家庭照顾者对老年失智患者照护抗拒行为应对体验的质性研究

doi:10.3761/j.issn.0254-1769.2024.23.012

摘要/Abstract

摘要：

目的探索家庭照顾者对老年失智患者照护抗拒行为的应对体验，为改善老年失智患者的照护质量、提高家庭照顾者应对照护抗拒行为的能力提供参考。方法采用目的抽样法，于2024年2月—5月，对郑州市某三级甲等医院和社区16名老年失智患者的家庭照顾者进行深入访谈，采用Colaizzi 7步分析法对访谈资料进行分析。结果共进行19次访谈，每名家庭照顾者访谈时间为30~44 min，共转录约8.2万字，提取4个主题和11个亚主题，包括身心负担沉重（受到负性情绪持续困扰、身体负担逐渐加重）、领悟自我价值（孝道责任感、照护获益感）、主观调整应对策略（主动寻求外界支持、被迫采取限制与保护、无奈选择消极应对）和面临多重应对困境（有效沟通机制难以建立、睡眠质量难以保证、自身照护技能尚缺、多元支持需求难以满足）。结论家庭照顾者在应对老年失智患者照护抗拒行为时照护负担较重，产生多种负性情绪。不同家庭照顾者在照护老年失智患者过程中逐渐适应并采取不同应对策略，然而仍存在一些应对困境亟待解决。医护人员应及时关注家庭照顾者对老年失智患者照护抗拒行为应对体验，协助家庭照顾者端正照护抗拒行为的应对态度，提高自身应对照护抗拒行为的能力。

关键词: 老年人, 失智症, 家庭照顾者, 照护抗拒行为, 质性研究, 护理

Abstract:

Objective To explore the experiences of family caregivers in dealing with the care-resistance behaviors in elderly patients with dementia，to improve the quality of care for elderly patients with dementia，and to enhance the ability of family caregivers to cope with resistance behaviors. Methods Utilizing purposeful sampling，we conducted in-depth interviews with 16 family caregivers of elderly patients with dementia between February 2024 and May 2024. The participants were recruited from a tertiary-grade hospital and the surrounding community in Zhengzhou，Henan Province. The interview data were subjected to thematic analysis using the Colaizzi 7-step method. Results A total of 19 interviews were conducted in this study，with each caregiver being interviewed for 30-44 minutes. The total transcription was about 82，000 words，and 4 themes and 11 sub-themes were identified：the considerable physical and psychological burden（persistent negative emotions，gradually increasing physical burden），realization of self-worth（sense of filial responsibility，care benefit feeling），subjective adjustment of coping strategies（actively seeking external support，resorting to restrictions and protection，passively coping out of helplessness），and facing multiple coping challenges（difficulty in establishing effective communication，poor sleep quality，lack of caregiving skills，unmet diverse support needs）. Conclusion Family caregivers experience a heavier burden of care and develop various negative emotions when dealing with resistance behaviors. Different caregivers gradually adapt and develop different coping strategies in the care process. However，there are still some coping dilemmas that need to be resolved. Healthcare professionals should pay timely attention to caregivers’ experiences in dealing with resistance behaviors，correct their attitudes towards care-resistance behaviors，strengthen health education on managing care-resistance behaviors，and improve their ability to cope with care-resistance behaviors.

Key words: Aged, Dementia, Family Caregiver, Care Resistant Behavior, Qualitative Research, Nursing Care

张荟钦, 刘腊梅, 魏志华, 王晓萱, 许彤瑶, 王浩杰, 张琪函. 家庭照顾者对老年失智患者照护抗拒行为应对体验的质性研究[J]. 中华护理杂志, 2024, 59(23): 2893-2899.

ZHANG Huiqin, LIU Lamei, WEI Zhihua, WANG Xiaoxuan, XU Tongyao, WANG Haojie, ZHANG Qihan. The experiences of family caregivers in dealing with care-resistant behaviors in elderly individuals with dementia：a qualitative study[J]. Chinese Journal of Nursing, 2024, 59(23): 2893-2899.

