professionals' support system, and expecting grief and dying with dignity. Health professionals are encouraged to understand and provide stage-specific support to help them meet psycho-spiritual needs.     

Nutrition in Renal Supportive Care: Patient‐driven and flexible

Renal Supportive Care is an alternative treatment pathway in advanced chronic kidney disease that is being increasingly adopted, particularly in the elderly. Renal Supportive Care uses principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non‐dialysis pathway. Nutrition management is often an under‐recognized component of care and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of Renal Supportive Care are met. Nutrition interventions need to target patient and treatment goals, with frequent monitoring to ensure patient needs are being met. This review outlines available literature on this topic and suggests some practical ways in which nutrition can be enhanced for these patients.     

癌症患者术前知情状况及其满意度与抑郁的相关性分析

目的 探讨癌症患者术前出现抑郁的原因,为预防患者发生抑郁提供依据.方法 采取方便抽样方法对58例癌症患者手术前知情状况、对知情的满意度及抑郁状况进行问卷调查.结果 癌症患者术前的知情状况与获得信息满意度呈显著正相关(r=0.571,P＜0.01);满意度与抑郁状态呈显著负相关(r=-0.468,P＜0.01);知情状况与抑郁状态呈显著负相关(r=-0.450,P＜0.01).术前癌症患者抑郁的总发生率为44.83%,其中轻度15例(57.69%)、中度7例(26.93%)、重度4例(15.39%).结论 癌症患者术前知情程度越高,满意度越高,抑郁程度越低.临床护理工作中应加强心理护理,为患者提供尽可能多的信息,满足他们对信息的需求,减少对癌症的恐惧和陌生感,以减少抑郁的发生.     

Palliative and shared care concepts in patients with advanced colorectal cancer

Approximately 50% of patients with colorectal cancer (CRC) will eventually die of metastatic disease. Effective palliative management can be used within a shared care model in CRC to provide optimum symptom control, psychological well-being and maintenance of quality of life for patients, their families and carers, including bereavement support. Maintenance of realistic hope and early goal setting are equally important in end-of-life discussions with patients and families. Palliative care should be incorporated early in the course of the illness, concurrent with disease-modifying therapies. Within shared care, the palliative medicine specialist, surgeon and other members of the multidisciplinary team can each bring their own expertise to provide a patient-centred approach. A case is presented that incorporates some of these principles and exemplifies the benefits of contemporary palliative care for patients with advanced CRC.