养老机构护理人员以人为中心痴呆症照护方式的研究进展

摘要/Abstract

摘要： 随着人口老龄化的加剧，痴呆症患病率呈逐年增长的趋势。日益庞大的痴呆症人群及其复杂的照护管理已成为全球健康卫生系统亟待解决的社会问题。目前痴呆症尚无有效的治疗方法，正确的照护方式可以提高痴呆症患者的生活质量。由于痴呆症患者认知功能和语言功能的下降，日常生活中常存在错误的认知和表达，照护者容易采取以现实为导向的痴呆症照护方式。以人为中心的照护方式是痴呆症照护实践的基本要素，不仅有助于缓解痴呆症患者的精神行为症状，改善痴呆症患者的生活质量，促进其健康和提升幸福感水平，而且有助于减轻照护者的压力和负担，促进积极的照护实践。本文从以人为中心痴呆症照护的概念、评估工具、形式、现状水平及影响因素等方面综述了国内外养老机构护理人员实施以人为中心痴呆症照护的研究进展，提出我国可进一步开展的相关质性研究与干预研究，为国内养老机构管理者采取有效措施，提高护理人员以人为中心痴呆症照护水平提供参考依据。

关键词: 养老机构, 护理, 以人为中心, 痴呆症, 文献综述

Abstract: With the aging of the population，the prevalence of dementia is increasing year by year. The increasing number of people with dementia and its complicated care management have become a social problem urgently to be solved in the global health system. At present，there is no effective treatment for dementia，socorrect nursing approach may improve the quality of life of dementia patients. Due to the decline in cognitive and language function，dementia patients generally have wrong perceptions and expressions in daily life，and caregivers tend to adopt reality-oriented dementia care. However，person-centered care is a basic element of dementia care practice，which not only helps to relieve patients' mental and behavioral symptoms，improve their quality of life，and promote their health and happiness，but also helps to reduce the pressure and burden of caregivers and promote positive care practice. The article reviewed the research progress of the person-centered dementia care，assessment tools，form，the present situation and influence factors of nursing institutions' nurses at home and abroad in implementation of person-centered dementia care，put forward the further relevant qualitative research and intervention research in China，so as to provide reference for managers of domestic elderly care institutions to take effective measures for improving nursing staff's level of person-centered dementia care.

Key words: Nursing institutions, Nursing, Person-centered, Dementia, Literature review

中图分类号:

R192.6

陈海雯, 宋洁, 张男, 刘霖, 鹿笑寒, 公晓菊. 养老机构护理人员以人为中心痴呆症照护方式的研究进展. [J]职业与健康, 2023, 39(1): 126-130.

CHEN Hai-wen, SONG Jie, ZHANG Nan, LIU Lin, LU Xiao-han, GONG Xiao-ju. Research progress of person-centered dementia care methods for nursing staff in nursing institutions. [J]OCCUPATION AND HEALTH, 2023, 39(1): 126-130.

