BACKGROUND & AIMS: :Deep brain stimulation (DBS) is an effective neurosurgical treatment for patients with advanced Parkinson's disease (PD) suffering from motor complications that are refractory to further medication management. DBS requires an invasive procedure of implanting brain electrodes while awake, followed by implantation of neurostimulators under general anesthesia. The neurostimulator requires battery monitoring and replacement approximately every 3 to 5 years. These two elements of the technology provide numerous decision points about continuing therapies that can involve ethical choices. Although motor function can be improved with subthalamic nucleus (STN) DBS, the long-term risks of living with implanted hardware should be carefully evaluated for patients with diminishing cognitive capacity. We describe two cases where ethical dilemmas occurred postoperatively as a result of cognitive decline and describe salient ethical dimensions that illustrate the need for a proactive postoperative plan for supervision as a prerequisite for surgery to include neuropsychological testing to predict the likelihood of net benefit to the patient and family beyond just motor improvement.

背景与目标： ：深部脑刺激（DBS）是对患有帕金森氏病（PD），运动并发症且无法进一步药物治疗的晚期帕金森病（PD）患者的有效神经外科治疗。 DBS需要在清醒时植入脑电极的侵入性程序，然后在全身麻醉下植入神经刺激器。神经刺激器大约每3至5年需要对电池进行监视和更换。该技术的这两个要素为可能涉及伦理选择的持续疗法提供了众多决策点。尽管丘脑下丘脑核（STN）DBS可以改善运动功能，但对于认知能力下降的患者，应仔细评估使用植入式硬件生活的长期风险。我们描述了由于认知能力下降而导致术后出现道德困境的两种情况，并描述了突出的道德维度，这些维度说明了需要积极的术后监督计划作为进行手术的先决条件，以包括神经心理学测试以预测对患者净收益的可能性和家庭不只是运动改善。

BACKGROUND & AIMS: :When adult children are financially responsible for their parents, they can take considerable interest in the amount of their parents' long-term care (LTC) insurance. In this paper, we look at the optimal levels of LTC insurance and of informal care, and at the link between these two decisions when the child, who provides informal care, is also the decision-maker with regard to LTC insurance. Interestingly, results differ depending on the degree of both parental and child altruism and indicate either complementarity or substitutability between insurance and informal care. In particular, we show in the presence of child altruism that insurance stimulates the offer of informal care, contrary to the case where the insurance decision is made by the elderly parent. We also investigate how exogenous shocks with respect to the opportunity cost of informal care, initial wealth levels and bequests modify simultaneously the optimal level of insurance and informal care.

背景与目标： ：成年子女对父母承担经济责任时，他们可以对父母的长期护理（LTC）保险金额产生极大的兴趣。在本文中，我们着眼于LTC保险和非正式护理的最佳水平，以及当提供非正式护理的孩子也是LTC保险的决策者时，这两个决定之间的联系。有趣的是，结果取决于父母和孩子利他主义的程度而不同，并且表明保险与非正式护理之间的互补性或可替代性。尤其是，我们表明，在儿童利他主义存在的情况下，保险会刺激提供非正式照料，这与年长父母决定保险的情况相反。我们还研究了与非正式护理的机会成本，初始财富水平和遗赠有关的外来冲击如何同时改变保险和非正式护理的最佳水平。

BACKGROUND & AIMS: BACKGROUND:Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. METHODS:A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents' current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care. RESULTS:A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low. CONCLUSION:The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

背景与目标： 背景：在医院环境中并不总是提供最佳实践的痴呆症护理。知识，态度和动机，从业者行为以及外部因素会影响对最佳实践和高质量护理的接受。这项研究的目的是确定医院工作人员认识到实施最佳实践痴呆护理的障碍和促成因素。
方法：2014年7月至9月，在澳大利亚的两家医院进行了一项17项调查。邀请急诊科和普通病房的多学科工作人员参加调查。该调查收集了以下数据：受访者当前的角色，工作领域和经验，他们对痴呆症护理的信心和知识水平以及痴呆症的常见症状，实施最佳实践痴呆症护理的障碍和推动因素，照料工作的满意度痴呆症患者，并评估医院的能力和可用资源以支持最佳实践痴呆症护理。
结果：共收到112份调查问卷。环境，人员配备水平和工作量，时间以及员工的知识和技能不足，被认为是实施最佳实践痴呆护理的障碍。大多数受访者将其对痴呆症治疗的知识和痴呆症的常见症状以及对识别某人是否患有痴呆症的信心分为中度或高度痴呆度。大约一半的受访者将获得培训和设备的机会定为低或非常低。
结论：调查结果突出了医院工作人员认为实施最佳实践痴呆护理的障碍，这些障碍可用于为当地量身定制的改善干预措施提供信息。

