小丑照护对养老院老年人情绪的影响

doi:10.3761/j.issn.0254-1769.2020.11.014

摘要/Abstract

摘要：

目的建立小丑照护在养老院老年人中的应用方案,并探讨其应用效果。方法组建小丑照护团队,通过理论研究、预试验和质性研究的方法确定本土化、个性化的个体干预和团体干预方案,灵活运用幽默、即兴表演、歌曲、游戏等技巧和方法,2019年4月—12月对34名养老院老年人实施每周2次,每次1.5~2 h的小丑照护方案。采用老年抑郁量表、UCLA孤独量表中文简化版、正性负性情绪量表和对老年人的半结构式访谈评价干预效果。结果干预后养老院老年人的负性情绪、孤独感、抑郁评分降低,正性情绪评分提高,差异有统计学意义（P<0.05）。老年人认为小丑照护可一定程度上满足其社交、被尊重和自我实现的需求。结论小丑照护可改善养老院老年人的抑郁情绪,有利于其维持正性情绪、抑制负性情绪,缓解其孤独感。

关键词: 小丑照护, 养老院, 老年人, 抑郁, 孤独, 情绪, 老年护理学

Abstract:

Objective To establish an application plan for clown care in the elderly in elderly institutions and explore its effects. Methods A clown care team was established,and the localized and personalized individual intervention and group intervention programs were determined through theoretical research,pre-experiment and qualitative research methods. 34 older adults in the nursing home received the clown care program for 1.5-2 hours twice a week by flexibly using of humor,improvisation,songs and games,etc. The Geriatric Depression Scale（GDS）,UCLA Loneliness Scale（ULS-6）,Positive and Negative Emotion Scale（PANAS） and semi-structured interviews with the elderly were used to evaluate the effect of the programe. Results After the intervention,the negative emotion,loneliness and depression scores of the elderly in the nursing home decreased,and the positive emotion scores increased significantly. The difference was significant（P<0.05）. Older people think that clown care can meet their social,respect and self-realization needs to a certain extent,but it needs more team members and further enrich- ment of the content. Conclusion Clown care can improve the depression status of elderly people in nursing homes,maintain positive emotions,suppress negative emotions and alleviate their loneliness.

Key words: Clown Care, Nursing Home, Aged, Depression, Loneliness, Mood, Geriatric Nursing

姚莉珮,张培莉,丁永霞,李军莉,孙慧群,崔晓红,晋雅丽. 小丑照护对养老院老年人情绪的影响[J]. 中华护理杂志, 2020, 55(11): 1685-1689.

YAO Lipei,ZHANG Peili,DING Yongxia,LI Junli,SUN Huiqun,CUI Xiaohong,JIN Yali. Study on the effect of clown care on mood in the elderly in nursing homes[J]. Chinese Journal of Nursing, 2020, 55(11): 1685-1689.