参考文献

[1] 世界卫生组织.降低认知衰退和痴呆症风险[EB/OL].(2019-06-15)[2022-04-23].http://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/zh/.
[2] 赵雅洁,吕晓珍,李立玉,等.长期照护机构中实施以人为中心痴呆患者照护的促进和障碍因素研究[J].中国护理管理,2021,21(10):1491-1496.
[3] JIA L,QUAN M,FU Y,et al.Dementia in China:epidemiology,clinical management,and research advances[J].Lancet Neurol,2020,19(1):81-92.
[4] KITWOOD T,BREDIN K.Towards a theory of dementia care:personhood and well-being[J].Ageing Soc,1992,12(3):269-287.
[5] WANG Y.The development and evaluation of a dementia education program for health professionals in primary care in China[D].Adelaide:Flinders University,School of Nursing&Midwifery,2015.
[6] KIM S K,PARK M.Effectiveness of person-centered care on people with dementia:A systematic review and meta-analysis[J].Clin Interv Aging,2017,12:381-397.
[7] MCCORMACK B,MCCANCE T V.Development of a framework for person-centred nursing[J].J Adv Nurs,2006,56(5):472-479.
[8] BROOKER D.Person-centrd dementia care:Making service better[M].London:Jessica Kingsley Publishers,2007:11-14.
[9] BROOKER D.What is person-centred care in dementia?[J].Rev Clin Gerontol,2004,13(3):215-222.
[10] NORMANN H K,ASPLUND K,NORBERG A.Attitudes of registered nurses towards patients with severe dementia[J].J Clin Nurs,1999,8(4):353-359.
[11] LIN P C,HSIEH M H,LIN L C.Hospital nurse knowledge of and approach to dementia care[J].J Nurs Res,2012,20(3):197-207.
[12] LINTERN T,WOODS B,PHAIR L.Before and after training:A case study of intervention[J].J Dementia Care,2000,8(1):15-17.
[13] TRAVERS C M,BEATTIE E,MARTIN-KHAN M,et al.A survey of the Queensland healthcare workforce:attitudes towards dementia care and training[J].BMC Geriatr,2013,30(13):101-107.
[14] EDVARDSSON D,FETHERSTONHAUGH D,NAY R,et al.Development and initial testing of the Person-centered Care Assessment Tool (P-CAT)[J].Int Psychogeriatr,2010,22(1):101-108.
[15] 王瑶,LILY DONGXIA XIAO,王婧,等.以人为中心照护服务测评量表的研究进展[J].中国全科医学,2013,16(25):2307-2310.
[16] ZHONG X B,LOU V W.Person-centered care in Chinese residential care facilities:A preliminary measure[J].Aging Ment Health,2013,17(8):952-958.
[17] 毛盼,LILY DONGXIA XIAO,张孟喜,等.湖南省养老机构痴呆照护单元以人为中心的照护现状调查[J].护理学杂志,2016,31(21):1-4.
[18] TERADA S,OSHIMA E,YOKOTA O,et al.Person-centered care and quality of life of patients with dementia in long-term care facilities[J].Psychiatry Res,2013,205(1-2):103-108.
[19] BROOKER D.Dementia care mapping:a review of the research literature[J].Gerontologist,2005,45(1):11-18.
[20] SURR C A,GRIFFITHS A W,KELLEY R.Implementing dementia care mapping as a practice development tool in dementia care services:A systematic review[J].Clin Interv Aging,2018,13:165-177.
[21] 李智慧,韩嘉琪,相玮,等.痴呆照护筹划在老年痴呆照护中的应用进展[J].护理学杂志,2018,33(1):104-106.
[22] DICHTER M N,QUASDORF T,SCHWAB C G,et al.Dementia care mapping:Effects on residents' quality of life and challenging behavior in German nursing homes:A quasi-experimental trial[J].Int Psychogeriatr,2015,27(11):1875-1892.
[23] ROKSTAD A M,RØSVIK J,KIRKEVOLD Ø,et al.The effect of person-centred dementia care to prevent agitation and other neuropsychiatric symptoms and enhance quality of life in nursing home patients:A 10-month randomized controlled trial[J].Dement Geriatr Cogn Disord,2013,36(5-6):340-353.
[24] 罗桢蓝,陈慧.痴呆患者以人为中心的照护模式的研究进展[J].中国实用护理杂志,2020,36(17):1348-1352.
[25] COHEN-MANSFIELD J,THEIN K,MARX M S,et al.Efficacy of nonpharmacologic interventions for agitation in advanced dementia:a randomized,placebo-controlled trial[J].J Clin Psychiatry,2012,73(9):1255-1261.
[26] HUNTER P V,HADJISTAVROPOULOS T,THORPE L,et al.The influence of individual and organizational factors on person-centred dementia care[J].Aging Ment Health,2016,20(7):700-708.
[27] RUTTEN J E R,BACKHAUS R,TAN F,et al.Work environment and person-centred dementia care in nursing homes-A cross-sectional study[J].J Nurs Manag,2021,29(7):2314-2322.
[28] DAI Y,ZHAO J,LI S,et al.Caregivers' dementia knowledge and care approach in residential aged care facilities in China[J].Am J Alzheimers Dis Other Demen,2020,35(1):1-7.
[29] WANG Y,XIAO L D,HE G P.A comprehensive approach to psychometric assessment of instruments used in dementia educational interventions for health professionals:A cross-sectional study[J].Int J Nurs Stud,2015,52(2):568-577.
[30] WHILE C,NUNN R,DONOHUE L,et al.Supporting practice in dementia care:Evaluation of an education programme for district nurses[J].J Ment Health Training,2010,5(3):14-21.
[31] SURR C A,SMITH S J,CROSSLAND J,et al.Impact of a person-centred dementia care training programme on hospital staff attitudes,role efficacy and perceptions of caring for people with dementia:A repeated measures study[J].Int J Nurs Stud,2016,53:144-151.
[32] LEE J,HUI E,KNG C,et al.Attitudes of long-term care staff toward dementia and their related factors[J].Int Psychogeriatr,2013,25(1):140-147.
[33] MULLAN M A,SULLIVAN K A.Positive attitudes and person-centred care predict of sense of competence in dementia care staff[J].Aging Ment Health,2016,20(4):407-414.
[34] SCERRI A,INNES A,SCERRI C.Person-centered dementia care in acute hospital wards-The influence of staff knowledge and attitudes[J].Geriatr Nurs,2020,41(3):215-221.
[35] MCEVOY P,PLANT R.Dementia care:Using empathic curiosity to establish the common ground that is necessary for meaningful communication[J].J Psychiatr Ment Health Nurs,2014,21(6):477-482.
[36] HAN Y A,HUR H K.Formal nursing home caregivers' dementia knowledge,empathy,and burden of care from behavioral and psychological symptoms of dementia[J].J Korean Gerontol Nurs,2020,22(3):216-225.
[37] LEE Y S,KIM H.The influence of dementia attitude,empathy,and burden related to behavioral and psychological symptoms in dementia patients on job satisfaction of long-term care hospital nurses[J].J Korean Gerontol Nurs,2020,22(3):205-215.
[38] PARK A Y.A study of knowledge about dementia,empathy and attitudes toward dementia in caregivers of older adults with dementia[J].J Digital Convergence,2018,16(1):389-397.
[39] YUN S W,RYU S A.Impact of dementia knowledge,burden from behavioral psychological symptoms of dementia and empathy in the caring behavior of certified caregivers in nursing homes[J].J Korean Gerontol Nurs,2015,17(3):131-141.
[40] HUNTER P V,HADJISTAVROPOULOS T,SMYTHE W E,et al.The personhood in dementia questionnaire(PDQ):Establishing an association between beliefs about personhood and health providers' approaches to person-centred care[J].J Aging Stud,2013,27(3):276-287.
[41] WESTERMANN C,KOZAK A,HARLING M,et al.Burnout intervention studies for inpatient elderly care nursing staff:Systematic literature review[J].Int J Nurs Stud,2014,51(1):63-71.
[42] KONG E H,KIM H,KIM H.Nursing home staff's perceptions of barriers and needs in implementing person-centred care for people living with dementia:A qualitative study[J].J Clin Nurs,2021,31(13-14):1896-1906.