轻度血管性痴呆的认知康复效果观察

目的观察认知康复对轻度血管性痴呆的疗效。方法 60例轻度血管性痴呆患者随机分为认知康复组 (A组 ,3 0例 )和非认知康复组 (B组 ,3 0例 )。两组均进行药物治疗及根据情况进行运动疗法 (PT)、作业疗法 (OT)、语言疗法 (ST)训练 ,A组在此基础上加用认知康复训练。对 60例患者在治疗前及治疗 3个月后 ,使用洛文斯顿作业疗法用认知功能成套测定 (LOTCA )评价认知功能 ,功能独立性评定 (FIM )评价日常生活能力 ,并进行组间比较。结果A组在认知功能、日常生活能力、主观总体印象方面均较B组有明显改善 (P <0 0 1或P <0 0 5 )。结论认知康复对轻度血管性痴呆有治疗效果。     

Aggressive behaviour by people with dementia in residential care settings: a review

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person-centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person-centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.     

A survey of staff attitudes and responses to people with dementia who are aggressive in residential care settings

Aggression is reportedly common among older people with dementia in residential care. The attitudes of staff in care homes and strategies they use are under researched. Theoretical models that may be used to both understand and respond to such behaviour exist. They are the standard and person-centred paradigms. The aim of this study was to explore the views of nursing staff about aggressive behaviour in people with dementia and strategies used in practice. A survey of the attitudes of staff in six dementia care units using the Management of Aggression in People with Dementia Attitude Questionnaire was conducted including an audit of aggressive incidents using the Staff Observation Aggression Scale-Revised over a 3-month period. Staff expressed views reflective of a person-centred as opposed to standard paradigm. They viewed aggressive behaviour by people with dementia as deriving from the environment, situation or interactions with others. Participants strongly supported interpersonal means of responding to aggression, the moderate use of medication, and were largely opposed to physical restraint. Aggressive incidents were managed using less intrusive strategies such as distraction and de-escalation. Responses to aggressive behaviour, while pragmatic, were largely underpinned by a person-centred ethic as reflected in the attitudes expressed by staff.     

老年性痴呆病人的护理研究现状

我国老年性痴呆发病率的逐年增加,严重地危害了人民的身体健康,对此,作者对老年性痴呆病人的影响因素、护理现状、护理干预进展进行了综述,指出通过对老年性痴呆病人的3R护理、家居安全护理、心理护理,可延缓老年性痴呆的进程,提高老年人的生活质量。     

Assessment by nurses of mood,general behaviour and functional ability in patients with dementia receiving nursing home care

The aim of this study was to investigate the reliability of the Patient Mood Assessment Scale (PMAS), the General Behaviour Assessment Scale (GBAS) and the Gottfries Bråne Steen scale and to investigate mood, general behaviour, degree of dementia and symptoms for patients with dementia living permanently in nursing home care (n = 75). Interviews were conducted with the contact nurses, focussing on their view of the patients during the preceding week, based on the above-mentioned assessment scales. In 29 cases a second interview was conducted with another nurse in order to investigate the inter-rater reliability. The inter-rater reliability was high for items associated with ADL and intellectual functions, but low for items associated with emotional aspects. The nurses' difficulties in assessing the patients' emotional state could arise because these matters are not regularly discussed among the staff or could reflect the nurse's inner state rather than that of the patient. The varying understanding that the nurses had of the patients raises the question of whether the care provided is based on the nurses' opinions rather than on the patients' needs. There is a need for continuous and reflective discussions in the staff group, focusing on the patients' physical as well as emotional needs.     

Tactile stimulation associated with nursing care to individuals with dementia showing aggressive or restless tendencies: an intervention study in dementia care

Aim.  This study aimed to describe from documentation both the caregivers' experiences of giving tactile stimulation to five people with moderate-to-severe dementia and who showed aggressive or restless tendencies, and the changes seen in them.
Background.  Clinical experiences indicate that tactile stimulation can contribute to a feeling of trust and confirmation as well as to improving communication, promoting relaxation and easing pain. There is, however, very little scientific documentation of the effects of touch massage for people with dementia.
Design.  From caregivers' documentation (28 weeks) of experiences, the giving of tactile stimulation to five randomly selected people with dementia showing aggressive or restless tendencies and the subsequent changes noticed.
Method.  The documentation was analysed by using qualitative content analysis.
Results.  All residents displayed signs of positive feelings and relaxation. The caregivers stated that they felt able to interact with the residents in a more positive way and that they felt they had a warmer relationship with them.
Conclusion.  Tactile stimulation can be seen as a valuable way to communicating non-verbally, of giving feedback, confirmation, consolation or a feeling of being valuable and taken care of.
Relevance to clinical practice.  Tactile stimulation has to be administered with respect and care, and given from a relational ethics perspective. Otherwise, there is a risk that tactile stimulation will be used merely as a technique instead of as a part of an effort to achieve optimal good, warm nursing care.     