BACKGROUND & AIMS: :Women with epilepsy who were service users of Epilepsy Action in the United Kingdom (UK) completed a questionnaire on the risks of caring for their baby and whether they were provided with useful information on fulfilling their caring role (Epilepsy Action is the trading name of the British Epilepsy Association a major UK charity for those with epilepsy). The cohort of 84 all reported some problems. The following were rated as being the most problematic; caring for their baby outside the home and bathing, whereas breastfeeding was rated as much less problematic. Some problems were rated as severe, which meant some babies were put at undue risk. Approximately 50% had been provided with information about caring and managing risk. Eighty-six percent found this information useful. The main conclusion is that more extensive, well-planned research is needed on this topic. There is virtually nothing in the academic literature to guide practice and this is needed. Present guidelines tend only to cover what the women rate as less problematic, e.g. breastfeeding, whereas what they rate highly problematic is often not covered. This needs attention in updates.

背景与目标： 英国癫痫行动的服务使用者：患有癫痫的妇女填写了一份调查表，内容涉及照看婴儿的风险以及是否为他们提供了履行照护职责的有用信息（癫痫行动是英国癫痫病协会是针对癫痫患者的英国主要慈善机构）。 84人的队列均报告了一些问题。以下问题被认为是最有问题的；在家外照顾婴儿和洗澡，而母乳喂养的问题被认为要少得多。有些问题被认为是严重的，这意味着一些婴儿处于不必要的风险中。已向大约50％的人提供了关怀和管理风险的信息。 86％的人认为此信息有用。主要结论是，需要对该主题进行更广泛，计划周密的研究。学术文献中几乎没有任何东西可以指导实践，这是必需的。目前的准则只倾向于涵盖妇女认为没有那么大问题的问题，例如母乳喂养，而他们认为非常棘手的问题通常无法解决。这需要在更新中注意。

BACKGROUND & AIMS: BACKGROUND:Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements. OBJECTIVE:To examine parents' management styles when caring for adult children with SMI and parents' perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. DESIGN:A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick's Family Management Style Framework. RESULTS:Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI. CONCLUSIONS:Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.

背景与目标： 背景：由于疾病的慢性和衰弱过程以及社区精神卫生服务和安置所的资金短缺，父母经常成为患有严重精神疾病（SMI）的成年子女的照料者。
目的：研究在照顾有SMI的成年子女时父母的管理方式，以及父母对于哪种类型的社区心理健康干预将支持和/或增强家庭整体功能的观点。
设计：一项定性描述性研究，使用半结构化访谈与照顾成年SMI患儿的父母进行。该研究受到Knafl和Deatrick的家庭管理风格框架的支持。
结果：从描述父母和家人照料成年SMI成年子女所经历的长期和艰难阶段的数据中得出了四个主要主题。
结论：对这些阶段的成功管理必须包括增加对成年子女及其家庭的心理健康信息的访问，心理健康筛查，早期干预和暴力预防。

BACKGROUND & AIMS: BACKGROUND:Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care. OBJECTIVE:To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients. METHODS:A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison. SETTING:An 18 bedded tertiary intensive care unit in New Zealand. PARTICIPANTS:Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m2. FINDINGS:Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient's body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients. CONCLUSIONS:Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care.

背景与目标： 背景：重症病态肥胖患者构成了相当大的医疗保健交付和资源利用挑战。然而，对于重症监护中这些患者的护理知之甚少。
目的：探讨重症病态肥胖患者的重症监护中的医疗和护理实践及态度。
方法：采用集中民族志方法。在四个月的时间内对参与者的护理习惯进行观察并与重症监护医生和护士进行了访谈。使用恒定比较进行定性分析。
地点：新西兰一个拥有18张床位的三级重症监护室。
参与者：67名重症监护护士和13名重症监护医生参与了7例体重指数≥40kg / m2的重症患者的护理和管理。
结果：病态肥胖的患者在重症监护实践中面临着重大的身体和语言挑战。病态肥胖患者的身体形状不适用于所使用的不同设备。工作人员使用了有关患者身体大小和形状的特定知识，以适应护理习惯并保持患者安全舒适。在存在特定的语言挑战时，工作人员对在病态肥胖患者在场时最适合用来形容体重的词语表示关注。
结论：需要制定B病护理途径，使用更合适的身体测量方法来告知减肥设备的使用。重症监护人员需要就减肥患者护理的提供中可以接受的，尊重的和适当的语言进行辩论。

