手术室护士心理健康状况及自我隐瞒程度调查分析

目的探讨手术室护士心理健康状况及自我隐瞒程度。方法 40名手术室护士和59名外科病房护士分别接受症状自评量表(SCL-90)和自我隐瞒量表(SCS)调查,将手术室护士调查结果与常模和外科病房护士比较,分析产生差异的原因。结果 1手术室护士躯体化、强迫、人际关系敏感、焦虑因子均高于中国青年常模,差异具有统计学意义(t=4.31,3.33,2.15,3.61;P均0.05)。其他因子未见统计学差异;2手术室护士强迫、焦虑、敌对因子高于外科病房护士,差异具有统计学意义(t=2.19,2.13,2.05;P均0.05);3手术室护士SCS得分显著高于外科病房护士,差异具有统计学意义(t=2.18,P0.05);4手术室护士SCL-90各因子与SCS之间存在一定程度的相关,其中强迫、焦虑因子与自我隐瞒程度成显著性正相关(r=0.33,0.32;P均0.05)。结论手术室护士的心理健康状况欠佳,自我隐瞒程度偏高。     

精神科开放与封闭病房护士心理健康状况调查

目的探讨精神科开放病房与封闭病房护士心理健康状况。方法在参考文献基础上自行设计一般状况调查表,应用症状自评量表（SCL-90）,对我院封闭病房109名护士和开放病房19名护士的心理状况进行对比研究。结果开放病房与封闭病房护士SCL-90评定结果比较,封闭病房护士在量表中的总分、阳性项目数、躯体化、人际关系、焦虑等方面,得分明显高于开放病房护士．结果具有统计学意义（P≤0．05）。结论精神科封闭病房护士心理健康状况相对较差,护理管理者应采取有效地干预措施。     

Social support,anxiety and depression after chemotherapy for ovarian cancer: A prospective study

Objectives: We aimed to describe the levels of anxiety and depression in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity. Method: We performed a prospective study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy. Sixty‐three consecutive patients were assessed at the completion of chemotherapy (Time 1) and 57 at 3 months follow‐up (Time 2). Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety, depression and their perception of emotional support, an index of their psychosocial environment. Anxiety and depression were re‐assessed at Time 2. Results: The results indicate significant initial psychological morbidity, with clinical caseness for anxiety (38%) and depression (33%) being common. Follow‐up at Time 2 shows that patients undergo a significant reduction in cases (19%) and symptoms of depression but an increase in cases of anxiety (47%). The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support, increased intrusive thoughts and, to a lesser extent, younger age. Medical parameters, such as the stage of disease, response of the cancer to treatment, Ca125 (a tumour glycoprotein) and Karnofsky Performance status (a measure of how well the patients is) were not associated with worse psychological outcome. Conclusion: These data show for the first time that social support and intrusive thoughts, rather than physical parameters, are the principal determinants of psychological morbidity in patients with ovarian cancer.     

青年护士心理健康状况研究

目的 探讨青年护士的心理健康问题,为护士开展心理咨询提供依据。方法 采用症状自评量表(SCL-90)对97名护生和89名青年护士进行调查。结果 青年护士和护生比较,表现在焦虑、抑郁、人际关系敏感和强迫等心理问题,青年护士与常模比较,表现在焦虑、抑郁、强迫、敌对和精神病性等心理问题。结论 应加强对青年护士进行心理咨询,提高青年护士的心理健康素质。     

Psychiatric sequelae following breast cancer chemotherapy: a pilot study using claims data

Despite attention to depression and cognitive disorders, the prevalence of other mental disorders following breast cancer chemotherapy has not been well described. The authors undertook a pilot study using insurance claims data to compare the prevalence of mental disorders other than depression in a population of breast cancer surgery patients who did versus did not receive postsurgical chemotherapy treatment. Women receiving chemotherapy in addition to surgery were more likely to be diagnosed with adjustment disorders (odds ratio=2.01, 95% CI=1.04-3.87). Prevalence of depression, anxiety, cognitive, and sleep disorders were not dependent on receipt of post-surgical chemotherapy treatment. These findings support the need for heightened awareness for mental conditions following chemotherapy.     

A pilot study exploring the effect of discharging cancer survivors from hospital follow-up on the workload of general practitioners.

