临终反向关怀在宁养疗护中的应用研究

为观察临终反向关怀干预对患者及照顾者改变的影响,选取南昌大学第一附属医院宁养院2014年10月~2015年8月服务的患者及其家属65例,分为试验组30例,对照组35例。对试验组进行1.0个月~1.5个月临终反向关怀干预。结果试验组患者付诸临终反向关怀行为的人次增长47.7%,高于对照组的18.1%;试验组照顾者获得患者赞赏的人次增长了15%,高于对照组的11.5%;试验组患者的简明心境量表和癌症应对方式量表评分下降、HERTH希望量表评分提升,两组患者评估结果差异具有统计学意义(P0.05);试验组照顾者焦虑、抑郁、压力及疲劳评分下降,两组照顾者评估结果差异具有统计学意义(P0.05)。在宁养服务中运用临终反向关怀模式,可以较为有效地支持患者及其照顾者。     

农村留守初中生心理健康状况及评价研究

目的:探讨陕西省农村留守初中生心理健康状况及表现。方法:采用中国中学生心理健康量表对186名陕西省农村留守初中生进行了问卷调查。结果:农村留守初中生监护类型以隔代抚养为主,监护类型对其心理健康状况影响无显著性影响(F=0.701,P0.05);亲子沟通情况对农村留守初中生心理健康具有显著性影响(F=10.093,P0.01);农村留守初中女生在心理健康的抑郁、焦虑和学习压力因子上明显高于农村初中留守男生(P0.05);农村留守初中生和农村非留守初中生在心理健康上存在显著性差异(T=2.29,P0.05);建构农村留守初中生心理健康评价模型,发现农中上及以上者占的17%,中等者占65.4%,中下及以下者17.6%。结论:亲子沟通影响农村留守初中生的心理发展,可以通过增进亲子沟通改善留守初中生心理健康状况,部分心理健康偏低学生应引起父母亲的关心与重视。     

浅议老年弱势群体的社区照顾体系

我国人口的老龄化与高龄化、家庭照顾功能的弱化使老年人的日常生活照顾问题凸显这就为尽快建立建全老年人的社区照顾体系提出了迫切的要求。本文着重围笔者家乡B市（我国西部城市）老年人社区照顾体系如何建立和完善展开对策研究,从描述老年人的日常生活及照顾状况入手,探寻怎样依托社区以妥善解决城市老年人的日常生活照顾困难。     

佛教的临终关怀与追福超度

人临终之际,身心蒙受剧苦,最需要关怀照顾。经中说临终最后一念决定死后的去向,故在斯际照顾亡者,帮助其保持正念、往生善处,至极重要。现代医学发现,病危时没有精神支持网络的人,尤其是男性,死亡率比具有精神支持网络者高3倍。西方天主教于1967年创办“善终院”,提倡对重病垂危濒死者给以“善终照顾”或“临终关怀”(H os-pice),对其作为“全人”的身体、心理、社会、心灵各个层面的需要给予关怀照顾,给以心理辅导,帮助其解除痛苦和恐惧,俾能平安、尊严地迎接死亡。此后,临终关怀逐渐受到重视,进行一系列临终照顾的“安宁病房”,现在已在…     

失歌症者对音乐和言语音高的加工

音高是音乐和言语领域中一个重要维度。失歌症是一种对音乐音高加工的障碍。探讨失歌症者对音乐和言语音高的加工有助于揭示音乐和言语音高加工是否共享特定的认知和神经机制。已有研究结果表明, 失歌症者对音乐音高加工存在障碍, 这种音高障碍在一定程度上影响到言语音高加工。同时, 声调语言背景无法弥补失歌症者的音高障碍。这些研究结果支持了资源－共享框架(resource-sharing framework), 即音乐和语言共享特定的认知和神经机制(Patel, 2003, 2008, in press), 并可能在一定程度上为失语症临床治疗提供借鉴。     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。     

叙事医学视角下的临终关怀研究

通过对临终个体照顾者的经历进行叙述,尝试通过"叙事医学"实践深入认识、吸收、解释和回应临终个体照顾者的故事,聆听临终个体照顾者被科学话语所排斥的声音,通过交流加强临终个体照顾者的优质体验。关注癌症晚期病人家属的问题。基于对癌症临终病人家属的深度访谈后发现,对这些个体经历分析发现,癌症晚期病人家属经历了5个阶段的哀伤旅程:宣判癌症晚期、癌症病人的病情告知、临近死亡、亲人死亡、复杂的哀伤。     

论护理学是医学中人文精神的主要承载者

医学是"以人为本"的科学,对病人的关怀照顾是医学中人文关怀的主要体现,护理学作为医学的分支科学,是以女天赋的母性慈爱为基础,以对病人的关怀照顾为目的的学问,所以,护理学是医学中人文精神的主要承载者.     

