中年癌症晚期患者及家属心理反应和临终关怀需求的调查分析

目的：了解中年癌症晚期患者及其家属心理反应和临终关怀的护理需求，提出有关护理对策，改善患者及家属的心理状态。方法：采用SCL-90问卷及对护理需求的自制问卷对55例中年癌症晚期患者及其家属进行调查。结果：60％的患者出现抑郁、焦虑，43．6％的患者出现孤独，40％的患者出现恐惧，10．9％的患者有敌对情绪；81．8％的患者不回避事实，想知道自己病情，87．3％的患者仍要求治疗，69．1％的患者要求控制疼痛，63．6％的患者希望多与护士交谈；72．7％的患者及家属难以接受现实，69．1％的患者及家属内心充满紧张、恐惧，100％的家属要求挽救患者生命，87．3％的家属希望减轻亲人的痛苦，69．1％的家属有对健康知识需求的愿望。结论：针对中年癌症晚期患者及其家属的不同心理反应和对护理人员的需求，提供相关的护理对策，使患者及其家属恢复了一定的心理平衡，从而帮助他们顺利地度过临终期。     

全喉切除术后患者主要家属需求的研究及护理对策

目的探讨全喉切除术后患者主要家属需求及对其的护理对策。方法对200例符合研究对象者进行问卷调查,设计患者家属心理反应和需求量表、患者对家属角色的反应量表进行统计分析。结果主要患者家属的心理需求量大,其中担心患者预后占93．2％,情绪易激动占84．6％,焦虑占93．5％,96．5％认为患者对自己经济收入影响很大,家属身体健康水平下降,对社会也造成了一系列的健康、经济和政治问题。结论对全喉切除术后患者家属需求进行评估,给予针对性的护理,达到提高患者及其家属的生活质量。从而减少患者不良心理状态,进而提高患者的生存率。     

高血压脑卒中后遗症患者家属人文关怀需求的调查

目的 了解高血压脑卒中后遗症患者家属人文关怀需求情况,以为加强人性化护理服务提供依据。方法应用自行设计调查问卷,对住院的高血压脑卒中后遗症患者家属332人进行调查,分析家属对疾病知识、陪护、住院环境及医疗服务等方面需求。结果对于患者病情的了解,98人想知道更多对于疾病治疗预后方面知识;对于患者所使用药物的了解,90人想知道更多对于所使用药物的疗效方面知识;陪护需求方面,患者家属留陪人的理由大部分认为是亲人陪伴感到安全和亲人陪伴感到安慰,分别占75．9％和69．9％,65．7％的患者家属愿意由医院统一安排护工解决陪护问题,并支付其费用;住院环境需求方面,50．3％的家属希望医院能建立“陪人休息室”,来解决离家远的陪人的住宿,能接受的费用以5-10元为主,占48．5％,希望住6人房的占50．0％,3～4人房18．4％,2人房17．2％,单人房间,不考虑价格占14．4％。结论高血压脑卒中后遗症患者家属负担重,做好家庭访视与社区康复护理是当今所面临的重大课题,在对患者家属的健康宣教中应加强对于病情方面的宣教;除了做好生活和病情方面的护理外,还应充分考虑到患者及其家属的情感需求,充分重视家属人文关怀,彰显“以人为本”的理念。     

胸外科肿瘤住院患者护理需求调查分析

目的了解胸外科肿瘤住院患者在心理、护理服务、基础护理、健康教育、最需护理方面的需求,提供有针对性的护理措施。方法采用自行设计的问卷对随机抽取的150名胸外科肿瘤住院患者进行问卷调查,运用SPSS13．0软件对调查结果进行分析。结果胸外科肿瘤患者护理需求呈现多样化趋势,对护士的心理关怀需求高占92．6％、技术操作需求占96．6％、但解除疼痛成了患者最迫切的需求,需求最高占100％、对护士责任心需求占94．6％、健康教育尤其是对出院指导需求最高,占91．2％,此外,疾病相关知识需求较高占88．5％、病房环境的需求也较高占87．8％,基础护理中除基本生活护理外,在病情需要时,患者及家属希望护士能指导或协助翻身及有效咳嗽的需求最高占93．2％。结论护士应针对不同需求提供不同的护理服务,通过护理干预,降低患者痛苦,提高患者满意度。     

