晚期肺癌化疗患者叙事护理体验的质性研究

对2021年1月～10月15名接受过为期2个月叙事护理的晚期肺癌化疗患者进行半结构式深入访谈,采用内容分析法归纳提炼主题,共归纳出3个主题：疗愈身心（减轻心理痛苦、缓解身体症状）;改变认知理念（对疾病的接纳、对自我意识的强化、自我反思）;提升生命意义感（征服对死亡的恐惧、支持性关系、浸入式意义体验）。在晚期肺癌化疗患者中实施叙事护理,能够从身体-心理-社会-精神四个维度促进患者成长,为肿瘤末期患者生命意义感的提升提供了新视角。

     

神经外科护士对开颅术患者手术压疮护理体验的质性研究

深入了解神经外科病房护士针对开颅术患者预防及护理手术压疮过程中所面临的问题及真实护理体验。以《定性研究统一报告标准：个体访谈和焦点组访谈的32项清单》为指导,采用质性研究中的现象学方法对8名神经肿瘤外科护士（师）进行一对一的半结构式访谈。共提炼3个主要概念：病房护士预见性护理评估很关键;缺乏科学有效的手术压疮风险评估工具;术后压疮护理措施实施有难度等,共8个次要概念。对手术压疮患者高危因素的识别及风险评估工具的应用,还需护理管理者及决策者作进一步的规范和研究。     

非识字高龄患者住院中的需求对策相关性研究

探讨患者的需求与对策。应用会谈法收集资料,教育患者认知所患疾病相关知识、帮助患者和家属适应住院环境、支持家属对患者的生活护理、缓解患者心理紧张情绪、协助患者遵从医疗护理服务行为、照顾患者口服用药过程、满足患者治疗过程中的需求、加强护理操作周边作业的督导,进而提出了满足需求对策的依据。     

非识字高龄患者住院中的需求对策相关性研究

探讨患者的需求与对策.应用会谈法收集资料,教育患者认知所患疾病相关知识、帮助患者和家属适应住院环境、支持家属对患者的生活护理、缓解患者心理紧张情绪、协助患者遵从医疗护理服务行为、照顾患者口服用药过程、满足患者治疗过程中的需求、加强护理操作周边作业的督导,进而提出了满足需求对策的依据.     

中国丧亲个体社会支持体验的质性研究

本研究通过对28位丧亲者进行深度访谈,使用解释现象学分析法对质性数据进行分析,探索中国丧亲个体的社会支持体验。结果显示,丧亲社会支持的内容包括后事处理、情感支持、生活恢复帮助,经济与物资支持等。支持来源除家人和朋友之外,还包括同事、相同经历者,以及相关机构等。社会支持通过调节情绪、改变认知等方式促进个体对丧亲的适应。本研究结果为最新丧亲社会支持模型提供了支持,同时也反映出中国社会对丧亲人群的社会支持特色。     

抑郁障碍患者心理治疗感受的质性研究

探索抑郁障碍患者在心理治疗前后及其过程中的内心体验.使用立意取样法选9倒抑郁患者,深入访谈法收集资料,Colaizzi法分析资料.结果显示:(1)发病前压力大,对心理治疗基本没概念;(2)心理治疗过程中喜忧掺半:既有正性的感受,又有负性的感受;(3)经济压力大;(4)对医院和学校不满;(5)对疾病有痛耻感.因此,社会需要加大心理卫生知识的普及,抑郁障碍患者需要深切的人文关怀,医生应努力为患者减轻病耻感,同时要注意其社会功能的恢复.     

抑郁障碍患者心理治疗感受的质性研究

探索抑郁障碍患者在心理治疗前后及其过程中的内心体验。使用立意取样法选9例抑郁患者,深入访谈法收集资料,Colaizzi法分析资料。结果显示:(1)发病前压力大,对心理治疗基本没概念;(2)心理治疗过程中喜忧掺半:既有正性的感受,又有负性的感受;(3)经济压力大;(4)对医院和学校不满;(5)对疾病有病耻感。因此,社会需要加大心理卫生知识的普及,抑郁障碍患者需要深切的人文关怀,医生应努力为患者减轻病耻感,同时要注意其社会功能的恢复。     

