脑卒中患者家庭照顾者的应对方式和抑郁状况的调查

目的探索脑卒中患者家庭照顾者应对方式和抑郁水平的相关因素和预测因子。方法采用立意取样方法，选择92名患者及他们的照顾者完成调查问卷。结果脑卒中照顾者主要采用计划、正性重构、接受和积极应对四种应对方式；44．6％的照顾者有不同程度的抑郁症状；住院时间、功能和认知状况、家庭收入与照顾者的抑郁显著相关；应对方式中拒绝、自责、计划和信教与照顾者的抑郁显著相关；拒绝、计划两种应对方式和患者的功能状况是抑郁的预测因子。结论照顾者常采用适应性应对方式，但是他们的抑郁水平却很高。因此，应加强对家庭照顾者的关注。     

卒中患者照顾者照顾感受的质性研究

目的深入了解我国卒中患者照顾者的照顾感受,以探索促进照顾者身心健康的相关措施。方法采用质性研究中的现象学研究方法,对10名卒中患者的照顾者进行非结构访谈,并用现象学分析方法进行资料分析。结果通过阅读、分析、反思、分类和提炼主题,得出4个主题：承受巨大的压力与痛苦;不断调整自己,以适应变化;全身心投入照顾中;在照顾中感受真情。结论我国卒中患者照顾者的照顾感受包括消极和积极两个方面,研究结果同时揭示了照顾者感受的发展历程和中国文化对我国照顾者感受的影响。因此,需要对卒中患者照顾者提供医疗支持、社会支持和经济帮助。     

Anxiety and Depression Associated With Caregiver Burden in Caregivers of Stroke Survivors With Spasticity

Objective

To investigate the relationship between anxiety/depression and caregiver burden in informal caregivers of stroke survivors with spasticity.

Design

Data were collected via online surveys from informal caregivers 18 years or older who cared for stroke survivors.

Setting

Internet-based survey.

Participants

2007 through 2009 U.S. National Health and Wellness Survey database or Lightspeed Research general panel respondents (N=153).

Interventions

Not applicable.

Main Outcome Measures

Anxiety and depression were self-reported by the caregiver as a physician diagnosis. Depression severity was measured by the Patient Health Questionnaire-9 (PHQ-9). Caregiver burden was measured by the Oberst Caregiving Burden Scale (OCBS) and the Bakas Caregiving Outcomes Scale (BCOS). Logistic regression analyses were conducted with anxiety, depression, and the PHQ-9 depression severity categories as a result of each caregiver burden scale.

Results

Data were analyzed for 153 informal caregivers; they were mostly women (70.6%) and white (78.4%), with a mean age of 51.6 years. For every 1-point increase in the OCBS Difficulty Scale, the odds of anxiety or depression were 2.57 times as great (P<.001) and 1.88 times as great (P=.007), respectively. The odds of PHQ-9 severe depression versus all other categories combined were 2.48 times as great (P<.001). For every 1-point decrease in the BCOS, the odds of anxiety or depression were 2.43 times as great (P<.001) and 2.27 times as great (P=.002), respectively. The odds of PHQ-9 severe depression versus all other categories combined were 4.55 times as great (P<.001).

Conclusions

As caregiver burden increases, caregivers are more likely to have anxiety and depression. Depression severity also increases. Providing treatment to stroke survivors with spasticity that lessens the time and more importantly, the difficulty of caregiving may lead to a reduction in caregiver anxiety and depression.     

Social Circles of Adults with Mental Retardation as Viewed by Their Caregivers

The Social Circles Questionnaire was developed for caregivers to rate the social support provided to adults with mental retardation from their families, workers, friends, and romantic partners. The questionnaire had good internal consistency and test-retest reliability as well as adequate interrater agreement. Results based on caregiver ratings of 121 adults with mental retardation indicate that there is a paucity of social support for individuals in many residential settings, across functioning levels. Caregivers responded with greater uncertainty to questions about friends and partners than they did to questions about staff and family. Results suggest that surveying only secondary sources may provide an incomplete view of the social support system of individuals with mental retardation.     

