基于家庭为中心的延续护理联合半结构化心理干预对PSD患者及照护者的影响

Effect of family centered continuing nursing combined with semi-structured psychological intervention on patients with post-stroke depression and caregivers

目的探讨以家庭为中心的延续护理模式联合半结构心理干预对脑卒中后抑郁(PSD)患者生活质量、照顾者疾病家庭负担及二者心理的影响。方法连续入选2018年10月至2019年10月该中心神经康复综合病房收治的86对PSD患者及其照顾者,应用随机数字表法,将其分为观察组和对照组各43对。比较干预前及干预6个月后两组患者抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、生命质量测定量表(QLQ-C30)及两组照顾者疾病家庭负担量表(FBS)评分。结果干预前两组患者SDS、NIHSS、BI、QLQ-C30评分及两组照顾者FBS评分比较,差异无统计学意义(P>0.05)。与干预前比较,干预6个月后两组患者NIHSS、SDS评分降低(P<0.05),BI、QLQ-C30评分升高(P<0.05),且观察组NIHSS、SDS评分低于对照组(P<0.05),BI、QLQ-C30评分高于对照组(P<0.05);两组照顾者FBS均降低,且观察组FBS评分低于对照组(P<0.05)。干预后,观察组患者治疗后人际学习(付出)、人际学习(收获)、自我了解、存在意识、情感宣泄、希望重塑、团体凝聚力7项因子得分均明显高于对照组(P<0.05)。结论以家庭为中心的延续护理模式联合半结构化心理干预不仅可以改善PSD患者心理状态,促进其功能恢复提高生活自理能力;同时还可改善照顾者疾病家庭负担和负面情绪,提高照顾者社会支持水平。

Objective To explore the effects of family centered continuous nursing model combined with semi-structured psychological intervention on the quality of life of the patients with post-stroke depression(PSD),disease family burden of caregivers and their psychology.Methods Eighty-six pairs of PSD patients and their caregivers treated in the comprehensive neurological rehabilitation ward of the center from October 2018 to October 2019 were successively selected and divided into the observation group and control group by using the random number table method,43 pairs in each group.The scores of Self-rating Depression Scale(SDS),National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI),quality of life scale(QLQ-C30)and caregiver family burden scale(FBS)before and in 6 months after intervention were compared between the two groups.Results There was no statistically significant difference in the scores of SDS,NIHSS,BI and QLQ-C30 before intervention in the patients and the FBS scores in the caregivers between the two groups(P>0.05).Compared with before intervention,the NIHSS and SDS scores after 6-month intervention in the patients of the two groups were decreased(P<0.05),the BI and QLQ-C30 scores were increased(P<0.05),moreover the NIHSS and SDS scores in the observation group were lower than those in the control group(P<0.05),and the BI and QLQ-C30 scores were higher than those in the control group(P<0.05);the FBS score of the caregivers in both groups was decreased,moreover the FBS score of the observation group was lower than that of the control group(P<0.05).After the intervention,the scores of seven factors the interpersonal learning(paying out),interpersonal learning(getting in),self understanding,existence awareness,emotional catharsis,hope remodeling and team cohesiveness in the observation group were significantly higher than those in the control group(P<0.05).Conclusion The family centered continuous nursing model combined with semi-structured psychological intervention can not only improve the psychological state of PSD patients,promote their functional recovery and improve their self-care ability;at the same time can also improve the disease family burden and negative emotion of the caregivers,and improve their social support level.