BACKGROUND & AIMS: :Introduction: Scant evidence reveals the influences of Confucianism on family caregiving in dementia. The purpose of this study was to explore the influence of Confucianism on the perceptions and process of caring among the Chinese family caregivers. Method: A qualitative study was conducted using semistructured interviews with 15 Chinese family caregivers of persons with dementia in three elderly care centers in Hong Kong. The interviews were audiotaped and transcribed, while a thematic analysis was performed to analyze the transcript at the latent level. Results: Three themes emerged from the interviews: (a) setting family as a top priority, (b) growth and development in families, and (c) enhancing family relationships. Discussion: Our findings provided insights into how Confucianism influences the experience of family caregivers in caring persons with dementia in Chinese communities. These findings help develop culturally adapted interventions to improve the support for family caregivers of persons with dementia.

背景与目标： ：简介：鲜有证据显示儒家思想对痴呆症家庭护理的影响。这项研究的目的是探讨儒家思想对中国家庭照顾者中关怀观念和过程的影响。方法：在香港的三个老人护理中心，对15位中国痴呆症患者的家庭护理人员进行了半结构化访谈，进行了定性研究。对访谈进行录音和转录，同时进行主题分析以分析潜在水平的笔录。结果：访谈中出现了三个主题：（a）将家庭放在首位，（b）家庭的成长和发展，以及（c）增进家庭关系。讨论：我们的发现为了解儒家思想如何影响家庭照顾者在华人社区照顾痴呆症患者的经历提供了见解。这些发现有助于发展适应文化的干预措施，以改善对痴呆症患者家庭照顾者的支持。

BACKGROUND & AIMS: :Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs.Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner.Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other.Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs.

背景与目标： ：目的：在晚年照顾脆弱的伴侣时，配偶处于脆弱的境地。探索他们的生存孤独感可能是一种更多地了解他们的生存需求的方法。方法：使用了一种诠释学方法。多阶段焦点小组访谈由分别由五名配偶组成的两个小组进行，他们各自见面三次。为了处理文本，采用了一种方法，其中将引文以语言方式转换为诗歌。结果：存在的孤独可以理解为以下几点：1）从我们到仅我的过渡，2）被迫做出决定和感觉被排除在外； 3）在陌生的环境中导航并自我询问，以及4）渴望团结但缺乏与他人相处的能量。主要的解释是，当一个人处于内心挣扎的时刻，一个人被迫做出不可能的选择，一个人接近并处于极限情况下，一个人正经历着另一方的无尽损失时，就会出现存在的孤独感。为了使医疗保健专业人员获得全面了解，以人为本可以成为使配偶的生存需求可见并根据其需求提供支持的一种方式。

BACKGROUND & AIMS: :Optimal learning of caring occurs when appropriate discussion, analysis, and examples are woven into a structured and guided program of practising the art of caring. Teaching caring includes nurturing the student's perception of the patient's need for caring, the opportunities for caring, and the benefits of caring. It also includes helping the student to acquire effective methods of caring. However, the most important component of teaching caring is helping the student to choose to be caring. The concept of caring as "trying to help love grow" can have a profoundly motivating and integrating effect on the physician's practice of caring. Many of the strategies we use to help love grow in our patients we can also use in a modified form to help medical students at all levels of training. We can also use them to help practising physicians, maintain and expand their capacity to care for and about their patients.

背景与目标： ：通过适当的讨论，分析和范例将其纳入结构化的有指导性的实践关怀艺术活动中，可以实现对关怀的最佳学习。教导护理包括培养学生对患者护理需求，护理机会和护理益处的认识。它还包括帮助学生掌握有效的护理方法。但是，关怀教学的最重要组成部分是帮助学生选择关怀。关怀的概念“试图帮助爱的成长”可以对医生的关怀实践产生深远的激励和综合作用。我们用来帮助​​患者成长爱心的许多策略，我们也可以修改后的形式使用，以帮助医学生接受各种程度的培训。我们还可以使用它们来帮助执业医师，维持和扩大他们护理和照顾患者的能力。

BACKGROUND & AIMS: :(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.