对颌骨骨折坚固内固定术患者心身感受的质性研究

了解颌骨骨折坚固内固定术患者不同阶段的心理和躯体感受,以便为其提供人性化的人文护理服务,使患者满意,使优质护理服务得到落实。采用立意取样法选取研究对象,对选取的31例颌骨骨折坚固内固定术患者采用质性研究中的现象学方法进行深度访谈,并对资料进行整理和分析。结果发现患者在三个阶段中的护理问题如下：（1）手术前;自我形象紊乱、功能障碍和焦虑。（2）手术后：舒适受到影响和愧疚感等。（3）出院时：渴求信息。本研究能规范颌骨骨折坚固内固定术患者人文护理的具体内容,改善其护理问题。     

A型性格高血压患者心理状况的质性研究

近年来随着生物心理社会医学模式的不断发展,性格与疾病的关系越来越受到人们的重视.本研究综合运用量性和质性研究方法以A型性格高血压患者为研究对象,深入探究他们的心理状况及体验,为其进一步干预策略的形成提供科学依据.     

中青年脑卒中患者创伤后成长质性研究

为深入了解中青年脑卒中患者创伤后成长的真实体验,运用现象学研究方法,选取10例受访者进行深度面对面半结构化访谈,访谈资料采用Colaizzi现象学分析法进行整理分析。提炼主题可归纳为中青年经历脑卒中后的心理痛苦、中青年患者创伤后成长促进因素及中青年患者创伤后成长体验三个部分。中青年脑卒中患者存在创伤后成长这一积极心理体验,为临床心理护理干预提供新的切入点。临床医护人员应关注患者早期创伤反应及压力源,从促进因素入手,激发中青年患者的潜能和力量,充分利用其心理资源以达到身心适宜的状态。     

Incongruent Perceptions Among Nurses and Patients: A Qualitative Study of Patient's Dignity in Iran

Dignity is the most fundamental right of every human being, patients in particular. Despite being a fairly disputed concept, dignity is a multidimensional issue, the interpretation of which is affected by a multitude of factors. Semistructured interviews and observation data from 35 patients, their companions, and nurses were performed to highlight their views with regard to patients’ dignity in health care centers. Although findings reveal that nearly all patients felt that their dignity had been violated, there is a considerable difference between participants’ viewpoints of dignity. Interactions among participants can increase their awareness of dignity and may lead to its maintenance.     

Identifying Training Needs of Health-Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England

SUMMARY

The Transgender Training Project of the New England AIDS Education and Training Center has been providing training on transgender-related issues to health-care providers in the New England region since 1999, having trained nearly 600 providers in that time. The Transgender Training Project embarked on a study during the 2001–2002 grant year to interview providers of HIV-related care and advocacy on their knowledge and experience with working with trans-gendered people and to assess training needs to increase their effectiveness with transgendered clients.

The methodology consisted of face-to-face interviews with 13 providers of HIV treatment and care who are affiliated with the New England AIDS Education and Training Center network to discuss clinical challenges in working with transgendered people.

In this exploratory study, we found that providers had:

1. Desire to treat transgendered patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.

2. Experience with a range of transgendered patients, but lack of information on distinctions among transgendered experiences.

3. Restrictions based on time constraints that create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care.

4. Concern and frustration with lack of information, studies and research.

5. Concern and frustration with lack of treatment guidelines, (or ability to access them), referral contacts and ways to advocate for transgender clients.

6. Belief that training by transgendered people themselves was an essential teaching element.

These results point to the need for the development and dissemination of specific training materials and resources for health-care providers serving transgendered people living with or at risk for HIV.     

Stigma and Ostracism Associated with HIV/AIDS: Children Carrying the Secret of Their Mothers' HIV+ Serostatus

Qualitative interviews were conducted with mothers (N = 47) who had disclosed their HIV status to their children. The majority of mothers explicitly told their child not to disclose to other people that she was HIV-positive because they feared repercussions in the way of stigma and ostracism for both themselves and their child. Approximately one-fourth of the mothers identified safe people, to whom their child could discuss her serostatus, such as family members, health care providers, or therapists. The majority of the children respected their mothers' wishes; only four children disclosed to someone after being explicitly told not to do so. A significant number of children expressed concerns about their friends finding out, fearing that they would be ostracized or that it would be assumed they were also infected. In addition, the children did not want others to find out because they wanted to protect their mothers. The burden of keeping the secret of their mothers' serostatus does seem to be a stressor for some of the children.     