住院脑卒中患者主要照顾者负担及影响因素的研究

目的调查住院脑卒中患者主要照顾者的负担情况,并分析其影响因素。方法 2009年9-11月对75例住院的脑卒中患者及主要照顾者进行调查,包括主要照顾者的一般情况、照顾负担、社会支持和自我效能,被照顾者的一般情况、日常生活活动能力（actives of daily life,ADL）和认知能力。结果脑卒中患者主要照顾者负担总分为（32.45±16.11）分,为轻度负担水平;多因素分析显示,对社会支持的利用度、照顾者的教育水平、患者的ADL、与患者的关系及照顾者的自我效能是照顾者负担的影响因素。结论护理人员应了解脑卒中患者主要照顾者的负担水平及其影响因素,并提供有针对性的护理措施以减轻其负担。     

老年痴呆患者家庭照顾者的心理弹性及其影响因素

目的了解老年痴呆患者家庭照顾者的心理弹性水平,并分析其影响因素。方法采用方便抽样法选取2015年11月至2016年5月在武汉某三级甲等医院神经科记忆门诊就诊、神经科病房住院治疗以及在湖北省痴呆与认知障碍医学研究中心照顾者网络平台登录的180例患者及其照顾者为研究对象。采用自行设计的一般情况调查表、康纳-戴维森韧性量表、领悟社会支持量表对其进行调查。结果老年痴呆患者家庭照顾者的心理弹性总分为(24.83±7.58)分;老年痴呆患者的照顾者自觉健康状况、朋友支持、患者的病情程度、照顾者的文化程度及其他支持是老年痴呆患者家庭照顾者心理弹性的影响因素(均P0.05),共解释老年痴呆患者家庭照顾者心理弹性的44.8%。结论老年痴呆患者家庭照顾者的心理弹性水平处于中等偏低的水平,照顾者的自觉健康状况、朋友支持、患者的病情程度、照顾者的文化程度以及其他支持是影响照顾者心理弹性水平的重要因素。提示医护人员可有针对性地给予心理支持和干预,提高照顾者的心理弹性水平,改善其心理健康状况。     

老年痴呆患者主要照顾者照顾负荷水平与社会支持相关性研究

目的:探讨老年痴呆患者主要照顾者照顾负荷水平与社会支持的相关性。方法:采用照顾负荷量表(CBI)和社会支持评定量表(SSRS)对108例老年痴呆患者的主要照顾者进行调查。结果:老年痴呆患者主要照顾者的负荷总得分为(49.13±4.41)分,前三位分别是时间依赖性负荷(17.14±1.76)、发展受限性负荷(11.32±1.79)和身体性负荷(8.64±1.07)。社会支持总分为(27.53±3.7)分,低于全国常模。照顾者照顾负荷总得分与社会支持利用度、主观支持、客观支持均呈负相关(P<0.01)。结论:护理人员应重视老年痴呆患者主要照顾者的负荷与社会支持状况,通过健康促进、护理支持,提高其社会支持水平,减轻照顾负荷,提高患者与照顾者双方生活质量。     

老年期痴呆患者照顾者照顾负担与社会支持及相关性研究

目的调查老年期痴呆患者照顾者负担及其与社会支持的相关性.方法采用照顾者负担量表及社会支持评定量表,对153对老年期痴呆患者及其照顾者进行调查.结果照顾者负担处于轻、中度水平,社会支持处于中度水平;照顾者照顾负担总分与患者记忆行为问题总分呈正相关(r=0.336,P<0.01);与社会支持总分呈负相关(r=-0.348,P<0.01).生活部分自理患者的照顾者,家中无人或有1~2人分担照顾的照顾者,市医保患者的照顾者负担高(P<0.05).结论老年期痴呆患者的照顾者承受轻、中度照顾负担,应关注生活部分自理患者的照顾者、少人/无人分担的照顾者、市医保患者的照顾者,提供足够的社会支持有助于减负.提示应加强社会保障建设,完善医疗保障体系,加快建立支持老年期痴呆患者家庭的服务机构,与患者家庭共同承担照顾任务.     

