痴呆患者抗拒护理评估工具的研究进展

Advances in Evaluation Tools for Resistiveness to Care in Patients with Dementia

抗拒护理(RTC)是在照护痴呆患者过程中发现的一种常见的异常行为表现,对患者及其照顾者可造成较严重的负面影响。国外对痴呆患者RTC评估工具的研究起步较早,研究内容更加深入和全面,自1999年阿尔茨海默病抗拒护理量表(RTC-DAT)被开发以来,国外研究者对其进行了多次评价内容和方法上的修订,打造出适用于不同护理情境且各具特色的痴呆患者RTC评估工具。本文对国外开发的痴呆患者RTC评估工具进行综述,着重探讨不同评估工具在评价内容和方法上的差异,分析其特点、优势和不足,旨在为我国开发或引入适合国情的痴呆患者RTC评估工具提供借鉴。当前,国外学者在开展痴呆患者RTC相关研究时,多由研究人员基于RTC-DAT使用观察法评估痴呆患者RTC行为发生情况,而这种方法在实际推广应用的过程中面临诸多挑战。2022年被开发的抗拒护理信息提供者量表(RoCIS)允许研究人员使用在其他领域常见的咨询照顾者的方法评价痴呆患者RTC行为发生情况,这为国内引入或开发适用于我国痴呆患者RTC行为评估的工具提供了新的借鉴。医务人员应在综合考虑不同类型评估工具适用性的基础上选择适宜工具评估痴呆患者RTC行为发生情况。

Resistiveness to care(RTC)is a common abnormal behavioral symptom in dementia patients during the care process,which seriously negatively impacts the patients and their caregivers.The research on assessment tools for RTC started earlier in foreign countries,and has explored relevant aspects more deeply and comprehensively.Since the Resistiveness to Care Scale for Dementia of the Alzheimer's Type(RTC-DAT)came out in 1999,overseas researchers have made several revisions to its content and methods,and have expanded it to include different scales for assessing RTC in different care settings.In this paper,we present a review of the tools developed overseas to assess RTC in patients with dementia,focusing on the differences in contents and methods of the tools,and the characteristics,strengths and weaknesses of each tool,which may offer insights into China's development of such a tool or introduction of a foreign tool applicable to China.The evaluation method of the assessment tools currently used in foreign research on RTC in patients with dementia is mostly based on the researcher-observed method used in the initial RTC-DAT,which faces many limitations in its practical application.The Refusal of Care Informant Scale(RoCIS)developed in 2022 attempts to use the method of evaluation by consulting caregivers,which is commonly used in other fields,providing a new way for China's introduction or development of a RTC assessment tool applicable to Chinese dementia patients.Considering various types of these tools,we recommend that the tool should be selected according to its applicability assessed comprehensively.