老年临终病人与家属的需求调查分析

目的 为探讨临终病人与家属的需求，从而做好临终护理。方法 采用问卷的形式调查在我科临终的18名病人及其家属在病人临终期最关心的问题。结果 病人临终期及其家属最关心的问题是病人能舒适、安详、有尊严地离开人世。病人家属最关心的是在做好病人的临终护理的同时能得到心里安慰，2项结果均为100％；同时在病人临终前允许家属陪护的需求率达88％：愿意接受临终关怀的病人和同意病人接受临终关怀的家属各占22％与11％。结论 做好临终护理，让病人舒适、安详、有尊严地离去，同时在丧亲悲哀高峰期能得到心里安慰是所有病人和家属的愿望，鼓励和允许家属陪护病人临终，对临终病人及其家属进行死亡教育很有必要。     

医院陪护家属存在原因的调查及分析

目的：调查陪护家属存在的主要原因,探讨如何减少陪护家属,规范病房管理工作,提高护理质量。方法：采用问卷调查和访谈的方式对医院消化科124名陪护家属进行调查,调查内容包括一般资料、陪护家属存在原因以及对陪护工作的认识。结果：大部分陪护家属认为陪护工作包括生活照顾（106例）、与患者交谈（95例）、观察输液（74例）等;陪护存在的重要原因有：给予患者生活照顾（114例）,担心患者病情（83例）,给予患者心理支持（78例）等。不同性别的陪护家属对陪护是否影响工作的认识有显著性差异（P〈0．01）,不同文化程度的陪护家属对医院采取减少陪护人员措施的看法有显著性差异（P〈0．01）。结论：加强对陪护家属的管理,从整体护理的角度出发,重视患者的生理、心理、社会需求,减少患者对陪护家属的依赖,降低住院陪护率。     

心内科加床患者家属的心理需求及对策

目的探讨心内科加床患者家属的心理需求，为采取相应的对策提供参考。方法采用自行设计的患者家属心理需求调查表对150例心内科加床患者家属的心理需求进行调查。结果家属对患者所患疾病的一般知识了解需求占100％；与正规床同等设施需求占93％；65％的家属担心加床不能及时更换输液；64％的家属要求专业护士一对一讲解疾病保健知识。结论通过对患者家属的心理需求调查，采取相应措施，以提高服务质量。     

心理康复病房青少年患者陪护家属心理需求的研究

目的探讨精神专科医院开放式心理康复病房青少年患者陪护家属的心理需求,为临床护理工作提供指导。方法采用问卷调查方法,对开放式心理康复病房35例青少年患者的陪护家属心理需求进行调查。结果陪护家属心理需求占70%以上的选项有:希望尽快将患儿病治疗好;希望医护人员医疗技术水平高;希望用效果最好的药物;希望住院环境好;希望与医护人员沟通中多了解病情。文化程度低及年龄大的陪护家属在不愿让人知道住专科医院、担心药物影响、想多了解病情、想知道注意事项这四项需求上有显著性差异(P<0.05、P<0.01)。结论治疗青少年心理疾病的同时要重视陪护家属的心理需求;开展健康教育;加强护士业务技能培训,使陪护家属了解更多的精神卫生知识,减轻其负性情绪。     

心理康复病房青少年患者陪护家属心理需求的研究

目的 探讨精神专科医院开放式心理康复病房青少年患者陪护家属的心理需求,为临床护理工作提供指导.方法 采用问卷调查方法,对开放式心理康复病房35例青少年患者的陪护家属心理需求进行调查.结果 陪护家属心理需求占70%以上的选项有:希望尽快将患儿病治疗好;希望医护人员医疗技术水平高;希望用效果最好的药物;希望住院环境好;希望与医护人员沟通中多了解病情.文化程度低及年龄大的陪护家属在不愿让人知道住专科医院、担心药物影响、想多了解病情、想知道注意事项这四项需求上有显著性差异(P＜0.05、P＜0.01).结论 治疗青少年心理疾病的同时要重视陪护家属的心理需求;开展健康教育;加强护士业务技能培训,使陪护家属了解更多的精神卫生知识,减轻其负性情绪.     

