The nurses' process of recognizing the demented elderly patients' patterns of verbal and non-verbal expressions

研究对象是7名被认为患有精神错乱的老年病人和18名城市医院神经科的护士。这些患者包括四女三男，年龄从68岁到85岁不等。护士的平均年龄约为29岁。护士对老年痴呆患者言语和非言语表达模式的识别过程由两个过程组成；<从不确定到确定的转变b>和<询问患者的意愿b>。从不确定性到确定性b>的转变过程由四个部分组成。护士以患者言语和非言语表达变化<识别提示> >为线索，通过询问患者对提示意义的问题<澄清问题> >进行推理，再通过获取其他信息<确认推理>。在这一过程中，护士对患者的确定性会影响护士对患者护理的决策。面对不确定的情况，许多护士试图照顾老年痴呆病人。患者意愿询问的过程由四个维度组成；1) <确定对指令的反应>是护士确定患者对其身体动作指令的反应的维度，2)<评价不适>是护士评估患者不适作为疼痛存在的维度，3)<把握决策>是护士给予患者决策机会并掌握患者决策的维度。4) <解释内在体验>是护士对患者可能不真实的内在体验故事的解释维度。通过观察老年痴呆患者与护士在日常护理中的互动，护士试图识别的是患者的意愿。对护士而言，询问患者意愿是与患者互动的主要主题，护士在护理过程中尽量确定患者的意愿。少

The subjects were seven elderly patients, who were thought of being demented, and eighteen nurses in an neurological unit in an urban hospital. The patients, who were four wamen and three men, were from sixty-eight to eighty-five years old. The mean of nurses' age was about twenty-nine years old.The nurses' processes of recognizimg the demented elderly patients' patterns of verbal and non-verbal expressions was composed of two processes ; <a shift from uncertainty to certainty> and <a inquire of the patinets' will>.The process of <a shift from uncertainty to certainty> was composed of four comporments. The nurses forcused on the cues which were the changes of the patients' verbal and non-verbal expressions <recognizing cue>, made inference by asking the patients their qeustions about the meaning of cues <clarifying question>, and then confirmed the inference by taking other informations <confirming inference>. Through this proccess, the nurses' certainty of the patients' will influence … More d on their making the decisions for the patients' care. Many nurses tried to lake care of the demented elderly patients in the face of uncertainty.The process of <a inquire of the patient's will> was composed of four dimensions ; 1) <ascertaining response to instruction> was the dimension of the nurses' making sure of the patinets' responses to their instructions of body movements, 2) <appraising discomfort> was the dimension of the nurses' assessing the presence of the patients' discomfort as pain, 3) <grasping decision-making> was the dimension of the nurses giving the chances of and getting hold of the patients' decision-making, 4) <interpretating inner experience> was the dimension of the nurses' interpretating the stories of the patients' inner experiences which might be not reality.By observing the interaction between the demented elderly patients and the nurses in daily care, what the nurses tried to recognize was the patients' will. For the nurses, the inquire of the patinets' will was main theme in interacting with the patients, and the nurses tried to make certainty of the patients' will for their care. Less