监狱民警心理健康和职业压力状况研究

目的调查民警心理健康和职业压力状况,思考民警心理减负的相关措施。方法采用分层抽样的方法,从496名民警中随机抽取80名在职民警,采用精神症状自评量表SCL—90和由中国政法大学罗大华教授编写的《监狱警察压力源调查表》进行统一施测,并运用t检验,方差分析和相关分析等统计方法来分析研究。结果镇江监狱民警的SCL—90各因子得分均高于全国常模,且有显著性差异。镇江监狱民警工作压力的平均值高于罗大华教授的全国监狱警察压力常模,但没有显著性差异。结论监狱民警处于高应激、高压力、高风险的职业领域中,职业压力感大,心理健康状况显著高于全国常模。     

以患者为中心的效应研究所——促进更好的医疗信息、决策和健康

以患者为中心的效应研究所（PCORI）的建立使人们普遍关注的长期效益比较研究问题得到解决,在许多情况下,患各和他们的医生、家庭成员和照顾者没有他们需要的医学信息．难以达到他们所渴望的健康结果。     

Reduction of caregiver burden in Alzheimer's disease by treatment with galantamine

Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words "caregiver and Alzheimer's disease" and "cost and Alzheimer's disease" was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.     

Dementia caregiving: recent research on negative health effects and the efficacy of caregiver interventions

Provision of care to an older adult with dementia is an important societal resource. This resource may also come at a high cost to informal caregivers, most of whom are family members. In this paper we provide an overview of recent research on dementia caregiving and caregiver interventions. First, we provide background information on the prevalence and costs of Alzheimer's disease and related disorders. Second, we describe the specific stressors and broader mental and physical health outcomes of dementia caregiving. Third, recent evidence of the efficacy of caregiver interventions for both caregiver and patient outcomes is reviewed. Throughout the paper, we describe promising new directions for future research in this area, including assessment and intervention with family caregivers of older patients with comorbid dementia and depression, and the focus on sleep disturbance as a critical health consequence of dementia caregiving.     

Impact of patient suffering on caregiver well-being: the case of amyotrophic lateral sclerosis patients and their caregivers

The impact of patient suffering on family caregivers is an understudied but important topic. This study of patients with amyotrophic lateral sclerosis (ALS) and their caregivers examined the associations of two components of patient suffering: patient physical symptoms, and mental distress, as well as the patient's support for the caregiver, with caregiver well-being. The sample consisted of 52 patients with ALS and their caregivers. Patients and caregivers each completed a structured survey assessing multiple domains including demographics, health, and well-being. Specifically, patients rated their own physical symptoms and mental distress. Caregivers rated their own daily affect, and the extent to which they perceived the patient as supportive. Caregivers also reported whether or not they had found any benefit in dealing with the patient's illness. Regression analyses yielded significant associations of patient distress with caregiver negative affect; patient support was associated with greater caregiver positive affect, and patient symptoms and support were associated with greater likelihood of caregiver benefit finding. There was a significant two-way interaction of patient symptoms by support, namely, benefit finding was not only more likely with greater physical suffering and patient support, but it was also the case that caregivers who perceived the care recipient as unsupportive could only find benefit when this person experienced intense physical suffering. Support interventions for ALS patients and their caregivers should devote particular attention to how caregivers may be affected by witnessing their loved one's sufferings, as well as identify and address challenges in support exchanges between caregivers and patients.     

Predictors of Appraisal and Psychological Well-Being in Alzheimer's Disease Family Caregivers

The objective of this study was to test a model of stress, appraisal, and adaptation in 114 family caregivers of patients diagnosed with dementia of the Alzheimer's type (white non-Hispanic, N = 64; Hispanic-American, N = 50). Results of structural equation analysis show that appraised caregiver burden played a central role in determining the psychological well-being of family caregivers. The findings indicate that this mediating variable, negative caregiver appraisal, was predicted by increased functional limitations and behavioral disturbances in the patient, poorer perceived physical health, and lower levels of perceived emotional support. Contrary to a priori hypotheses, functional limitations in the patient also exhibited a direct association with caregiver depression. Further, patient cognitive impairment and caregiver ethnicity were not related to caregiver appraisal. Overall, these results support the role of appraised burden in mediating the relationships between caregiving factors and the adaptational outcome of depression. The implications of these findings, limitations of the study, and future directions are discussed.     

Exasperations as Blessings: Meaning-Making and the Caregiving Experience

This study examines the process of how caregivers can shape the frustrations and exasperations of caring for a family member with Alzheimer's disease into blessings. Heidegger's hermeneutic phenomenological perspective is used to interpret a caregiver's narrative, in which she describes caring for her husband with Alzheimer's disease. The interpretive analysis focuses specifically on how the caregiver finds meaning in the caregiving process. The analysis reveals that the caregiver constructs meaning by emphasizing particular aspects of her experiences, including cherished memories, creating a happy life by living life intensely, and counting her blessings. While some caregivers naturally find such meaning, this study suggests that reading the narratives of others as well as writing about one's own thoughts and feelings can facilitate this meaning-making process. Structured written emotional expression, in particular, fosters meaning-making, diminishes psychological distress, improves immune function, and promotes health and well-being.     

Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease

The spouse caregivers of 406 patients with Alzheimer's disease were randomly assigned to an enhanced counseling and support intervention or to a usual care control condition. Structured interviews were conducted to assess changes in social support and psychosocial outcomes for the 312 caregivers who provided care in the home for at least 1 year. The number of support persons, satisfaction with the support network, and support persons' assistance with caregiving all increased significantly as a function of the intervention. Structural equation models indicated increased satisfaction with the social support network mediated a significant proportion of the intervention's impact on caregiver depression. A portion of this mediated effect was further mediated by changes in caregiver stress appraisals. Implications for strengthening intervention programs for spouse caregivers of individuals with Alzheimer's disease are discussed.     

Impact of Spina Bifida on Parental Caregivers: Findings from a Survey of Arkansas Families

The well-being of caregivers of children with spina bifida and other conditions is an important topic. We interviewed the primary caregivers of 98 children aged 0–17 years with spina bifida sampled from a population-based birth defects registry in Arkansas and the caregivers of 49 unaffected children. Measures of caregiver well-being were compared between the groups and by level of lesion (sacral, lower lumbar, and upper lumbar/thoracic). We performed linear and logistic regression analysis to test the associations controlling for other characteristics. Among caregivers of children with spina bifida, the average number of hours of sleep was significantly less than reported by other caregivers and was associated with lesion level among children less than 7 years of age. Significant associations, often varying by child age, were also found for the caregiver’s reports of lower Quality of Well-Being (QWB) score, often feeling blue, rarely feeling happy, fair or poor health, lack of leisure days, and not hosting friends, but no significant association was found with not visiting friends. The intensive long-term care required by children with spina bifida, particularly by those with higher lesions, can negatively impact caregiver health and well-being. Support for these caregivers is needed.     

The cortisol awakening response in caregivers of schizophrenic offspring shows sensitivity to patient status

Abstract

Taking care of offspring during a prolonged period of time is probably one of the most stressful life experiences for parents. The present study compares the cortisol awakening response (CAR) in 38 long-term caregivers (mothers and fathers of schizophrenic relatives) with a control group of 32 non-caregivers. Factors such as general stress, caregiver burden, patient severity, and institutionalization were studied. Although a blunted CAR was observed in caregivers in comparison with controls, this difference was not significant. Among caregivers, the absence of institutionalization for the patient is associated with a lack of CAR in caregivers in comparison with caregivers of institutionally supported patients. General stress, caregiver burden, and patient severity themselves did not favor significant changes in CAR. CAR shows greater sensitivity to institutional support than patient severity and perceived stress. Further research is needed to explain the impact of these factors on health and the psychological factors involved.     

Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health

The current study investigated the effects of balancing elder care and work on emotional health. Responses from 43 retired caregivers, 211 not retired caregivers, 49 retired non-caregivers, and 224 not retired non-caregivers, who had participated in the national Health and Retirement Study, served as the data base. Results indicate that Caregiver Status (Caregiver vs. Non-caregiver) and Retirement Status (Retired vs. Not Retired) interact, depending on the measure of emotional health. The relationship between the number of depression symptoms reported and Caregiver Status depended on whether the respondent was also retired or employed; a significant interaction was not found when emotional health was measured with one overall item. A significant difference was not found between employed caregivers and employed non-caregivers, in terms of emotional health. Employed caregivers who gave more caregiving hours did report poorer emotional health than employed caregivers who gave fewer hours. Female caregivers reported more depression symptoms than male caregivers. The results suggest that employers may need to develop interventions which may help caregivers who are highly involved with caregiving responsibilities.     

Caregivers’ Level of Trust in Their Children's Health Care Providers

Trust in healthcare providers is associated with clinical outcomes among adult patients. Children with disabilities have complex health needs that place stress on caregivers. Consequently, they are increasingly likely to rely on their children's health care providers to ensure children's health care needs are met. However, no studies have explored factors affecting caregivers’ trust in their children's providers. We assessed caregivers’ trust in their children's providers and identified predictive factors of trust. The results indicate that children's disability condition, functional status, age, the providers’ specialty, and the type of health care plan are significant predicators of caregiver's trust. Specifically, caregivers of children with emotional/behavioral disabilities and children with poor physical or emotional/behavioral functioning reported less trust in their children's providers compared to caregivers of children without physical disabilities or no disability and those having higher levels of physical or emotional/behavioral functioning. In addition, caregivers of younger children had more trust compared to caregivers of older children. Caregivers of children enrolled in a managed care plan for physical health care reported less trust compared to caregivers of children in other organizational arrangements. Finally, caregivers reported more trust in physical health providers compared to mental health providers.