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1.
Fur-Hsing Wen Jen-Shi Chen Wen-Chi Chou Wen-Cheng Chang Wen Chi Shen Chia-Hsun Hsieh Siew Tzuh Tang 《Journal of pain and symptom management》2019,57(1):64-72
Context
Family caregivers constitute a critical component of the end-of-life care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.Objectives/Methods
We used multivariate hierarchical linear modeling to simultaneously evaluate associations between five distinct patterns of conjoint symptom distress and functional impairment (symptom-functional states) and subjective caregiving burden, QOL, and depressive symptoms in a convenience sample of 215 family caregiver–patient dyads. Data were collected every 2 to 4 weeks over patients' last 6 months.Results
Caregivers of patients in the worst symptom-functional states (States 3–5) reported worse subjective caregiving burden and depressive symptoms than those in the best two states, but the three outcomes did not differ between caregivers of patients in State 3 and States 4–5. Caregivers of patients in State 5 endured worse subjective caregiving burden and QOL than those in State 4. Caregivers of patients in State 4 suffered worse subjective caregiving burden and depressive symptoms but comparable QOL to those in State 2.Conclusion
Patients' five distinct, conjoint symptom-functional states were significantly and differentially associated with their caregivers' worse subjective caregiving burden, QOL, and depressive symptoms while caring for patients over their last 6 months. 相似文献2.
Samar M. Aoun Gail Ewing Gunn Grande Chris Toye Natasha Bear 《Journal of pain and symptom management》2018,55(2):368-378
Context
The investigation of the situation of bereaved family caregivers following caregiving during the end-of-life phase of illness has not received enough attention.Objectives
This study investigated the extent to which using the Carer Support Needs Assessment Tool (CSNAT) intervention during the caregiving period has affected bereaved family caregivers' perceptions of adequacy of support, their grief and well-being, and achievement of their preferred place of death.Method
All family caregivers who participated in a stepped-wedge cluster trial of the CSNAT intervention in Western Australia (2012–2014) and completed the pre-bereavement study (n = 322) were invited to take part in a caregiver survey by telephone four to six months after bereavement (2015). The survey measured the adequacy of end-of-life support, the level of grief, the current physical and mental health, and the achievement of the preferred place of death.Results
The response rate was 66% (152, intervention; 60, control). The intervention group perceived that their pre-bereavement support needs had been adequately met to a significantly greater extent than the control group (d = 0.43, P < 0.001) and that patients have achieved their preferred place of death more often according to their caregivers (79.6% vs. 63.6%, P = 0.034). There was also a greater agreement on the preferred place of death between patients and their caregivers in the intervention group (P = 0.02).Conclusions
The results from this study provide evidence that the CSNAT intervention has a positive impact on perceived adequacy of support of bereaved family caregivers and achievement of preferred place of death according to caregivers. The benefits gained by caregivers in being engaged in early and direct assessment of their support needs before bereavement reinforce the need for palliative care services to effectively support caregivers well before the patient's death. 相似文献3.
4.
Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits
Claire J. Han Nai-Ching Chi Soojeong Han George Demiris Debra Parker-Oliver Karla Washington Margaret F. Clayton Maija Reblin Lee Ellington 《Journal of pain and symptom management》2018,55(5):1296-1303
Context
Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.Objectives
We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised.Methods
Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges.Results
From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges.Conclusion
To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes. 相似文献5.
6.
Background
Schizophrenia is a chronic mental illness that affects the client, family, and community. Nurses are educated to use the nurse-patient relationship to provide health education and collaborative health decision-making. However, challenges abound for nurses and clients with schizophrenia to effectively utilize the relationship to reach these goals.Problem
There is a lack of evidence-based information to assist nurses to meet the challenges of building effective therapeutic relationships with clients for whom schizophrenia hinders health education and decision-making.Purpose
To examine current research findings on factors that influence therapeutic relationships in psychiatric treatment settings as an initial effort to provide empirically based guidance for psychiatric nurses who seek to better use the relationship to work with the client toward health-related goals.Method
This integrative review of the literature follows Whittemore and Knafl's (2015) method, analyzes 15 studies from multiple databases between the years 2006–2017, and assesses the rigor of each.Findings
Numerous methods are used to assess therapeutic relationships. Few studies included nurses. Provider perception of client symptoms can negatively affect provider assessment of quality of relationship; no such association was found on the part of clients. Providers and clients prioritize client needs differently, with providers influenced by treatment setting demands, but provider-training programs can have a beneficial effect on their relationships.Conclusion
Nurses and nurse educators can use the findings to guide assessment of how perceptions and priorities influence relationships. Findings also provide the foundation for further study of nurses' perceptions of therapeutic relationship, in progress, to yield more detailed information on what nurses and educators need to strengthen therapeutic relationships. 相似文献7.
Jennifer L. Woodburn Linda L. Staley Sara E. Wordingham Jenifer Spadafore Eva Boldea Samantha Williamson Sharene Hollenbach Heather M. Ross D. Eric Steidley Octavio E. Pajaro 《Journal of pain and symptom management》2019,57(2):330-340.e4
Context
Destination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL).Objectives
We evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP.Methods
We instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables.Results
All patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52% to 73% after implementation and advance directives increased from 71% to 83%. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51% completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management.Conclusion
A programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach. 相似文献8.