The care of older people with dementia in acute hospitals

cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5 , 83–92. Aim. To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background. The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method. An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings. Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion. Bourdieu’s Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice. It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken.     

Reconciling mental health recovery with screening and early intervention in dementia care

If early intervention in dementia care is to be enhanced, it is important to have a critical debate over how this should be realized. In this paper, we offer a synthesis of two approaches to care: mental health recovery and person-centred care, and apply them to early-stage dementia care. 'Person-centred care' has become a catchphrase for good dementia care. However, many people have not experienced improvements in care, and other lynch pin concepts, such as 'mental health recovery', might have utility in driving reform. The similarities and differences between the two approaches are drawn out, and the difficulties of using the word 'recovery' when discussing a degenerative disease are highlighted. The implications of this discussion for early intervention are discussed. It could be seen that the two bodies of knowledge have much to offer each other, despite initial dissonance with the label of recovery in dementia care.     

Nurses' experiences of abusive/non-abusive caring for demented patients in acute care settings

Nurses caring for patients with dementia in acute care settings often lack specialized education in geriatric nursing. The acute care settings do not have an environment made for dementia care. The staff often had a high workload, which makes the situation stressful and the nurses who take care of these patients might end up in difficult situations. The aim of this study was to describe nurses' experiences of difficulties related to caring for patients with dementia in acute care settings. Interviews were performed with 12 nurses. Qualitative thematic content analyses were carried out in several steps. The results show that the nurses experienced various difficulties in meeting patients with dementia in acute care settings. This gave rise to for example frustration. Most commonly reported was lack of time to treat these patients satisfactorily. The difficulties were mostly related to the often disorderly conduct of these patients, the ethical problems that appeared in the care of these patients, and the medical care organization. The problematic situations described sometimes led to abuse and neglect of these patients.     

养老院护理员对老年痴呆病人护理的认知和依从性研究

[目的]研究养老院护理员(简称养老护理员)在护理老年痴呆病人方面的认知和依从性情况。[方法]利用自行设计的调查问卷,对248名养老护理员的认知和依从性两方面进行调查,并进行量化分析。[结果]年龄<40岁,工作年限为1年~3年,高中或以上文化程度的养老护理员对老年痴呆病人护理认知程度提高、依从性最好;认知程度低组和依从性差组主要归因于疾病护理、生活护理、心理护理这3个方面得分较低,而安全护理方面与对照组无显著性差异(P>0.05)。[结论]精选执业人员,加强职业教育,建立监督机制是提高养老护理员对护理痴呆老人的认知和依从性的3个重要举措。     

养老院护理员对老年痴呆病人护理的认知和依从性研究

[目的]研究养老院护理员（简称养老护理贞）在护理老年痴呆病人方面的认知和依从性情况。[方法]利用自行设计的调查问卷，对248名养老护理员的认知和依从性两方面进行调查，并进行量化分析。[结果]年龄〈40岁，工作年限为1年～3年，高中或以上文化程度的养老护理员对老年痴呆病人护理认知程度提高、依从性最好；认知程度低组和依从性差组主要归因于疾病护理、生活护理、心理护理这3个方面得分较低，而安全护理方面与对照组无显著性差异（P〉0．05）。[结论]精选执业人员，加强职业教育，建立监督机制是提高养老护理员对护理痴呆老人的认知和依从性的3个重要举措。     

Outcome and quality of care of patients who have acute myocardial infarction

Coronary artery disease is the number-one killer in developed countries, with lifetime prevalence of up to 50% in American men, and is the topic of much medical literature. Recently, multiple therapies have emerged to save lives after acute myocardial infarction (AMI), backed by well-conducted studies; however, appropriate implementation of therapy guidelines is less than optimal. Recent efforts have focused on improving the quality of care (QC) after AMI in order to improve outcomes. This article illustrates how outcome after AMI is related to QC, describes the underuse of evidence-based therapies, and discusses factors associated with poor guideline adherence. It also reviews current quality improvement projects, and some available means to measure and optimize the QC for patients with AMI.     

Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.