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。

BACKGROUND & AIMS: OBJECTIVES:The aim of this study was to explore benefit finding in cancer carers taking account of timeline and care recipient, in relation to burden of care, perceived stress, optimism, resilience, self efficacy, perceived support and psychological distress. METHODS:A cohort sequential survey was conducted with a group of 842 female cancer carers who were caring for a spouse, a parent or a child. A stress-coping model of benefit finding was proposed and tested. RESULTS:Analysis supported the stress-coping model for global benefit finding and also the multidimensional model of benefit finding and identified important differences on outcome measures depending on care recipient and timeline. CONCLUSIONS:This study concludes that a focus on benefit finding interventions may be useful in the area, but that a developmental approach taking into account the relationship between carer and the carer recipient is required.

背景与目标： 目的：本研究旨在探讨癌症护理人员在时间表和护理对象方面的益处，涉及护理负担，感觉到的压力，乐观，弹性，自我效能感，感觉到的支持和心理困扰。
方法：对一组842名照顾配偶，父母或子女的女性癌症护理人员进行了队列研究。提出并测试了一种发现利益的压力应对模型。
结果：分析支持用于全球效益发现的压力应对模型以及效益发现的多维模型，并根据护理对象和时间表确定了结局指标的重要差异。
结论：本研究的结论是，在该领域，关注利益寻找干预措施可能会有用，但是需要考虑照顾者与照顾者之间的关系的发展方法。

BACKGROUND & AIMS: BACKGROUND:The trend of patients who are invasively ventilated to prefer home care is one that benefits both the patient and the health care system. However, this assumes a role for patients' family members to become informal caregivers. OBJECTIVE:To explore the impact of caring for a ventilator-assisted individual on informal caregivers. METHODS:A descriptive design with semistructured caregiver interviews and the Caregiver Burden Inventory were used. Participants were informal caregivers of a family member with a progressive neuromuscular disease on invasive ventilation for at least six months. Transcript coding was performed and regularly reviewed, and recruitment continued until data saturation. Qualitative analysis was based on 'thematic analysis'. RESULTS:A total of 21 caregivers were interviewed. Five themes developed: a sense of duty; restriction of day-to-day life; physical and emotional burden; training and education; and the need for more paid support. Caregivers described a sense of duty to take care of loved ones, but suffered a significant restriction of their own time with a negative impact on their physical and mental health. The initial transfer home was highlighted as the most stressful part of the process. The Caregiver Burden Inventory scores supported a high level of burden: median 49 (interquartile range 39.5 to 53.0) of a maximum 96. CONCLUSION:Homecare for ventilator-assisted individuals with progressive neuromuscular disease causes significant burden to informal caregivers. Approaches to lessen this burden, such as increased paid care, improved professional support and respite care, may enable home ventilation to be a more sustainable modality of care.

背景与目标： 背景：有创通气的患者倾向于家庭护理的趋势是既有利于患者又有利于医疗保健系统的趋势。但是，这假定患者的家庭成员成为非正式的护理人员。
目的：探讨护理呼吸机辅助人员对非正式护理人员的影响。
方法：采用半结构照料者访谈和照料者负担量表的描述性设计。参加者为有创神经肌肉疾病家族成员的有创通气治疗，至少持续六个月。进行成绩单编码并定期进行审查，并继续招募直至数据饱和。定性分析基于“主题分析”。
结果：共采访了21名护理人员。形成了五个主题：责任感；责任感。限制日常生活；身心负担；培训和教育；以及需要更多有偿支持的需求。照顾者描述了照顾亲人的责任感，但是他们自己的时间受到了极大的限制，对他们的身心健康产生了负面影响。最初的转移家园是该过程中最紧张的部分。照顾者负担清单得分支持较高的负担水平：中位数49（四分位数范围为39.5至53.0），最高为96。
结论：对于进行性神经肌肉疾病的呼吸机辅助患者的家庭护理给非正式护理人员带来了沉重负担。减轻这种负担的方法，例如增加付费护理，改善专业支持和暂缓护理，可能使家庭通风成为一种更可持续的护理方式。

BACKGROUND & AIMS: :Medical trainees will inevitably make errors as they learn. Errors should be minimized by a stronger focus on competence through better supervision and increased opportunities for simulation, as well as by reinforcing a culture that supports open identification of errors, disclosing errors to patients and families, and that focuses on prevention through quality improvement. Yet, errors are also opportunities for education and remediation. Medicine's duty of care includes care for those harmed through errors and should also include care for those who have made the error. Errors that cause harm to patients challenge trainees to engage the character traits of honesty, humility, trustworthiness, and compassion and to strengthen the practical wisdom to know when and how to exercise these character traits. The moral core of medicine-care of the patient in circumstances that may be uncertain and imperfect-as well as the duties of honesty, disclosure, repair, and redress may make equanimity (the calmness, composure, and evenness of temper needed in difficult and challenging situations) one of the most important character traits medical educators should identify, nurture, and encourage in trainees.