背景与目标： ：（1）探索新生儿护士对垂死新生儿的护理态度和信念； （2）评估新生儿护士的个人和专业特征对其垂死婴儿临终护理态度的影响。使用横截面设计。使用问卷调查收集了80位新生儿护士的数据。研究地点是台湾中部地区四个医疗中心的四个III级重症监护病房。研究对象是在三级重症监护病房之一中至少工作了一年并直接参与垂死婴儿护理的新生儿护士。研究参与者为80名新生儿护士（答复率为100％）。研究发现确定了八种阻碍新生儿姑息治疗实践的障碍。这些障碍是由于缺乏在职教育计划而导致的沟通不足。新生儿临床医生缺乏可用的咨询帮助；无法表达对新生儿姑息治疗的个人见解，价值观和信念；人员不足；缺乏支持姑息治疗的单位政策/指南；技术上的必要性；父母对死亡的要求和个人信念，以及对垂死婴儿的照顾。需要进行进一步的研究以探索每种障碍，并提供减少这些障碍所需的在职新生儿姑息治疗教育计划。

BACKGROUND & AIMS: AIM:This paper reports an exploratory study of nurses' experiences of caring for families who have relatives in adult intensive care units. BACKGROUND:The admission of a critically ill patient into adult intensive care is universally accepted as a crisis for both patients and their families. Family members of critically ill people may experience emotional turmoil and therefore have many needs throughout the course of the relative's illness. It has been identified that nurses are best placed to meet families' needs. Whilst there is a substantial evidence base associated with family needs, little is known about nurses' experiences of caring for these families. METHOD:Interviews, informed by Heideggerian philosophy, were conducted with a purposive sample of 12 Registered Nurses working in an adult intensive care unit. Interview transcripts were analysed using Colaizzi's framework. The data were collected in Autumn 2005. FINDINGS:Participants' experiences were categorized into the following themes: defining the nurse's role, role expectations and role conflict. Participants reported lack of confidence, doubts about their professional competence and conflicts between their professional and personal self. These experiences were linked to participants' expectations and self-imposed standards. CONCLUSION:Registered Nurses caring for families who have relatives in adult intensive care units face a fundamental conflict both between role expectations and patient care and between professional ideals and being a human. This not only highlights a disparity between nurses everyday family care practice and the underpinning theories but also may contribute to occupational stress.

背景与目标： 目的：本文报道了一项探索性研究，研究了护士照顾成人重症监护病房有亲属的家庭的经历。
背景：危重患者进入成人重症监护室已被普遍认为是患者及其家人的危机。重症患者的家庭成员可能会遭受情绪动荡，因此在亲戚生病的整个过程中都有许多需求。已经确定护士最适合满足家庭需求。尽管有大量的证据证明与家庭需求有关，但对护士照料这些家庭的经验知之甚少。
方法：在海德格尔哲学指导下进行的访谈，是针对12名在成人重症监护室工作的注册护士的目的性样本而进行的。访谈笔录使用Colaizzi的框架进行了分析。数据收集于2005年秋季。
结果：参与者的经历分为以下主题：定义护士的角色，角色期望和角色冲突。参与者报告缺乏信心，对其专业能力存有疑问，以及他们的专业和个人自我之间存在冲突。这些经验与参与者的期望和自我强加的标准有关。
结论：照顾成人加护病房有亲属的家庭的注册护士面临着角色期望与患者护理之间，专业理想与人类之间的根本冲突。这不仅突出了护士日常家庭护理实践与基础理论之间的差异，而且可能加剧了职业压力。