图/表 1

参考文献 27

[1]	世界卫生组织. 中国老龄化与健康国家评估报告[EB/OL].(2016-12-20)[2019-01-15]. http://apps. who. int/iris/bitstream/10665/194271/5/9789245509318_chi. pdf?ua=1.
	WHO. China National Assessment Report on Aging and Health[EB/OL].(2016-12-20)[2019-01-15]. http://apps. who. int/iris/bitstream/10665/194271/5/9789245509318_chi. pdf?ua=1.
[2]	范书南, 郭海岚, 董雪. 中国老年人养老模式的研究进展[J]. 中国老年学杂志, 2019,39(4):996-999.
	Fan SN, Guo HL, Dong X. The research progress of China’s elderly care model[J]. Chin J Geron, 2019,39(4):996-999.
[3]	徐凤麟, 孙建萍, 吴红霞, 等. 太原市养老机构老年人述情障碍现状及影响因素分析[J]. 中华护理杂志, 2018,53(8):990-995.
	Xu FL, Sun JP, Wu HX, et al. The status and influencing factors of alexithymia among institutionalized older people in Taiyuan[J]. Chin J Nurs, 2018,53(8):990-995.
[4]	罗美丽, 任滨海. 老年人心理健康在不同养老模式下的差异[J]. 中国老年学杂志, 2019,39(1):227-229.
	Luo ML, Ren BH. Differences in the mental health of the elderly under different pension models[J]. Chin J Gerontology, 2019,39(1):227-229.
[5]	柳家贤, 钟华凤, 秦雨露, 等. 珠海市养老院老人生活质量状况及相关因素研究[J]. 重庆医学, 2019,48(2):335-338.
	Liu JX, Zhong HF, Qin YL, et al. Study on the quality of life and related factors of the elderly in nursing homes in Zhuhai[J]. Chongqing Med, 2019,48(2):335-338.
[6]	Barbe C, Morrone I, Wolak-Thierry A, et al. Impact of functional alterations on quality of life in patients with Alzheimer’s disease[J]. Aging Ment Health, 2017,21(5):571-576. DOI URL PMID
[7]	董微, 李菲, 刘延迪. 幽默疗法对老年人影响的研究进展[J]. 护理研究, 2018,32(4):537-540.
	Dong W, Li F, Liu YD. Research progress on influence of humor therapy on old people[J]. Chin Nurs Research, 2018,32(4):537-540.
[8]	Kontos P, Miller KL, Colobong R, et al. Elder-clowning in long-term dementia care:results of a pilot study[J]. J Am Geriatr Soc, 2016,64(2):347-353. DOI URL PMID
[9]	丁永霞, 郭文俊, 王斌全. 跨文化背景下“医疗小丑”护理志愿服务模式的实践探讨[J]. 护理研究, 2018,32(19):3041-3045.
	Ding YX, Guo WJ, Wang BQ. Discussion on practice of nursing volunteer service model of "clown doctor" under cross-cultural background[J]. Chine Nurs Research, 2018,32(19):3041-3045.
[10]	赵艳花, 李诗韵, 江宇, 等. 广东省妇幼保健院探索“小丑医生”志愿服务实践[J].中华医院管理杂志, 2016(6):476-477.
	Zhao YH, Li SY, Jiang Y, et al. The exploration of the practice of “clown doctors” volunteer service in Guangdong Pro-vincial Maternity and Child Health Hospital[J]. Chin J Hosp Administ, 2016(6):476-477.
[11]	Warren B, Spitzer P. Laughing to longevity:the work of elder clowns[J]. Lancet, 2011,378(9791):562-563. DOI URL PMID
[12]	Rämgård M, Carlson E, Mangrio E. Strategies for diversity:medical clowns in dementia care-an ethnographic study[J]. BMC Geriatr, 2016,16(1):152. DOI URL PMID
[13]	Kontos P, Miller KL, Kontos AP. Relational citizenship:supporting embodied selfhood and relationality in dementia care[J]. Sociol Health Illn, 2017,39(2):182-198. DOI URL PMID
[14]	项丹妮, 郑松柏. 老年病科常用评估工具及其应用[J]. 中华老年病研究电子杂志, 2018,5(1):23-36.
	Xiang DN, Zheng SB. Common assessment tools and their applications in geriatrics[J]. Chin J Geriatrics Research(Electronic Edition), 2018,5(1):23-36.
[15]	黎芝. UCLA孤独感量表中文简化版(ULS-8)的考评及应用研究[D]. 长沙:中南大学, 2012.
	Li Z. The evaluation and application of the Chinese Version of the Short-form UCLA Loneliness Scale(ULS-8)[D]. Changsha:Central South University, 2012.
[16]	黄丽, 杨廷忠, 季忠民. 正性负性情绪量表的中国人群适用性研究[J]. 中国心理卫生杂志, 2003(1):54-56.
	Huang L, Yang TZ, Ji ZM. Applicability of the Positive and Negative Affect Scale in Chinese[J]. Chin J Ment Heal, 2003(1):54-56.
[17]	姜安丽. 新编护理学基础[M]. 北京: 人民卫生出版社, 2014: 106.
	Jiang AL. The new foundation of nursing[M]. Beijing: People’s Medical Publishing House, 2014: 106.
[18]	Quintero Á, Henao ME, Villamil MM, et al. Cambios en la depresión y la soledad,después de la terapia de la Risa en adultos mayores institucionalizados[J]. Biomédica, 2014,35(1):90-100.
[19]	白治繁, 沈军. 医养结合养老机构老年人抑郁、孤独与认知功能现状及其影响因素[J]. 解放军护理杂志, 2018,35(18):7-12.
	Bai ZF, Shen J. Depression,loneliness and cognitive function among elderly in medical and elderly care institution[J]. Nurs J PLA, 2018,35(18):7-12.
[20]	杨阳, 曾铁英. 健康赋权理论在老年护理中的启示[J]. 中华护理杂志, 2016,51(6):737-741.
	Yang Y, Zeng TY. Research progress and enlightenment of health empowerment theory in geriatric nursing[J]. Chin J Nursing, 2016,51(6):737-741.
[21]	包少少, 肖惠敏, 何佳琳, 等. 不同养老模式下老年人健康老龄化的比较研究[J]. 中华护理教育, 2018,15(9):687-691.
	Bao SS, Xiao HM, He JL, et al. The comparative study on living arrangements and healthy aging of older adults under different old-aged care model[J]. Chin J Nurs Edu, 2018,15(9):687-691.
[22]	曹侃华. 澳大利亚养老护理的发展概况[J]. 中华护理教育, 2017,14(2):146-150.
	Cao KH. Overview of the development of elderly care in Australia[J]. Chin J Nurs Edu, 2017,14(2):146-150.
[23]	赵珺瑜, 李红, 杨爱萍, 等. 创造性故事疗法对轻度认知障碍老年人的干预效果研究[J]. 中华护理杂志, 2018,53(5):606-611.
	Zhao JY, Li H, Yang AP, et al. Action research of creative expression therapy for older adults with mild cognitive impairment[J]. Chin J Nurs, 2018,53(5):606-611.
[24]	周鼒, 潘玲玲, 方亚. 老年人心理社会因素与抑郁症状发生风险关系[J]. 中国老年学杂志, 2019,39(16):4092-4094.
	Zhou Z, Pan LL, Fang Y. The relationship between psychosocial factors in the elderly and the risk of depressive symptoms[J]. Chin J Geron, 2019,39(16):4092-4094.
[25]	Hendriks R. Clown’s view as respiciō:looking respectfully to and after people with dementia[J]. Med Health Care Philos, 2017,20(2):207-217. DOI URL PMID
[26]	庄嘉元, 姜小鹰, 张旋, 等. 我国东部地区老年人护理服务需求及影响因素研究[J]. 中华护理杂志, 2016,51(8):992-997.
	Zhuang JY, Jiang XY, Zhang X, et al. Nursing demands and influencing factors among elderly people in eastern China[J]. Chin J Nurs, 2016,51(8):992-997.
[27]	Auerbach S. Are clowns good for everyone? The influence of trait cheerfulness on emotional reactions to a hospital clown intervention[J]. Front Psychol, 2017,8:1973. DOI URL PMID