BACKGROUND: The tradition of routine, long-term follow-up of cancer patients in the outpatient clinic has led to busy clinics and long waiting times. Many cancer patients are anxious and have become dependent on the specialist clinic for reassurance. General practitioners (GPs) have been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonstrated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased demand on GP practices. AIM: To determine the consequences for GPs of discharging long-term cancer patients from a hospital outpatient follow-up clinic. METHOD: A consecutive sample of 65 patients under annual review in a hospital oncology clinic were offered a planned discharge in which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depression rates were assessed using the Hospital Anxiety and Depression Scale (HADS) at the time of discharge and four months later at a home interview. The GPs of all patients who were discharged were sent questionnaires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity. RESULTS: The results showed no significant increase in the consultation rates during the 12 months after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depression. GPs thought there was a need for more specialist Macmillan nurses working in the community and highlighted the importance of fast-track specialist referral. CONCLUSION: Discharging this group of long-term cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the community suggests that primary care services may find it difficult to cope adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training requirements of GPs in the routine follow-up of cancer patients.     

Women's experiences of information, psychological distress and worry after treatment for gynaecological cancer

Sensitive, appropriate patient information is considered to be an important element in the psychological support of patients. Specialist nurses are seen to have a key responsibility for this work. With regard to gynaecological cancer, evidence suggests that women do not get optimum psychological care. This study set out to explore women's experiences of information, psychological distress and worry after treatment for gynaecological cancer. The study was a survey (not an RCT) and 70 patients from two specialist gynaecological oncology centres were interviewed at the time of diagnosis/initial treatment and again at 6 months. The semi-structured schedule included recognised instruments to assess; sources of information, concerns, and psychological distress. Both initially and at 6 months there was evidence of a considerable burden of worry; over half the women had four or more significant concerns related to their illness experience. However, women who had initial support from a clinical nurse specialist at the time of diagnosis experienced a clinically significant reduction in their level of psychological distress 6 months from diagnosis. Hospital linked professional sources of information were well used at the time of diagnosis, but by 6 months many patients were using non-professional sources such as television, magazines and newspapers. This study suggests that support from a clinical nurse specialist may be able to assist psychological recovery. However, to be effective in this area nurses should be skilled and willing to assess the individual's need for help with information, and managing their worry.     

Workplace bullying in nurses

The article reports a study of workplace bullying in community nurses in an NHS trust. The aims were to determine the prevalence of bullying, to examine the association between bullying and occupational health outcomes, and to investigate whether support at work could moderate the effects of bullying. Forty-four percent of nurses reported experiencing one or more types of bullying in the previous 12 months, compared to 35 percent of other staff. Fifty percent of nurses had witnessed the bullying of others. Nurses who had been bullied reported significantly lower levels of job satisfaction and significantly higher levels of anxiety, depression and propensity to leave. They were also more critical of aspects of the organizational climate of the trust. Support at work was able to protect nurses from some of the damaging effects of bullying.     

延续性护理对癌症患者焦虑抑郁情绪影响的Meta分析

目的 采用Meta分析评价延续性护理对癌症患者焦虑抑郁情绪的影响效果。方法 计算机检索2013年1月1日~2018年10月1日Cochrane、PubMed、EMBASE、CIANHL、CBM、CNKI、维普和万方数据库,收集延续性护理对癌症患者焦虑抑郁情绪影响的随机对照试验。由2名研究者独立筛选文献、提取资料、质量评价,应用RevMan5.3软件对纳入的文献进行Meta分析。结果 共纳入15项随机对照研究,1347例患者;Meta分析结果显示:与常规出院护理比较,采用延续性护理能降低癌症患者焦虑评分（SMD=1.14,P＜0.05）与抑郁评分（SMD=1.24,P＜0.05）。结论 延续性护理较常规出院护理能降低癌症患者焦虑抑郁评分。本次纳入研究文献数量以及质量存在一定局限性,尚需高质量的研究进一步验证。     

Could worry and rumination mediate relationships between self‐compassion and psychological distress in breast cancer survivors?

Many breast cancer (BCa) patients experience clinically significant anxiety and depression in survivorship. Self‐compassion offers a bulwark to anxiety and depression in nonclinical, mental health, and some chronic physical health populations. We examined whether self‐compassion predicted lower anxiety and depression symptoms in survivors and whether this might be mediated by lower worry and rumination. The design was a cross‐sectional survey using self‐report measures. Female adult BCa survivors of mixed stages who had finished primary surgical, radiotherapy, or chemotherapy treatments completed self‐compassion subscales and worry, rumination, and anxiety and depression scales. Higher self‐compassion subscale scores were negatively associated with anxiety and depression. Depressive brooding and worry mediated any effects of self‐kindness and mindfulness on depression and anxiety, whereas common humanity directly predicted lower depression scores. Findings are consistent with the view that self‐compassion reduces threat‐related rumination and worry in BCa survivors, consequently reducing anxiety and depression. This may form a basis for prevention and treatment.     