BACKGROUND & AIMS: :Employed persons caring simultaneously for children and care-dependent relatives - a scoping review Abstract.Background: Due to the demographic changes with higher life expectancy, later childbirth, and an increasing number of working women, more middle-aged persons are confronted with the care needs of younger and older generations while they themselves are still employed. Aim: The objective of this manuscript is to review the body of knowledge about employed people caring simultaneously for underaged children and care-dependent relatives. Methods: The databases MEDLINE, CINAHL, Cochrane Library, GeroLit, CC Med, SOWIPORT Gesis, PsycINFO and BASE were searched without any time limitations. Publications in German and English were included into this scoping review regardless of the study design. Results: A total of 85 studies from Western countries were included. Research activity is centered in North America and there are only limited empirical findings from the German-speaking regions. Nearly 70 % of the studies used a quantitative design. Research questions address the consequences of adopting multiple roles and the compatibility of different areas of life. In total, role theoretical perspectives predominate. Conclusions: The findings show that little attention has been paid to this specific issue in German-speaking regions. The methodical limitations and inadequate theoretical differentiation of the studies led to partly contradictory results. Future research should take the complexity of this living situation into account while considering methodical approaches and theoretical foundations. :Zusammenfassung.Hintergrund: Aufgrund der demographischen Veränderungen mit einer höheren Lebenserwartung, der späteren Familiengründung und der steigenden Berufstätigkeit von Frauen werden Personen im mittleren Lebensalter zunehmend mit Sorgeerfordernissen der jüngeren und älteren Generation konfrontiert, die sie mit einer Erwerbstätigkeit vereinbaren. Ziel: Ziel ist es, einen Überblick über den Erkenntnisstand zu berufstätigen Personen mit gleichzeitiger Erziehungsverantwortung für minderjährige Kinder und Pflegeverantwortung für pflegebedürftige Angehörige zu geben. Methoden: Die Datenbanken MEDLINE, CINAHL, Cochrane Library, GeroLit, CC Med, SOWIPORT Gesis, PsycINFO und BASE wurden ohne zeitliche Eingrenzung nach deutsch- und englischsprachigen Studien durchsucht, die unabhängig vom Studiendesign in das Scoping Review aufgenommen wurden. Ergebnisse: Eingeschlossen wurden 85 Studien, die in westlichen Ländern durchgeführt wurden. Die Forschungsaktivitäten konzentrieren sich auf Nordamerika, während Befunde aus dem deutschsprachigen Raum nur in begrenztem Umfang vorliegen. Fast 70 % der Studien folgen einem quantitativen Studiendesign. Es werden Fragestellungen zu den Auswirkungen der multiplen Rollenübernahme sowie zur Vereinbarkeit der unterschiedlichen Lebensbereiche untersucht und überwiegend rollentheoretische Bezugsrahmen verwendet. Schlussfolgerungen: In der Übersicht zeigt sich, dass die Thematik im deutschsprachigen Raum bislang wenig beachtet wurde. Die methodischen Limitierungen und die mangelnde theoretische Differenziertheit der Studien führten zu teilweise widersprüchlichen Ergebnissen. Zukünftige Forschung sollte deshalb die Komplexität dieser Lebenssituation im methodischen Vorgehen und in der theoretischen Fundierung berücksichtigen.

背景与目标： 摘要：背景：由于人口结构的变化，预期寿命延长，分娩晚，女工的人数增加，越来越多的中年人正面临着照顾子女和照料亲属的问题。仍在工作的年轻人和老年人的护理需求。目的：本手稿的目的是回顾有关同时照顾未成年儿童和依赖照料的亲属的就业人员的知识体系。方法：搜索数据库MEDLINE，CINAHL，Cochrane库，GeroLit，CC Med，SOWIPORT Gesis，PsycINFO和BASE，没有任何时间限制。不论研究设计如何，该范围评估均包括德语和英语出版物。结果：总共包括来自西方国家的85项研究。研究活动集中在北美，来自德语地区的实证研究结果有限。近70％的研究使用了定量设计。研究问题涉及采用多种角色的后果以及不同生活领域的兼容性。总的来说，角色理论观点占主导地位。结论：研究结果表明，德语区对这一特定问题的关注很少。研究的方法上的局限性和理论上的不足导致了部分矛盾的结果。未来的研究应在考虑方法论方法和理论基础的同时，考虑到这种生活状况的复杂性。
：Zusammenfassung.Hintergrund：Aufgrund DER demographischenVeränderungenMIT einerhöherenLebenserwartung，DERspäterenFamiliengründungund明镜steigendenBerufstätigkeit冯Frauen werden Personen IM mittleren Lebensalter zunehmend MIT Sorgeerfordernissen DERjüngerenUNDälteren代konfrontiert，模具SIE MIT einerErwerbstätigkeitvereinbaren。 Ziel：Ziel ist es，einenÜberblicküberden Erkenntnisstand zuberufstätigenPerson mit gleichzeitiger ErziehungsverantwortungfürminderjährigeKinder和PflegeverantwortungfürpflegebedürftigeAngehörigezu。方法：Date Datenbanken MEDLINE，CINAHL，Cochrane图书馆，GeroLit，CC Med，SOWIPORT Gesis，PsycINFO和BASE Wurden ohne zeitliche Eingrenzung nach deutsch- and englischsprachigen Studien durchsucht，以及在研究中发表的文章。 Ergebnisse：Eingeschlossen wurden 85学生，死于westlichenLänderndurchgeführtwurden。诺曼底利卡（Nordamerika）纪念馆，乌姆方（Umfang vorliegen）的贝芬德（Befunde aus dem deutschsprachigen Raum nur）。在Studiendesign中快速获得70％的定量研究结果。从多方面的角度来看，不合时宜的法律和其他法律之间的关系。 Schlussfolgerungen：在德国，Theatik im deutschsprachigen Raum bislang wenig beachtet wurde。方法论的局限性和理论论的差异性ZukünftigeForschung脱盐模具的方法和方法的理论基础。