背景与目标： 医学实习生在学习过程中不可避免地会犯错误。应该通过更好的监督和更多的模拟机会，更加注重胜任力，以及加强支持开放式识别错误，向患者和家属公开错误，并致力于通过质量改进来预防的文化，来最大程度地减少错误。但是，错误也是教育和补救的机会。医学的护理责任包括对因错误而受到伤害的人的护理，也应包括对那些犯过错误的人的护理。对患者造成伤害的错误使受训人员挑战诚实，谦卑，守信和同情的性格特征，并增强实践智慧，以了解何时以及如何行使这些性格特征。在不确定和不完美的情况下，患者的医疗护理的道德核心，以及诚实，公开，修复和补救的职责可能会使人感到镇定（镇定，镇定和脾气平和，而困难和具有挑战性的情况）医学教育者应在学员中识别，培养和鼓励的最重要的性格特征之一。

BACKGROUND & AIMS: BACKGROUND:Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants. AIM:The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care. METHOD:Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care. FINDINGS:Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants. CONCLUSION:As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.

背景与目标： 背景：技术的进步已导致甚至对于极早产儿的存活率也有所提高。尽管先进的医疗管理对婴儿的生存至关重要，但研究发现，社会因素和护理过程是婴儿后期结局的重要预测指标。因此，越来越多的证据表明母亲和家庭对于早产儿的最佳发育结果具有根本的作用。
目的：此处报道的工作目的是对婴儿早产护理做法进行历史回顾，以提高新生儿护士对母亲和家庭在婴儿早产护理中的关键作用的了解。了解过去的做法和当前趋势可以为新生儿护士提供重要的见识，这将有助于制定当前和将来的护理方案。
方法：研究和历史文章侧重于从孵化器发展到现在的产妇参与早产婴儿护理。使用MEDLINE，CINAHL和PSYCLIT数据库对1960年至2002年之间的文献进行了检索。搜索词是早产儿，新生儿重症监护，病史和孕产妇保健。
结果：确定了三个主要主题，它们反映了新生儿护理的发展。首先，在上个世纪，医学和公共卫生实践的进步使母亲和婴儿的死亡率下降。其次，这种新知识的应用导致了产科和新生儿保健的制度化和专业化，进而导致婴儿与母亲隔离。最后，婴儿研究的同时进展强调了母婴关系对婴儿发育结局的重要性，因此在父母与婴儿接触方面的医院实践中具有更大的灵活性。
结论：随着生物医学技术的不断发展，帮助身材矮小的，病态的早产儿得以生存，新生儿护士在战略上处于有利地位，通过将社会科学和行为研究整合到护理实践中，为婴儿及其家庭带来积极的成果。

BACKGROUND & AIMS: BACKGROUND:Stroke is the third most common cause of death in industrialized countries and a major cause of adult disability. However, the burden of caring for stroke survivors usually rests with family members who have neither chosen nor volunteered for the role of 'carer'. AIMS:This paper reports on a study which aimed to describe the experience of caring for a stroke survivor at one year after stroke in Scotland. STUDY DESIGN:Semi-structured, taped interviews were conducted with 90 carers of stroke survivors one year after stroke and the data analysed using NUD*IST. The interviews were part of a larger study, which included the administration of a range of valid and reliable multidimensional instruments to both carers and stroke survivors. The interview prompt schedule had been developed and tested in a previous study. FINDINGS:Although a medical emergency, stroke was not always diagnosed or treated as such by either the public or general practitioners. Initially most carers found that they lacked the knowledge and skills to care for the stroke survivor at home and so they had to learn how to obtain the information and assistance required. Carers had to adapt to the changes that stroke effected in the stroke survivor and seek alternative ways of securing the resources they needed for managing their lives. They thought that they had not been prepared adequately for the caring role or assessed satisfactorily in terms of whether they could manage given their skill level, age and/or health status. CONCLUSIONS:A public health campaign to educate and inform that stroke is a medical emergency is required if stroke disability is to be minimized. The use of new technologies should be considered in facilitating carers' learning how to care. There is a need to test alternative models of stroke follow-up in multi-centre studies that are holistic and place the carer-stroke survivor at the centre of care.

背景与目标： 背景：中风是工业化国家中第三大最常见的死亡原因，也是成人残疾的主要原因。然而，照顾中风幸存者的负担通常由既未选择也未自愿担任“看护者”角色的家庭成员承担。
目的：本文报道了一项旨在描述苏格兰中风后一年对中风幸存者的照护经历的研究。
研究设计：卒中后一年对90名卒中幸存者的护理人员进行了半结构化的录音访谈，并使用NUD * IST对数据进行了分析。访谈是一项较大研究的一部分，该研究包括为护理人员和中风幸存者提供一系列有效且可靠的多维工具。采访提示时间表已在先前的研究中制定并进行了测试。
结果：尽管发生医疗紧急情况，但公众或全科医生并不总是对中风进行诊断或治疗。最初，大多数护理人员发现他们缺乏在家照顾中风幸存者的知识和技能，因此他们必须学习如何获得所需的信息和帮助。照顾者必须适应中风幸存者中发生的变化，并寻求其他方法来确保他们管理生活所需的资源。他们认为他们没有为照顾角色做好充分的准备，也没有就他们的技能水平，年龄和/或健康状况对自己是否可以应付做出令人满意的评估。
结论：如果要最大程度地减少中风残疾，就必须开展公共卫生运动，以教育和告知中风为医疗急症。在促进护理人员学习护理方法时，应考虑使用新技术。有必要在多中心研究中测试卒中随访的替代模型，这些模型应是整体的，并将照顾者-卒中幸存者置于治疗中心。