湖南省二级以上医院住院患者陪护需求的调查与分析

目的 调查并分析湖南省二级以上医院住院患者陪护需求的现状,为医疗机构向住院患者提供满意的陪护服务提供科学依据.方法 采用自制"住院患者对陪护需求及相关因素调查表",对湖南省60家二级以上医院1030名住院患者从陪护需求、对家属陪护和职业陪护的看法等方面进行问卷调查.结果 ①92%的住院患者希望有陪护;95%的患者有陪护.②住院患者需要家属陪护的原因排序依次是"看到家属心理踏实、有安全感"、"家属更能了解患者需求"、"需要家属安慰"、"家属照顾更周到"、"别人不能取代家属在患者心里的位置".③住院患者对职业陪护的看法各条目得分从高到低依次是"可以得到更精心、更专业的护理"、"家属太忙"、"可减轻家属的压力"、"增加经济负担"、"可减轻心理压力".72.3%的患者知道有职业陪护这个职业,76.8%的患者认为医院有必要提供职业陪护.④对家属陪护影响看法的条目得分最高的是"家属陪护有利于患者康复".结论 二级以上医院的陪护率高于卫生部制定标准及陪护需求,由此医疗机构应该适当考虑患者陪护需求,放宽陪护标准,采取家属陪护与职业陪护相结合的方式,以满足不同患者的需求.     

How relatives of patients with head and neck cancer experience pain,disease progression and treatment: A qualitative interview study

PurposeThis study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patient's situation, especially with respect to pain, and how the relatives themselves experienced the situation.MethodsSemi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed.ResultsThe relatives experienced that the patients suffered from physical, psychological, and social pain. A dark picture consisting of lack of participation and knowledge, psychological distress, and lack of support were reported. Thus, a main category: relatives struggle with loved one's pains related to head and neck cancer treatment and with their own demanding situation – was based on the following four categories: inability to relieve and comprehend the physical suffering of the patients; overwhelming emotions were experienced that affect the patients and the relatives themselves; in need of support from the health care service; and altered daily activities and family roles due to illness and treatment.ConclusionIn patients physical, psychological, and social pain were prominent and in relatives psychological distress, lack of knowledge and support were experienced. Thus, to reduce pain and anxiety in patients and relatives, the health care professionals should provide relevant knowledge about pain management. The health care professionals should also provide educational interventions that address the psychological and social factors that impact pain for HNC patients and their relatives. Well-thought supporting care and easily accessible information about practical concerns should be offered to HNC patients and their relatives.     

创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响

[目的]探讨创伤性颅脑损伤病人病情程度对亲属心理状况及需求的影响。[方法]采用90项症状清单（SCL-90）和重危病人亲属需求量表（CCFNI）调查不同病情组的病人亲属的心理健康状况及需求。[结果]不同病情组病人亲属的SCL-90总分和各维度得分存在显著的差异（P均〈0．05）;需求种类也存在差异（P〈0．05）。[结论]病人的病情越重,亲属的心理压力越重,医护人员应关注病人亲属的心理健康,尤其是重症病人的亲属;重度病情组的亲属其获取信息、接纳及病情保证的需求明显高于轻度病情组,且获取信息和病情保证明显高于中度病情组的亲属。     

从呼吸支持治疗的选择看"降阶梯"思维的临床应用

选择42例医生根据病情认为需要采取有创呼吸机治疗的病例,统计患者及家属最终选择不同呼吸支持的病例数,并了解患者及家属的选择依据。通过分析需要呼吸机支持治疗患者的最终选择,了解患者及家属对医疗决策接受的影响因素,阐明急诊临床"降阶梯"思维在急诊中的应用。     

Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress.

Clinical observations suggest that many patients with chronic pain have difficulty forgiving persons they perceive as having unjustly offended them in some way. By using a sample of 61 patients with chronic low back pain, this study sought to determine the reliability and variability of forgiveness assessments in patients and to examine the relationship of forgiveness to pain, anger, and psychological distress. Standardized measures were used to assess patients' current levels of forgiveness, forgiveness self-efficacy, pain, anger, and psychological distress. Results showed that forgiveness-related constructs can be reliably assessed in patients with persistent pain, and that patients vary considerably along dimensions of forgiveness. Furthermore, correlational analyses showed that patients who had higher scores on forgiveness-related variables reported lower levels of pain, anger, and psychological distress. Additional analyses indicated that state anger largely mediated the association between forgiveness and psychological distress, as well as some of the associations between forgiveness and pain. These findings indicate that forgiveness can be reliably assessed in patients with persistent pain, and that a relationship appears to exist between forgiveness and important aspects of living with persistent pain. PERSPECTIVE: This preliminary study suggests there is a relationship between forgiveness and pain, anger, and psychological distress in patients with chronic low back pain. Patients who report an inability to forgive others might be experiencing higher pain and psychological distress that are mediated by relatively higher levels of state anger.     