BACKGROUND & AIMS: PURPOSE:The aim of this integrative review is to synthesize quantitative and qualitative research evidence on challenges in caring for a child with a disability among immigrant parents and to understand their coping strategies and resiliency factors associated with their coping. METHODS:A comprehensive literature search was conducted to identify relevant studies from the following databases: MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO, Social work abstract, Cochrane library, and EMBASE. FINDINGS:This review included 25 studies: 1 quantitative, 23 qualitative, and 1 narrative review. The main challenges that parents faced were language barriers, financial hardships, service utilization challenges, poor adaptation to new culture, stigma related to mental illness, discrimination, and social isolation. This review found poor communication and lack of cultural awareness among some healthcare professionals. Immigrant parents used problem-focused coping, avoidance coping, spiritual coping, and social support to manage their challenges. Parents who received social, emotional, and instrumental support were more resilient. Personality traits and faith were protective factors that enhanced resilience. CONCLUSIONS:When immigration and disability are considered concurrently, the burden of care multiplies. Immigrant parents with children who have disabilities faced extra challenges related to adaptation, finance, service utilization, and stigma. Healthcare providers can play an important role in aiding these parents in service utilization and adaptation. SIGNIFICANCE:This review adds new knowledge on immigrant parents' challenges in caring for their children with disabilities. Such knowledge could help health professionals to develop supportive interventions to enhance parental coping and resilience. CLINICAL RELEVANCE:Culturally appropriate and sensitive communication and care provided by healthcare providers can facilitate service utilization and reduce perceived stigma. Special training provided to healthcare providers regarding the challenges of these families may enhance awareness. Information support and parental support groups may help to enhance parental coping and reduce isolation. An interpreting service should be provided in all aspects of care.

背景与目标： 目的：本综合综述的目的是综合定量和定性研究证据，说明在移民父母中照料残疾儿童所面临的挑战，并了解他们的应对策略和与应对相关的适应力因素。
方法：进行了全面的文献检索，从以下数据库中检索了相关研究：MEDLINE，护理和相关健康文献累积索引（CINAHL），Scopus，PsycINFO，社会工作摘要，Cochrane库和EMBASE。
结果：该评价包括25项研究：1项定量，23项定性和1项叙述性评价。父母面临的主要挑战是语言障碍，经济困难，服务使用挑战，对新文化的适应性差，与精神疾病，歧视和社会孤立有关的污名化。这篇评论发现一些医疗保健专业人员之间沟通不畅，缺乏文化意识。移民父母使用以问题为中心的应对，逃避应对，精神应对和社会支持来应对挑战。受到社会，情感和工具支持的父母更具韧性。人格特质和信仰是增强韧性的保护因素。
结论：同时考虑移民和残疾时，护理负担成倍增加。有残疾儿童的移民父母面临着与适应，经济，服务利用和污名化相关的额外挑战。医疗保健提供者可以在帮助这些父母进行服务利用和适应方面发挥重要作用。
重要性：该评论为移民父母在照顾残疾儿童方面面临的挑战增加了新的知识。这些知识可以帮助卫生专业人员制定支持性干预措施，以增强父母的应对能力和应变能力。
临床相关性：医疗保健提供者提供的文化上适当且敏感的沟通和护理可以促进服务利用并减少可耻的污名。向医疗服务提供者提供有关这些家庭面临的挑战的特殊培训可能会增强意识。信息支持和父母支持小组可能有助于增强父母的应对能力并减少孤立感。应在护理的各个方面提供口译服务。

