Maas Meridean L, Reed David, Park Myonghwa, Specht Janet P, Schutte Debra, Kelley Lisa S, Swanson Elizabeth A, Trip-Reimer Toni, Buckwalte Kathleen C
College of Nursing, The University of Iowa, Iowa City, 52242, USA.
Nurs Res. 2004 Mar-Apr;53(2):76-86. doi: 10.1097/00006199-200403000-00003.
Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships.
The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role.
A quasi-experimental design with nonequivalent groups and repeated pretest and posttest measures was used to examine the effects of the Family Involvement in Care intervention. The study recruited 14 Midwestern nursing home special dementia care units, matched by aegis and staff turnover, and randomized from matched pairs to experimental and control conditions. The samples included 185 family members and 895 staff. The Family Involvement in Care intervention is a protocol for family and staff negotiation of a written partnership agreement. Family caregiver outcomes were measured using instruments pretested for reliability and validity. Data were analyzed using hierarchical linear modeling.
With adjustment for multiple tests, statistically significant beneficial intervention effects were found in three areas of family caregiver outcomes (emotional reactions to the caregiving role, perceptions of relationships with staff, and perceptions of care for relatives) and in one of three areas of staff outcomes (staff perceptions of the family caregiving role). For family members, effects were found for the measures assessing loss, captivity, staff disregard, resident activities, and physical care. Some of the intervention effects for family members were found only for caregivers of the same generation as the resident. For staff, effects were found for measures of dominion, disruption by family, and irrelevance of family.
The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members. The intervention did not influence the perceived conflict with staff on the part of family caregivers or the perception of a partnership with family caregivers on the part of staff.
尽管越来越多患有痴呆症的人从家庭护理转移到养老院，但仅有少量文献研究机构性家庭导向型做法对家庭成员护理认知及家庭与工作人员关系的影响。
本研究测试了“家庭参与护理伙伴关系”干预措施对家庭成员对其护理角色的认知、与工作人员的关系、对居住在特殊护理单元的痴呆症亲属护理的满意度的影响，以及对工作人员对家庭的态度和工作人员对护理角色满意度的影响。
采用非等效组的准实验设计以及重复的前测和后测措施来检验“家庭参与护理”干预措施的效果。该研究招募了14个中西部养老院的特殊痴呆症护理单元，根据庇护机构和员工流动情况进行匹配，并从匹配对中随机分为实验组和对照组。样本包括185名家庭成员和895名工作人员。“家庭参与护理”干预措施是一项家庭与工作人员就书面伙伴关系协议进行协商的方案。使用经过可靠性和有效性预测试的工具来测量家庭照顾者的结果。数据采用分层线性模型进行分析。
在对多次测试进行调整后，在家庭照顾者结果的三个领域（对护理角色的情绪反应、与工作人员关系的认知、对亲属护理的认知）以及工作人员结果的三个领域之一（工作人员对家庭护理角色的认知）中发现了具有统计学意义的有益干预效果。对于家庭成员，在评估失落感、束缚感、工作人员忽视、居民活动和身体护理的措施方面发现了效果。家庭成员的一些干预效果仅在与居民同代的照顾者中发现。对于工作人员，在控制权、家庭干扰和家庭无关性的措施方面发现了效果。
研究结果表明，“家庭参与护理”干预措施改善了养老院中家庭成员的护理体验以及养老院工作人员对家庭成员的态度。该干预措施并未影响家庭照顾者对与工作人员冲突的认知，也未影响工作人员对与家庭照顾者建立伙伴关系的认知。