Anxiety in medical situations: adult cancer patients

Anxiety associated with medical situations was studied in a heterogeneous sample of 320 adult cancer patients. Patients completed the Cancer Inventory of Problem Situations, which identifies anxiety in a variety of medical situations. On the average, 44% of patients reported some anxiety in medical situations; 23% reported significant anxiety. Anxiety was somewhat situation dependent. Females were more likely to report anxiety and with greater intensity than males in situations such as watching other patients receive treatments, waiting to see the doctor, waiting to find out the results of tests, going to the hospital, and receiving chemotherapy. Multiple regression techniques were used to identify the correlates of anxiety. Age, sex, problems communicating with the health team, and global adjustment to the illness all accounted for a significant amount of the variance. The results suggest important areas for mental health professionals to be involved in the care of individuals with cancer if comprehensive care is to be provided.     

Assessment-based group counseling to address concerns of chronic hemodialysis patients.

A Dialysis Patient Concerns Inventory (DPCI) was administered to 15 chronic hemodialysis outpatients by their nurses to assess concerns related to being a hemodialysis patient. This direct information from patients rather than experts in the field was used to construct a group counseling program to address these and other concerns later acknowledged by patients once group counseling began. Components of the counseling program, how the program was implemented, its effects, and factors important in effective program implementation with nurse involvement are discussed. It was concluded that it is important for nurses to play key roles in group counseling to address patients' concerns. It is also important for such counseling to be based on structured assessment of specific concerns reported from patients. Furthermore, it was concluded that group counseling should be planned and executed in ways that actively involve patients and that allow patients to participate for skill development and for life enhancement, rather than to get help with personal problems--a motivator that is often stigmatized.     

Cancer patients' expressions of emotional cues and concerns and oncology nurses' responses, in an online patient-nurse communication service

Objective

To (1) investigate emotional cues and concerns (C&;C) of cancer patients expressed in e-mail communication with oncology nurses in an online patient–nurse communication service (OPNC), and (2) explore how nurses responded to patients’ C&;C.

Methods

283 e-messages sent from 38 breast and 22 prostate cancer patients and 286 e-responses from five oncology nurses were coded with the Verona Coding Definitions of Emotional Sequences.

Results

We identified 102 cues and 33 concerns expressed in patients’ messages. Cues indicating expression of uncertainty or hope, occurred most frequently (in 38.5% of messages), followed by concerns (in 24.4% of messages). Nurses responded to 85.2% of patients’ C&;Cs; more than half of patients’ C&;Cs were met with a mixture of information giving and empathic responses.

Conclusion

Patients with breast and prostate cancer express many C&;C in e-mail communications with oncology nurses, who demonstrated satisfactory sensitivity to patients’ emotions in their responses to patients.

Practice implications

Offering e-communication with oncology nurses to cancer patients is a promising and feasible supplement to usual care to address and relieve patients’ concerns and emotional distress during illness and recovery.     

Perception of risk, anxiety, and health behaviors in women at high risk for breast cancer

Perception of risk, anxiety, psychological distress, and early detection behavior were investigated in 23 women with a family history of breast cancer who attended genetic counseling and 21 women without a family history of breast cancer. In addition to a breast cancer-specific questionnaire, the Symptom Checklist 90-Revised and the State-Trait Anxiety Inventory were used. Thirty-nine percent of the women with a family history of breast cancer correctly identified and 48% overestimated their own lifetime risk. Risk perception was independent of genetic counseling. Levels of general psychological morbidity were similar between women with a family history of breast cancer and controls. For controls, early detection behavior was related to lifetime risk estimate and was, in general, independent of level of anxiety. Despite genetic counseling, many women continued to perceive their own lifetime risk of breast cancer inaccurately. They might benefit from additional counseling on risk assessment.     

团体心理治疗对乳腺癌患者焦虑抑郁情绪的影响

目的探讨团体心理治疗对乳腺癌患者焦虑抑郁情绪的影响。方法将96例乳腺癌病人随机分为两组。对照组接受常规化疗,干预组在临床治疗的同时,进行团体心理治疗,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定其情绪状况,观察比较病人在团体心理治疗8周前后SAS和SDS评分结果。结果干预组患者焦虑、抑郁情绪得到明显改善,前后比较有显著性差异(t=3.34,3.65;P<0.01)。结论乳腺癌患者在进行躯体治疗的同时,实施有效的心理治疗可以纠正患者不恰当的认知,改善其焦虑抑郁情绪,故可作为乳腺癌治疗的辅助方法应用于临床。     

