脑卒中患者居家护理模式的设计与应用

目的 :探讨针对脑卒中患者的居家护理模式的设计与应用效果。方法 :设计居家护理模式,对168例脑卒中患者(实验组)按居家护理模式实施护理,并与实施常规护理的173例脑卒中患者(对照组)进行回顾性分析比较。结果 :实验组平均住院日短于对照组(P<0.05),出院后30d日常生活活动能力评分高于对照组(P<0.05),出院后30d内吸入性肺炎发生率与再住院率均低于对照组(P<0.05),出院满意度高于对照组(P<0.01),差异均有统计学意义。结论:居家护理模式能够改善脑卒中患者生存质量,实现了脑卒中患者护理的专业性、持续性和延伸性,保证了脑卒中患者在出院后能够得到专业支持和帮助,是一种先进、有效的延伸护理服务模式。     

居家护理服务模式的构建

通过构建和应用居家护理服务模式,保证了患者在出院后能够得到专业支持和帮助,为临床提供了一种先进、有效的延伸护理服务模式,体现了护理的专业性、持续性和延伸性。     

脑卒中吞咽障碍患者居家护理模式及效果评价

目的:构建脑卒中吞咽障碍患者居家护理模式并评价其效果。方法:选取脑卒中吞咽障碍患者78例为研究对象。采用计算机产生随机序列法将患者随机分为观察组和对照组,每组各39例。对照组给予常规健康教育,观察组在常规健康教育基础上给予居家护理服务计划和干预措施,干预12周后,评价并比较2组患者干预前后的吞咽障碍情况、神经功能缺损程度、营养风险、自理能力、日常活动能力、心理状态及康复依从性。结果:干预12周后,2组吞咽障碍功能较治疗前明显提高(P0.05),且观察组更优于对照组(P0.05)。干预后,观察组患者神经功能缺损、营养风险、抑郁评分明显低于干预前及对照组(均P0.05),观察组患者自理能力、日常活动能力、依从性得分均高于干预前及对照组(均P0.05);对照组各项指标干预前后比较除营养风险和抑郁评分外,其余各项指标差异有统计学意义(均P0.05)。结论:脑卒中吞咽障碍患者居家护理模式有较高的实用价值,对改善脑卒中吞咽障碍患者吞咽情况,提高患者生活质量,促进患者康复,实现医院-社区-家庭的无中断长期护理服务有重要作用。     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients'physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.     

社区脑卒中患者家庭康复现状调查分析

目的了解社区脑卒中患者家庭康复现状,分析其中存在的问题。方法对62例脑卒中患者及其主要照顾者进行家庭入户问卷调查。结果居家康复的脑卒中患者遗留有多种功能障碍,缺乏家庭康复训练,家庭设施未行相应改造,患者的综合自理能力及主要照顾者的照顾能力均较差。结论社区脑卒中患者的家庭康复存在问题较多,应加强家庭康复护理指导工作。     

The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives

Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55–72 from Ontario, Canada, participated in semi‐structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers’ comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.     

国外血友病家庭治疗和护理管理现状

归纳了近年来国外家庭治疗和护理管理的主要进展,即国外家庭护理观点的演变、患者管理,分析了患者评估、资料管理、患者对血友病知识及对家庭治疗、护理和自我管理的需求.在此基础上,对我国血友病家庭治疗和护理的前景进行了展望.     

Predictive factors for home deaths among cancer patients in Swedish palliative home care

Five palliative home care teams participated in a prospective Swedish study that included 221 palliative cancer patients. All patients with incurable malignant disease that were admitted and died during 1999 were included. On admission, demographic data were recorded. When patients, despite ongoing home care, were referred to institutional care, doctors and nurses involved were interviewed about the reasons for this. After the patients' death next of kin involved in the care were interviewed according to a questionnaire. Approximately half of the patients died at home. The reasons for referral showed a wide diversity and included both social and psychosocial factors, medical emergencies and problems related to symptom control. A preference for dying at home and not living alone were shown to be the strongest predictors of home death (p = 0.001). However, 35% of patients living alone died at home. Interestingly enough, Karnofsky performance index (KPI) at admission was significantly lower for those dying at home, despite similar mean time of care. The understanding of impending death was significantly more common among the families of those patients dying at home.     

Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care

Aim

To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long‐term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care.

Methods

This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t‐test and the changes in LTCS benefit levels were compared by using the χ²‐test.

Results

The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups

Conclusion

All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.

     

对老年慢性病患者实施居家护理的效果分析

目的探讨居家护理对提高老年慢性病患者居家护理的效果分析。方法将141例老年慢性病患者分为观察组和对照组,观察组75例,对照组66例。观察组实施出院后居家护理：包括电话随访和上门访视。对照组出院后不实施居家护理。比较两组患者出院后6个月的Barthel指数得分、再住院率,并对居家护理工作满意度进行问卷调查。结果出院后6个月观察组Barthel指数、再住院率与同期对照组比较差异具有统计学意义（P〈0．01）,出院后观察组患者对居家护理工作表示满意。结论实施居家护理可以提高老年慢性病患者的日常生活能力,降低再住院率。     

我国延续性护理在癌痛居家患者中的研究进展

延续性护理对居家癌痛患者的生活质量具有重要作用,本文通过对国内癌痛居家患者开展延续性护理的必要性、具体形式和内容,及其干预后效果评价三方面内容进行综述,以期为构建和完善我国癌痛居家患者的延续性护理模式提供借鉴。     

Quality of nursing home care assessed by competent nursing home patients

Interviews were conducted with 60 chronically ill but cognitively competent nursing home patients with a mean age of 80 years, living in 13 nursing homes in the county of Stockholm, Sweden. Quality of nursing home care was assessed through discrepancy between individual priorities (i.e. degree of perceived personal autonomy) and institutional possibility. The results show that there was a high degree of satisfaction with quality of care with regard to meal and shower routines, as well as with the possibilities to watch television, listen to the radio and feel secure. Social relations, on the other hand, was a subject which exposed large discrepancies. Most respondents believed in the importance of social relations whereas results point to a lack of intimacy in the daily living.     

A client-centered approach in home care for older persons – an integrative review

Objective To describe and synthesize client-centered care and service in home care for older persons.Methods The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis.Results The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients’ involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members’ and care partners’ participation in care; family members’ and care partners’ commitment to care, family members’ and care partners’ competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing.Conclusions According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services.

KEY POINTS

• Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons
• This paper:
• deepens and structures the concept of client-centered care in the context of home care.
• assists professionals to understand the factors behind client-centered care within the home care environment.
• provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

     

脑卒中患者延续性护理的研究进展

脑卒中(stroke)又称中风或脑血管意外,是指由于机体脑循环障碍所致的局限或全面性脑功能缺损综合征或急性脑血管病事件,包括脑出血、脑梗死、蛛网膜下腔出血等[1]。脑卒中发病率、死亡率高、致残率和复发率高。目前,国内脑卒中护理的重点在患者住院期间,如超早期的溶栓治疗和护理、急性期的治疗和护理、病情稳定后的早期康复护理[2]。     

Patient satisfaction in home health care

Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care. Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care. Design. A critical review of the literature. Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care. Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow‐up programmes, care process and management practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments. Conclusions. Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many frameworks. Relevance to clinical practice. Home healthcare mangers and researchers need to take in consideration the reliability and validity of measures and tools of patient satisfaction.