Birgitte Lerbæk Rikke Jørgensen Jørgen Aagaard Julie Nordgaard Niels Buus 《Archives of Psychiatric Nursing》2019,33(2):174-181
Background
Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI.Methods
Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis.Results
Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions.Discussion and conclusion
Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care. 相似文献9.
Background
Liaison psychiatry nurses in Emergency Departments assess and plan onward treatment for individuals, often following self-harm or suicide attempts. These nurses are at high risk of occupational stress. Reflective practice groups may be beneficial, but there is currently no research evaluating this.Aim
We explored nurses' experiences of attending psychology-led reflective practice groups.Method
Thematic analysis of semi-structured interviews with 13 nurses was undertaken.Results
Four themes emerged from the data: (i) Sharing and learning; participants discussed how the group provided a platform to share common experiences, express emotions and learn from each other. (ii) Grounding and perspective; participants said the group encouraged reflection on the impact of their work, with a sense of valuing their skills and the difference they make. (iii) Space; participants spoke about the group being a protected, structured and safe space. (iv) Relationships; participants said the group allowed them to support each other and have conversations in a sensitive and non-threatening way. Discussions in the group increased some participants' confidence and self-esteem.Discussion
Some nurses perceive a range of benefits from participating in reflective practice groups.Implications for practice
For some mental health nurses reflective practice groups are an acceptable and valued intervention which may reduce burnout. 相似文献10.
Background
Stigmatization and bias toward the obese population has been studied globally in a variety of professional groups, supporting the existence of negative attitudes and weight bias against this population. Attitudes fostering the prevalence of stigmatization undermine the effectiveness and quality of health care. Studies have not compared attitudes and beliefs of graduate and undergraduate students from professional schools within the same university. As an exemplar, this study compared nursing students' attitudes and beliefs toward obese individuals with students' attitudes in other professional schools.Methods
The Attitudes Toward Obese Persons and Beliefs About Obese Persons scales were administered to undergraduate and graduate nursing students and graduate education and social work students at a US northeastern university.Results
Analyses indicated students who were younger; in nursing programs; and reported not having a friend or family member who is overweight had significantly worse attitudes than others. Gender, location of residence, perceptions of own body weight, and participating in an exercise regimen were not significant.Conclusion
Understanding attitudes toward obese people may guide educators as they train nursing, education, and social work students. Reducing negative attitudes, beliefs, and stigmatization is an important starting point in the battle against this growing public health concern. 相似文献11.
Hye Yoon Park Young Ae Kim Jin-Ah Sim Jihye Lee Hyewon Ryu Jung Lim Lee Chi Hoon Maeng Jung Hye Kwon Yu Jung Kim Eun Mi Nam Hyun-Jeong Shim Eun-Kee Song Kyung Hae Jung Eun Joo Kang Jung Hun Kang Young Ho Yun 《Journal of pain and symptom management》2019,57(4):774-782
Context
To respect a patient's wish for end-of-life care, “the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted in South Korea in 2016. Current understanding of people who would be involved in advance care planning (ACP) is crucial to disseminate it systematically.Objectives
The objective of this study was to investigate awareness and attitudes toward ACP in South Korea.Methods
A multicenter, nationwide cross-sectional study was conducted, a survey regarding ACP among four groups that would have different positions and experiences: 1001 cancer patients, 1006 family caregivers, 928 physicians, and 1241 members of the general public.Results
A total of 15% of the general population, 33% of the patients and caregivers, and 61% of the physicians had knowledge of advance directives. More than 64% of the general population, above 72% of the patients and caregivers, and 97% of the physicians were willing to do so when the disease status was aggravated or terminal. The possibility for changing the plan, uncertainty as to whether directives would actually be followed, and psychological discomfort were common reasons for not wanting to engage in ACP. Routine recommendations for a specific medical condition, heightened accessibility, and health insurance support were common factors that could help facilitate ACP.Conclusion
Our findings suggest that strategies for promoting ACP should reflect different perspectives among the general public, patients, family caregivers, and physicians. Public advocacy, resources for approaching and integrating ACP into routine health care, as well as systematic support provisions are needed. 相似文献12.
Introduction
Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success.Aim/question
The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons.Method
The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review.Results
Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity).Discussion
Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency.Implications for practice
Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula. 相似文献13.