40例抑郁症患者心身症状及抑郁焦虑共病情况调查

目的分析抑郁症患者的心身症状及与焦虑共病情况。方法对40例抑郁症患者进行症状自评量表(SCL-90)和汉密顿抑郁(HAMD)、汉密顿焦虑(HAMA)量表评定,将SCL-90得分与中国成人常模比较,对汉密顿量表焦虑、抑郁得分进行分级,分析共病情况。结果 40例抑郁症SCL-90的9个症状因子得分均明显高于常模(t=4.91～9.75,P<0.01),HAMD得分分级:重度29例(72.5%)、轻中度11例(27.5%),HAMA得分分级:中度焦虑3例(7.5%)、有肯定焦虑症状30例(75%)、没有明显焦虑7例(17.5%),抑郁焦虑共病率82.5%。结论抑郁症患者心身症状突出,抑郁焦虑共病率较高。     

PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care.

BACKGROUND: Common mental health problems account for up to 40% of all general practitioner (GP) consultations. Patients have limited access to evidence-based psychological therapies. Cognitive behavioural therapy self-help strategies offer one potential solution. AIM: To determine differences in clinical outcome, patient satisfaction and costs, between a cognitive behavioural-based self-help package facilitated by practice nurses compared to ordinary care by GPs for mild to moderate anxiety and depression. DESIGN OF STUDY: Randomised controlled trial. SETTING: Seventeen primary healthcare teams. METHOD: Patients presenting to their GP with mild to moderate anxiety and/or depression were recruited to the study and randomised to receive either a self-help intervention facilitated by practice nurses or ordinary care. The self-help intervention consisted of up to three appointments: two 1 week apart and a third 3 months later. There were no restrictions on ordinary care. RESULTS: Intention-to-treat analysis showed that patients treated with practice nurse-supported cognitive behavioural therapy self-help attained similar clinical outcomes for similar costs and were more satisfied than patients treated by GPs with ordinary care. On-treatment analysis showed patients receiving the facilitated cognitive behavioural therapy self-help were more likely to be below clinical threshold at 1 month compared to the ordinary care group (odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.87 to 4.37). This difference was less well marked at 3 months (OR = 1.36, 95% CI = 0.52 to 3.56). CONCLUSION: Facilitated cognitive behavioural self-help may provide a short-term cost-effective clinical benefit for patients with mild to moderate anxiety and depression. This has the potential to help primary care provide a choice of effective psychological as well as pharmacological treatments for mental health problems.     

延续护理模式对宫颈癌患者生活质量和抑郁焦虑的影响

目的:探讨延续护理模式对宫颈癌患者生活质量和抑郁焦虑的影响。方法:选取2015年2月—2016年7月于我院因宫颈癌行根治术后接受化疗的患者共90例,随机分为干预组和对照组各45例,处理组采用延续护理模式,对照组采用常规护理随访,采用癌症康复评价简表(CARES-SF)进行生活质量评估,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)比较两组患者干预前后的焦虑抑郁情况。结果:两组患者干预前的CARES-SF评分对比差异没有统计学意义,干预后1个月、3月、6月干预组显著低于对照组,差异具有统计学意义(t=-7.342,-8.316,-5.937;P0.01);两组患者干预前的SAS评分对比差异没有统计学意义,干预后1个月、3月、6月干预组显著低于对照组,差异具有统计学意义(t=-5.027,-11.192,-10.241;P0.01),两组患者干预前的SDS评分对比差异没有统计学意义,干预后1个月、3月、6月干预组显著低于对照组,差异具有统计学意义(t=-4.228,-4.943,-5.843;P0.01)。结论 :延续护理模式有助于提高宫颈癌患者的生活质量,同时能进一步缓解患者的焦虑和抑郁情绪。     

Dysphoric mood and symptomatology in schizophrenia.

The relationships between depression, anxiety and positive and negative symptoms of schizophrenia were examined in a study of 95 schizophrenic patients who were receiving out-patient care. Various measures of depression and anxiety showed a pattern of interrelationships which suggested that they were measuring a general state of dysphoria rather than separate dimensions of anxiety and depression. Dysphoria was found to be more reliably related to level of positive symptomatology than to negative symptoms.     

心理干预对乳腺癌术后化疗患者负性心理的研究

目的 探讨心理干预对乳腺癌术后化疗患者负性心理的影响.方法 将本院肿瘤科收治的120例乳腺癌术后患者,随机分为两组即实验组(心理干预组)和对照组(未干预组)各60例,两组均接受常规治疗和护理,实验组在此基础上,根据患者的心理问题,采取相应的心理干预措施.采用抑郁自评量表(SDS)、焦虑自评量表(SAS)进行评定.结果 ...