社会支持在肝癌患者主要照顾者生活质量与照顾负担间的作用

目的在了解肝癌患者主要照顾者负担和生活质量现状的基础上,探讨社会支持在两者关系中的作用.方法便利抽样选取某三级甲等肝胆外科医院2018年10月至2019年4月住院治疗的肝癌患者主要照顾者为研究对象,采用照顾负担问卷、社会支持量表及癌症照顾者生活质量量表对其进行调查,采用Pearson相关分析、中介效应检验分析其中的关系.结果照顾负担与生活质量、社会支持均呈负相关(均P<0.05),生活质量与社会支持呈正相关(P<0.01),社会支持在生活质量与照顾负担中起部分中介作用,Bootstrap检验中介效应显著,中介效应量的95%置信区间为(-0.733,-0.237).结论肝癌患者主要照顾者生活质量有待提高,可通过减轻照顾者负担来直接提高,也可通过提高社会支持水平来间接提高.     

Stroke: coping strategies and depression among Chinese caregivers of survivors during hospitalisation

Aims and objectives. The main aim of this study was to identify the coping strategies of stroke caregivers, to identify the factors associated with caregivers’ depression and to identify predictors of caregivers’ depression. Background. Stroke has a high incidence in China. Most stroke survivors are accompanied by family caregivers during hospitalisation. However, little is known about these informal caregivers’ coping strategies to the consequences brought on by stroke and their depressive symptoms. Method. A correlation and cross‐sectional design was used and a purposive sample of 92 stroke survivors and their caregivers completed the questionnaires, which were used to describe the demographic of both the caregiver and stroke survivor, coping strategies (the Brief COPE Inventory) and depression of caregivers (the Center for Epidemiologic Studies Depression Scale). Spearman's correlation and multiple stepwise regression analysis were used in data analyses. Results. Several coping strategies (planning, positive reframing, acceptance, active coping, use of instrumental support and humour) were most commonly used by stroke caregivers. The length of hospital stay, stroke survivor's cognitive status and functional status, family income and coping strategies such as (i) denial, (ii) self‐blame, (iii) planning and (iv) religion had significant correlations with caregiver's depression. The best predictors of caregiver's depression were denial, planning and stroke survivor's functional status. Conclusions. This study contributes to our knowledge about the coping strategies and depression level of stroke caregivers on the Chinese mainland. The depression rate is very high during hospitalisation, although these caregivers often had positive coping responses to the stroke event. Many factors were associated with caregivers’ depression. Relevance to clinical practice. Nurses should not only pay attention to stroke survivors but also to their caregivers. To help them adjust well from the stroke consequences and avoid depression, nurses should implement effective interventions.     

Falling and Mobility Experiences of Stroke Survivors and Spousal Caregivers

ABSTRACT

More than 50% of survivors of stroke (SSs) fall after discharge from the hospital, some of whom sustain significant injury. The purpose of this study was to explore SSs’ and spousal caregivers’ (CGs’) lived experiences about falling and general mobility. Qualitative methods were used to perform a secondary analysis of interviews obtained from a larger study of 133 couples. Time, loss, and life changes emerged as themes in the qualitative analysis of expressers with “keep stepping no matter what,” as the overarching theme. Number of SSs were examined for reports of falls and fall-related events. Of the 133 couples, 65 were in the original study's intervention group. Sixty-six percent of the intervention group reported at least one fall, and 12% of the intervention group and total study population sustained fall-related adverse events. Health care providers can learn from the experiences of SSs and CGs related to falling and mobility for enhanced discharge planning and fall prevention. Falling can cause injury in the SS or fear of falling of the SS, CG, or both.     