图/表 1

参考文献 24

[1]	Gale SA, Acar D, Daffner KR. Dementia[J]. Am J Med, 2018, 131(10):1161-1169. DOI PMID
[2]	Jia LF, Du YF, Chu L, et al. Prevalence,risk factors,and ma-nagement of dementia and mild cognitive impairment in adults aged 60 years or older in China:a cross-sectional study[J]. Lancet Public Health, 2020, 5(12):e661-e671.
[3]	Aarsland D. Epidemiology and pathophysiology of dementia-related psychosis[J]. J Clin Psychiatry, 2020, 81(5):AD19038-BR1C.
[4]	Spigelmyer PC, Schreiber JB. A pilot study:resistive behavior in the context of informal caregiver-assisted activities of daily living[J]. Geriatr Nurs, 2019, 40(4):399-404. DOI PMID
[5]	Sefcik JS, Madrigal C, Heid AR, et al. Person-centered care plans for nursing home residents with behavioral and psy-chological symptoms of dementia[J]. J Gerontol Nurs, 2020, 46(11):17-27.
[6]	Jablonski-Jaudon RA, Winstead V, Jones-Townsend C, et al. Re-vising the Resistiveness to Care Scale[J]. J Nurs Meas, 2016, 24(2):72-82. DOI PMID
[7]	Shaw C, Ward C, Gordon J, et al. Characteristics of elderspeak communication in hospital dementia care:findings from the nurse talk observational study[J]. Int J Nurs Stud, 2022,132:104259.
[8]	Spigelmyer PC, Hupcey J, Kitko L. A concept analysis of re-sistiveness to care[J]. Clin Nurs Res, 2021, 30(1):50-58.
[9]	Fauth EB, Femia EE, Zarit SH. Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia:associations with informal caregivers’ stress and well-being[J]. Aging Ment Health, 2016, 20(9):888-898.
[10]	Lotfalinezhad E, Andersen-Ranberg K, Bhalla D, et al. Crucial role of respite care in supporting informal caregivers:a challenge for the care of older adults in the middle east and North Africa[J]. Gerontology, 2022, 68(2):146-150.
[11]	Vandepitte S, Putman K, van Den Noortgate N, et al. Effec-tiveness of an in-home respite care program to support informal dementia caregivers:a comparative study[J]. Int J Geriatr Psychiatry, 2019, 34(10):1534-1544.
[12]	白文辉, 丁金锋, 唐四元. 居家喘息服务研究进展[J]. 解放军护理杂志, 2017, 34(5):58-61.
	Bai WH, Ding JF, Tang SY. Research progress of home breathing service[J]. Nurs J Chin PLA, 2017, 34(5):58-61.
[13]	李琬予, 寇彧, 李贞. 城市中年子女赡养的孝道行为标准与观念[J]. 社会学研究, 2014, 29(3):216-240.
	Li WY, Kou Y, Li Z. Filial piety behavior standards and concepts of supporting middle-aged children in cities[J]. Sociol Stud, 2014, 29(3):216-240.
[14]	李超, 陈博. 国内外孝道研究共识与差异取向——基于中国特色积极应对人口老龄化视角的分析[J]. 老龄科学研究, 2024, 12(5):1-21.
	Li C, Chen B. Analysis of consensus and differential orien-tation of filial piety research at home and abroad from the perspective of active response to population ageing with Chinese characteristics[J]. Sci Res Aging, 2024, 12(5):1-21.
[15]	崇海燕, 陈燕茹, 苏文丽, 等. 失智患者家庭照顾者照护体验质性研究的Meta整合[J]. 军事护理, 2022, 39(12):79-82.
	Chong HY, Chen YR, Su WL, et al. Care experience of family caregivers of patients with dementia:a Meta-integration of qualitative studies[J]. Mil Nurs, 2022, 39(12):79-82.
[16]	Kim B, Lee KH, Cho E, et al. Behaviors of care providers and resistiveness to oral care of persons living with dementia[J]. Geriatr Nurs, 2021, 42(4):915-918. DOI PMID
[17]	解恒革, 解子怡. 痴呆患者护理过程中的抗拒行为及应对策略[J]. 中国护理管理, 2023, 23(9):1281-1286.
	Xie HG, Xie ZY. Resistive behaviors in dementia care and coping strategies[J]. Chin Nurs Manag, 2023, 23(9):1281-1286.
[18]	Mast BT, Ertle EM, Kolanowski A, et al. Person-centered asse-ssment of apathy and resistance to care in people living with dementia:review of existing measures[J]. Alzheimers Dement, 2022, 8(1):e12316.
[19]	解恒革, 康丰娟. 七问法则:痴呆优质照护的解决策略[J]. 中国护理管理, 2020, 20(9):1281-1284.
	Xie HG, Kang FJ. Seven-question framework for dementia optimization care[J]. Chin Nurs Manag, 2020, 20(9):1281-1284.
[20]	郭永攀, 潘婉玉, 张春慧, 等. 慢性病共病老年患者家庭照顾者照顾体验的Meta整合[J]. 中华护理杂志, 2023, 58(6):727-734. DOI URL
	Guo YP, Pan WY, Zhang CH, et al. Caring experience of family caregivers of aged patients with multi-morbidity:a qualitative Meta-synthesis[J]. Chin J Nurs, 2023, 58(6):727-734.
[21]	Williams KN, Perkhounkova Y, Herman R, et al. A communica-tion intervention to reduce resistiveness in dementia care:a cluster randomized controlled trial[J]. Gerontologist, 2017, 57(4):707-718.
[22]	王业青, 宋洁, 张小满, 等. 痴呆症患者居家照顾者需求质性研究的Meta整合[J]. 护理学报, 2019, 26(23):50-54.
	Wang YQ, Song J, Zhang XM, et al. Meta-integration of qualitative research on the needs of caregivers of dementia patients at home[J]. J Nurs (China), 2019, 26(23):50-54.
[23]	朱培嘉, 张良文, 方亚. 失智症老年人长期照护及其预防干预研究进展[J]. 中国公共卫生, 2024, 40(1):98-102.
	Zhu PJ, Zhang LW, Fang Y. Research progress on long-term care and preventive interventions for elderly people with dementia[J]. Chin J Public Health, 2024, 40(1):98-102.
[24]	左顺利, 吴建炜, 郭军, 等. 中国澳门地区失智症照护管理师的培养及启示[J]. 中华护理杂志, 2024, 59(6):764-768,封3. DOI URL
	Zuo SL, Wu JW, Guo J, et al. Introduction and enlightenment of dementia care managers in Macao,China[J]. Chin J Nurs, 2024, 59(6):764-768,F003.