Sources of Stress for Family Members of Nursing Home Residents With Advanced Dementia
Sources of Stress for Family Members of Nursing Home Residents With Advanced Dementia
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DOI：
10.1097/wad.0b013e31823899e4
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发表时间：
2012-07-01
影响因子：
2.1
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
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作者：
Givens, Jane L.;Lopez, Ruth Palan;Mitchell, Susan L.
疗养院（NH）居民的压力的来源与老年痴呆症的家庭还没有很好地描述。对16名家庭成员进行了半结构化访谈，这些家庭成员之前参加了“临终时晚期痴呆症护理的选择、态度和策略”研究，这是一项由323名晚期痴呆症患者及其家庭成员组成的前瞻性队列研究。问题涉及有家庭成员在NH的经历、与医疗保健专业人员的沟通、替代决策、情绪困扰以及改善护理的建议。转录本采用恒定比较法进行分析。大多数参与者是女性（63%），居民的孩子（94%）和白人（94%）。平均年龄为62岁。出现了四个主题：(1)住院居民个人护理不足，导致家庭成员警惕和参与护理；(2) NH入院时的应力；(3)与医院医生缺乏沟通；(4)替代决策的挑战，包括需要教育来支持提前护理计划和临终决定。我们的研究结果支持在住院患者入院时为家庭提供情感支持，对预后进行教育以指导决策，改善住院患者护理，并加强与卫生保健专业人员的沟通。
The sources of stress for families of nursing home (NH) residents with advanced dementia have not been well described. Semistructured interviews were conducted with 16 family members previously enrolled in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study, a prospective cohort of 323 NH residents with advanced dementia and their family members. Questions were asked pertaining to the experience of having a family member in the NH, communication with healthcare professionals, surrogate decision making, emotional distress, and recommendations for improvement in care. Transcripts were analyzed using the constant comparative method. The majority of the participants were women (63%), children of the resident (94%), and white (94%). The average age was 62 years. Four themes emerged: (1) inadequate resident personal care, resulting in family member vigilance and participation in care; (2) stress at the time of NH admission; (3) lack of communication with NH physicians; and (4) challenges of surrogate decision making, including the need for education to support advance care planning and end-of-life decisions. Our results support the provision of emotional support to families upon resident admission, education regarding prognosis to guide decision making, improved resident care, and greater communication with health care professionals.