Occupational Performance Coaching adapted for Stroke Survivors (OPC-Stroke): A Feasibility Evaluation

ABSTRACT

Background: The majority of stroke survivors experience participation restrictions, that is problems with meaningful involvement in life situations. Effective interventions to promote participation following stroke are needed. Purpose: The purpose of this study was to examine the acceptability, potential effectiveness, and essential elements of Occupational Performance Coaching adapted for stroke survivors (OPC-Stroke). Methods: A case study approach was used. Four participants were recruited to receive OPC-Stroke. Outcome measures were administered pre and postintervention. Semistructured interviews were conducted postintervention to explore participants’ experiences of OPC-Stroke. Results: Two participants reported improvements in goal performance, goal satisfaction, and overall participation. Two participants appeared to have difficulty understanding the approach and withdrew from the study. Conclusion: OPC-Stroke was feasible to deliver and shows promise as an intervention for improving participation following stroke. Further research is needed to determine the effectiveness of OPC-Stroke and characteristics of stroke survivors who may benefit most from this intervention.     

脑卒中患者居家主要照顾者负荷水平与影响因素的调查

目的　探讨脑卒中患者居家主要照顾者的负荷水平及其影响因素。方法　选取脑卒中患者居家主要照顾者79例,用自编脑卒中患者居家主要照顾者负荷量表和社会支持量表进行评定。结果　脑卒中患者居家主要照顾者负荷的得分指标为5 7.88%,处于中等水平,身体负荷最重,其次为经济负荷。对负荷影响最大的因素为照顾对象需人照顾项目总分为(β=为0 .4 5 5 ) ,其次为社会支持度(β=为0 .4 0 5 ) ,均有显著性意义(P<0 .0 0 1 )。共它影响因素包括照顾对象是否有慢性疾病(P<0 .0 5 )、照顾对象医疗费用支付形式(P<0 .0 1 )、照顾对象家中常见症状(P<0 .0 0 1 )、照顾者每天用于照顾患者时间(P<0 .0 0 1 )和照顾者是否有宗教信仰(P<0 .0 5 )。结论　脑卒中患者居家主要照顾者承受着较重的身体负荷和经济负荷。在社会支持方面信息性支持是最为不足的。因此,要为照顾者提供可及、可承受的社区服务,建立多种渠道加强信息性支持,以提高社会支持度,同时给予主要照顾者更多的情感和精神支持,这样才能全面降低脑卒中患者居家主要照顾者的负荷水平,促进其身心两方面的健康,以提高脑卒中患者的照顾质量。     

社会支持状态对脑卒中患者疗效的影响

目的:探讨社会支持状态评分对脑卒中患者康复疗效的影响,寻求其规律性。方法:51例脑卒中患者住院康复治疗结束后1周内分别采用Barthel指数评定ADL功能,用社会支持评定量表调查和评定影响患者疗效的因素。结果:51例患者住院康复治疗20-30 d后,ADL评分由治疗前(32.43±8.25)提高至(59.97±11.70)。将ADL≥59.97的患者分为显效组30例,<60.0为无效组21例,其社会支持总分主观支持得分、客观支持得分、个人利用度得分及显效组均明显高于无效组(P<0.01或0.05);社会支持分项分显效组除与邻居、同事及参与各类团体组织活动分外余各项分亦均高于无效组。结论:社会支持状态的好坏明显影响脑卒中患者功能状况及康复疗效。     

社会支持对脑卒中患者日常生活能力恢复影响的研究

目的 探讨社会支持对脑卒中患日常生活能力(ADL)恢复的影响。方法 对64例未经正规康复训练的脑卒中患,于发病第2周和3个月进行日常生活能力的评价,据此分为恢复良好组和恢复欠佳组,同时对两组患进行《社会支持测评量表》的测评。结果恢复良好组患的社会支持水平明显高于恢复欠佳组,且有显差异(P＜0．01)。结论 良好的社会支持对脑卒中患ADL的恢复有积极促进作用。护理人员应强化患的社会支持系统,以降低脑卒中后的致残率,提高患的生活质量。     