BACKGROUND & AIMS: BACKGROUND:Spirituality can give meaning to life, providing support and guidance in complex situations. Despite its importance in palliative care, the role of spirituality for family caregivers of patients under exclusive palliative care has not received enough attention in the literature. We aimed to address the correlation between spirituality and the emotional burden of family members of patients under exclusive palliative care. METHODS:This transversal study was conducted in a tertiary private teaching hospital, in São Paulo, Brazil. The study comprised family members of patients receiving palliative care exclusively. Only one caregiver who cared for the patient for at least 2 months was invited to participate. Family members answered the following questionnaires: WHOQOL spirituality, religiousness and personal beliefs (SRPB), Zarit Burden Interview (ZBI) and Self-Reporting Questionnaire (SRQ-20). They were excluded if patients were residing in a Long Stay Institution. Continuous variables were expressed by median and quartiles and analyzed with the Kruskal-Wallis test with Muller-Dunn post-test adjusted by Bonferroni or with the Mann-Whitney test for two groups. We used multivariable linear regression to identify independent predictors of caregiver burden. RESULTS:A total of 178 family members were interviewed in a median of 8 [4-13.25] days after patient admission. Almost 40% of families presented high score of burden. Faith and Meaning in Life were the facets that scored the highest, with a median of 4.50 [4.00-5.00] for both facets. There was an inverse correlation between Zarit score and all of the WHOQOL-SRPB facets, indicating that the lower the spirituality, the greater the emotional burden. Inner peace was the strongest protective factor associated with burden. CONCLUSIONS:Psycho-socio-spiritual interaction can improve the coping ability of family caregivers of patients under exclusive palliative care, addressing a critical gap in the provision of holistic palliative care services.

背景与目标： 背景：灵性可以赋予生命意义，在复杂的情况下提供支持和指导。尽管它在姑息治疗中很重要，但是灵性在唯一姑息治疗下对家庭照顾者的作用在文献中并未得到足够的重视。我们的目标是解决在姑息治疗下患者家属的精神状态与情绪负担之间的相关性。
方法：这项横向研究是在巴西圣保罗的一家三级私立教学医院进行的。该研究仅包括接受姑息治疗的患者的家庭成员。只有一名照顾患者至少2个月的护理人员才被邀请参加。家庭成员回答了以下问卷：WHOQOL灵性，宗教和个人信仰（SRPB），Zarit Burden访谈（ZBI）和自我报告问卷（SRQ-20）。如果患者居住在长期住院机构中，则将其排除在外。连续变量用中位数和四分位数表示，并用两组的Kruskal-Wallis检验，由Bonferroni调整的Muller-Dunn后检验或Mann-Whitney检验进行分析。我们使用多元线性回归来确定照顾者负担的独立预测因子。
结果：患者入院后的中位数为8 [4-13.25]天，总共采访了178个家庭成员。几乎40％的家庭负担很高。信念和人生意义是得分最高的方面，两个方面的中位数为4.50 [4.00-5.00]。 Zarit得分与所有WHOQOL-SRPB方面之间均呈反比关系，这表明灵性越低，情感负担就越大。内心的和平是与负担相关的最强有力的保护因素。
结论：心理-社会-精神互动可以改善接受姑息治疗的患者的家庭护理人员的应对能力，从而解决了在提供整体姑息治疗服务方面的重大缺口。

BACKGROUND & AIMS: :Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.

背景与目标： ：家庭关怀是姑息治疗必不可少的组成部分，但是对于关注其癌症家族史是否与遗传遗传有关的家庭或其他护理专业人员应对家庭需求的方式，人们关注得很少易感性。本文讨论了姑息治疗护士如何看待有癌症家族史的患者的护理需求。通过与10名从事专科姑息治疗的护士进行记录的，半结构化的访谈，收集了数据。研究结果表明，在生命终结时（特别是当患者接近死亡且缺乏遗传学知识时）提出遗传遗传易感性问题存在令人信服的论点和担忧。尽管如此，仍以典型案例来说明为什么在专科姑息治疗场所工作的护士了解这一患者群体的需求很重要的原因。该论文强调指出，护士不仅需要适当的知识基础，而且还需要对支持具有癌症家族史的患者提供帮助时的见解。