Health outcomes resulting from the quality of emotional expression in HIV/AIDS patients

IntroductionStudies on emotional expression and its impact upon health have mainly focused on quantitative aspects of interactions rather than on their quality.ObjectiveThe present study aimed to examine the interpersonal quality of interactions in the social sharing of emotions (SSE) in people living with HIV/AIDS (PLWHA), and its impact on patients’ physical and psychological well-being.MethodOne hundred and one PLWHA answered a questionnaire (Likert scale items) which assessed the following: shame, guilt, perceived stigma, perceived physical health, perceived mental health, SSE and the interpersonal quality of SSE (IQSSE). The main hypotheses were compiled into a theoretical model which was tested by a series of structural equation modeling (SEM) analyses.ResultsThe final solution resulted into a well-fit model which showed that: shame predicted IQSSE, perceived stigma mediated the relationship between IQSSE and guilt, and perceived mental health mediated the relationship between IQSSE and perceived physical health.ConclusionThese results corroborate previous findings which demonstrate that IQSSE is independent from quantitative aspects of SSE and that the way the SSE takes place is crucial to the benefits it induces.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Culture at the Heart of Coping with HIV/AIDS

This study explored the manner in which a South African informal community coped with living with HIV/AIDS by relying on existing assets and local resources. A case study research design applying participatory reflection and action principles was used. Focus group/workshop sessions were conducted with ten selected female educators from the community. In addition, individual interviews with stakeholders and other members of the community (n=31, males=6, females=25) were also carried out. Supplemental data collection methods included observation, visual techniques, field notes and a reflective journal. The study found that community members coped with HIV/AIDS by relying on culture and family, faith in God, religiosity and prayer. Inner strength, hope, optimism and expectancy appeared to be key resources for informal settlement residents.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

Psychosocial Well-being of Children in HIV/AIDS-Affected Families in Southwest China: A Qualitative Study

We investigated the psychosocial well-being of children in HIV/AIDS-affected families in rural China from the child’s and caregiver’s perspectives. Semi-structured interviews were conducted among children living in HIV/AIDS-affected families (n = 16), their caregivers (n = 16) and key community informants (n = 5). Our findings showed that all of the children relied heavily on caregivers and peers to gain psychological support. Children’s psychosocial problems included fear, anxiety, grief, and loss of self-esteem and confidence. Stigma towards children existed, including isolation, ignorance and rejection. Our study illustrates that HIV/AIDS has impacted negatively on the psychosocial well-being of children. These findings can be used as preliminary data supporting more researches to profoundly explore the psychosocial impact of HIV/AIDS on children and appropriately indicate the need for interventions.     

受艾滋病影响儿童的歧视知觉在歧视经历和心理健康之间的作用分析

本研究旨在考察中国农村地区受艾滋病影响儿童(包括双孤儿童、单孤儿童和非孤儿童)在经历了父母感染艾滋病、父母因为艾滋病丧亡后的歧视经历和歧视知觉状况,及其对心理健康的影响.采用问卷调查了1221名被试,测查了他们的歧视经历、歧视知觉、心理健康(抑郁、孤独、自尊).经过数据分析发现:(1)歧视经历和歧视知觉存在显著的年龄段和儿童类别的差异,12岁及以下的儿童得分显著高于13岁及以上的,双孤儿童得分显著高于单孤儿童和非孤儿童;抑郁、孤独和自尊存在显著的儿童类别差异,双孤儿童、单孤儿童差于非孤儿童;且孤独和自尊还存在显著的年龄段差异,12岁以下的儿童差于13岁以上的;(2)不同歧视经历和歧视知觉的儿童在抑郁、孤独和自尊上存在显著差异,均是歧视经历、歧视知觉多的儿童抑郁和孤独严重、自尊低;(3)歧视经历对抑郁、孤独和自尊都有显著的预测作用,歧视知觉在其中起到了部分中介作用.