Mollie E. Aleshire Alexandra Dampier Leslie Woltenberg 《Journal of Professional Nursing》2019,35(1):37-43
Background
Nursing students' attitudes related to health care teams in the context of interprofessional education (IPE) and the impact of these attitudes on IPE and future practice are not fully understood.Purpose
The current study assesses baccalaureate nursing students' attitudes toward health care teams and evaluates if these attitudes have changed after completion of a nursing course focusing on health care systems from an interprofessional perspective.Method
A convenience sample of 116 undergraduate nursing students in a required interprofessionally-focused course was invited to participate. The Attitudes Toward Health Care Teams Scale Quality of Care subscale (ATHCT-QC) and Team Understanding Scale (TUS) were employed via a pretest-posttest design. Paired samples t-tests were conducted to compare mean scores.Results
Ninety-five respondents (81.8%) voluntarily participated at the beginning and conclusion of the course.Conclusions
There were no significant differences between pretest-posttest attitudes toward interprofessional health care teams. Nurse educators must create and evaluate innovative IPE interventions to enhance students' preparedness to be effective interprofessional health care team members. 相似文献14.
Background
Violence is a large concern for mental health professionals: 90% of physicians and nurses working in mental health areas have been subject to violence from patients. Approximately 80% of violent acts from patients are directed toward nurses.Objective
The purpose of this integrative literature review was to identify violence risk–assessment screening tools that could be used in acute care mental health settings.Design
The Stetler model of evidence-based practice guided the literature search, in which 8 violence risk–assessment tools were identified, 4 of which were used for further examination.Results
The Brøset Violence Checklist and Violence Risk Screening-10 provided the best assessment for violence in the acute care mental health setting.Conclusions
Using a violence risk assessment screening tool helps identify patients at risk for violence allowing for quick intervention to prevent violent episodes. 相似文献15.
Nancy Hoffart Thomas P. McCoy Lynne P. Lewallen Shemeka Thorpe 《Journal of Professional Nursing》2019,35(2):93-100
Background
The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.Purpose
The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.Method
An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.Results
Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.Conclusion
Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male. 相似文献16.
C. Gamondi Murielle Pott Nancy Preston Sheila Payne 《Journal of pain and symptom management》2018,55(4):1085-1094
Context
Thousands of family members worldwide are annually involved in assisted dying. Family participation in assisted dying has rarely been investigated and families' needs typically are not considered in assisted dying legislation and clinical guidelines.Objectives
To explore family caregivers' reflections on experiences of assisted suicide in Switzerland.Methods
A cross-sectional qualitative interview study conducted in the Italian- and French-speaking regions of Switzerland. Interpretation and analysis were performed using qualitative content analysis.Results
Twenty-eight close relatives and family carers of 18 patients who died by assisted suicide in Switzerland were interviewed. Family members perceived their involvement in assisted suicide as characterized by five phases; 1) contemplation, 2) gaining acceptance, 3) gaining permission, 4) organization, and 5) aftermath. Families can participate in these phases at diverse levels and with varying degrees of involvement. Important triggers for families and patients for transition between phases include patients' experiences of their life-threatening illnesses and related treatments, their increasing awareness of approaching death, and family member recognition of their loved one's unbearable suffering. Participating in assisted suicide created further demanding tasks for families in addition to their role of caregivers.Conclusion
Families appeared to be involved in the preparation of assisted suicide along with patients, irrespective of their personal values regarding assisted dying. Support for family members is essential if they are involved in tasks preparatory to assisted suicide. Clinical guidelines and policies concerning assisted dying should acknowledge and address family needs. 相似文献17.
Judith B. Vick Katherine A. Ornstein Sarah L. Szanton Sydney M. Dy Jennifer L. Wolff 《Journal of pain and symptom management》2019,57(2):199-208.e2
Context
Family caregivers play critical and demanding roles in the care of persons with dementia through the end of life.Objectives
The objective of this study was to determine whether caregiving strain increases for dementia caregivers as older adults approach the end of life, and secondarily, whether this association differs for nondementia caregivers.Methods
Participants included a nationally representative sample of community-living older adults receiving help with self-care or indoor mobility and their primary caregivers (3422 dyads). Older adults' death within 12 months of survey was assessed from linked Medicare enrollment files. Multivariable logistic regression was used to assess the association between dementia and end-of-life status and a composite measure of caregiving strain (range: 0–9, using a cut point of 5 to define “high” strain) after comprehensively adjusting for other older adult and caregiver factors.Results
The prevalence of dementia in our sample was 30.1%; 13.2% of the sample died within 12 months. The proportion of caregivers who experienced high strain ranged from a low of 13.5% among nondementia, non–end-of-life caregivers to a high of 35.0% among dementia caregivers of older adults who died within 12 months. Among dementia caregivers, the odds of high caregiving strain were nearly twice as high (aOR = 1.94, 95% CI: 1.10–3.45) for those who were assisting older adults nearing end of life. Among nondementia caregivers, providing care near the end of life was not associated with high strain.Conclusion
Increased strain toward the end of life is particularly notable for dementia caregivers. Interventions are needed to address the needs of this population. 相似文献18.
Aasha I. Hoogland Hailey W. Bulls Brian D. Gonzalez Brent J. Small Lianqi Liu Joseph Pidala Heather S.L. Jim Asmita Mishra 《Journal of pain and symptom management》2019,57(5):952-960.e1
Context
Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.Objective
To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.Methods
Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.Results
Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).Conclusion
Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample. 相似文献19.
20.
Laurie Malia V. Matt Laurich Jesse J. Sturm 《The American journal of emergency medicine》2019,37(1):85-88