Caring for a relative with dementia: family caregiver burden

AIM: This paper is a report of part of a study to investigate the burden experienced by families giving care to a relative with dementia, the consequences of care for the mental health of the primary caregiver and the strategies families use to cope with the care giving stressors. BACKGROUND: The cost of caring for people with dementia is enormous, both monetary and psychological. Partners, relatives and friends who take care of patients experience emotional, physical and financial stress, and care giving demands are central to decisions on patient institutionalization. METHOD: A volunteer sample of 172 caregiver/care recipient dyads participated in the study in Cyprus in 2004-2005. All patients were suffering from probable Alzheimer's type dementia and were recruited from neurology clinics. Data were collected using the Memory and Behaviour Problem Checklist, Burden Interview, Center for Epidemiological Studies-Depression scale and Ways of Coping Questionnaire. FINDINGS: The results showed that 68.02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patient psychopathology and caregiver sex, income and level of education. There was no statistically significant difference in level of burden or depression when patients lived in the community or in institutions. High scores in the burden scale were associated with use of emotional-focused coping strategies, while less burdened relatives used more problem-solving approaches to care-giving demands. CONCLUSION: Caregivers, especially women, need individualized, specific training in how to understand and manage the behaviour of relatives with dementia and how to cope with their own feelings.     

Developing and setting up a patient and relatives intensive care support group

Aim:  The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups.
Background:  Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors' personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery.
Methods:  Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves.
Conclusions:  Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely.     

心理干预对截肢患者亲属心理状态的影响

目的了解截肢患者亲属的心理健康状态，并对所存在的问题进行健康指导，以期为截肢患者亲属提供及时有效的心理干预与护理。方法采用症状自评量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表对1000例截肢亲属进行心理问卷调查，并对检出心理障碍者进行心理干预。结果心理干预前后患者家属其SCL-90评分、焦虑及抑郁检出率及评分均有统计学差异（均P〈0．05），其中干预后患者的SCL-90评分、焦虑及抑郁的评分均较干预前降低，焦虑及抑郁的检出率也有所下降。结论截肢患者亲属的心理健康状况均较差，亲属的心理健康状况更需要得到社会与医务人员的关注与支持。心理干预可显著改善截肢患者亲属心理健康状态，提高心理应激水平。     

Dysphoria and Hostile Cognition: The Relationship Depends on Levels of Trait Anger

Previous research has found that persistent hostility was associated with a different pattern of attributions than persistent sadness in dysphoric episodes (W. D. Scott, R. E. Ingram, & W. G. Shadel, 2003). In the present study, we attempted to extend these findings by examining another cognitive correlate of hostility in dysphoria: hostile cognition. Measures of dysphoria, trait anger, and hostile cognition were administered to college students. We found that the relationship between dysphoria and hostile cognition depended on the level of trait anger. Specifically, the presence of high trait anger in dysphoria was associated with high levels of hostile cognition whereas low trait anger in dysphoria was not associated with elevated hostile cognition. Moreover, the relationship between trait anger and hostile cognition was stronger among dysphoric participants. This finding adds to existing evidence of affective confounds in clinical research and suggests that discrete moods should be taken into account when assessing cognitive correlates in dysphoria.     

甲型H1N1流感疑似患者隔离期间的心理分析与护理

目的探讨H1N1流感疑似患者隔离期间的心理特点,以便为患者提供相应的护理措施。方法选择2009年5—9月114例由我院感染科负责隔离治疗的甲型H1N1流感疑似患者为研究对象,进行观察、谈话、记录存在的心理问题及采取的心理=F预措施,并进行回顾性分析搜集整理。结果在隔离期间,114例甲型H1N1流感疑似患者存在不同程度的心理问题,以恐惧和焦虑症状为主;住院隔离治疗患者心理问题较居家隔离治疗患者严重,15岁以上患者恐惧和焦虑较为严重。但经过医护人员的正确护理,均顺利通过了隔离观察期。结论根据甲型H1N1流感疑似患者在隔离期间产生的特殊心理问题,需要护理人员采取相应的护理措施,以取得满意效果。