住院癌症患者配偶照顾者焦虑抑郁状况及影响因素分析

目的：了解住院癌症患者配偶照顾者的焦虑及抑郁状况,分析其影响因素。方法采用一般资料问卷及焦虑抑郁量表,对5所三级甲等医院的150例癌症患者的配偶照顾者进行问卷调查。结果癌症患者配偶照顾者可疑存在焦虑症状35名（23.3%）,肯定存在焦虑症状69名（46%）;可疑存在抑郁症状42名（28%）;肯定存在抑郁症状60名（40%）;配偶照顾者焦虑、抑郁水平高于国内常模（P＜0.01）。多元逐步回归分析结果显示：照顾者年龄、医疗费用负担、累计照顾患者时间、有无照顾经验是影响其焦虑情绪的主要因素（R2=0.146,F=11.841,P<0.001）;抑郁情绪的主要影响因素是照顾者性别、医疗费用负担及患者身体状况（R2=0.249,F=16.104,P<0.001）。结论住院癌症患者的配偶照顾者焦虑抑郁水平较高,护理人员需重视对癌症患者配偶照顾者的心理干预,尤其加强对女性、处于中年的照顾者、累计照顾时间较长者关注。对无照顾经验的照顾者,指导其掌握照顾患者的知识与技巧,同时密切观察配偶照顾者的情绪变化,主动并积极与他们交流,以减轻照顾者焦虑抑郁水平。     

照顾者教育对改善脑卒中患者及其照顾者健康状况的效果

目的探讨健康教育和技能培训对家庭照顾者的健康状况及脑卒中患者康复治疗效果的影响。方法脑卒中住院患者分为干预组38例,对照组36例,住院1个月均接受正规康复训练。对干预组家庭照顾者采用适时干预模式(Timing It Right)分阶段进行有针对性的知识教育和技能培训。干预前及出院3个月后对患者采用欧洲脑卒中量表(ESS)、简易精神状态检查(MMSE)、简易Fugl-Meyer评定(FMA)、改良Barthel指数(MBI)进行评定,对照顾者采用一般健康问卷(GHQ-12)进行评定。结果治疗后,干预组患者ESS、FMA、MBI均较对照组改善更多(P<0.05),照顾者在角色、紧张感、克服困难、面对问题、抑郁、失去信心、自我价值、日常活动范围项较对照组改善更多(P<0.05)。结论对家庭照顾者的教育和培训,能有效提高家庭照顾者的心理状况和护理技巧,继而进一步提高患者的康复效果。     

脑卒中后患者及陪护者抑郁发生因素的1年后社区随访

目的分析影响脑卒中发病后产生抑郁的因素。方法将脑卒中患者及其陪护者(照料患者日常生活的人)分成4组(总数为1048例)。其中423例幸存者中的321例患者和195例陪护者在脑卒中发生后3个月和12个月时以接受和不接受康复活动分组。390例幸存者中的311例患者和184名陪护者于12个月时仍以是否接受康复活动分组。接受为康复组,不接受为对照组。追踪调查2年。结果3个月时康复组患者出现抑郁者少于对照组(差异率0.59),12个月时仍保持差异(差异率0.55);3个月时康复组与对照组的陪护者之间没有明显差异,12个月时结果相同。然而12个月时在对照组中,有比康复组患者更明显的严重抑郁陪护者。结论脑卒中幸存者及其陪护者在3个月时普遍存在抑郁,它的几率在以后的1年中没有下降,康复组比对照组抑郁的发生率低,由此可见参加康复活动是降低脑卒中后抑郁发生率的有效方法。