Koekkoek Bauke, van Meijel Berno, Schene Aart, Hutschemaekers Giel
Department of Outpatient Community Care, Altrecht Mental Health Care, Zeist, The Netherlands.
J Adv Nurs. 2008 Jun;62(6):689-97. doi: 10.1111/j.1365-2648.2008.04645.x.
This paper is a report of a study to explore problems encountered by mental health professionals in the long-term care of patients with chronic depression.
Patients who do not profit from psychopharmacological or psychotherapeutic treatment often need long-term care. Although they experience severe symptoms and loss of functioning, little is known about these people and the care they receive.
Experts in chronic depression (n = 8) participated in a four-phase Delphi study in 2006-2007. Problems were elicited through a focus group interview (first round) which was analysed using thematic analysis. The resulting problem list was validated (second round) and scored twice on a 7-point Likert scale (third and fourth rounds) by the participants. Urgency and changeability scores of 35 problems were obtained and a hierarchy of problems was set. In addition, qualitative data from the focus group interview were used to frame the results in the context of long-term care for patients with chronic depression.
Problems were subdivided into five areas. Relapses by the patient, a pessimistic attitude by the professional and demoralization in both were major problems. Also noted were the negative societal connotations of chronic depression and the lack of a coherent view on treatment within mental health care.
Chronicity of depression may be denied by both patients and professionals, resulting in an overly strong focus on cure and a limited quality of care. The results may be used as a starting point for construction of a best-practice programme to improve long-term care.
本文是一项关于探索心理健康专业人员在长期护理慢性抑郁症患者过程中所遇到问题的研究报告。
那些无法从心理药物治疗或心理治疗中获益的患者常常需要长期护理。尽管他们经历着严重的症状和功能丧失，但对于这些患者及其所接受的护理了解甚少。
慢性抑郁症专家（n = 8）于2006 - 2007年参与了一项四阶段的德尔菲研究。通过焦点小组访谈（第一轮）引出问题，并使用主题分析法进行分析。所得问题清单经过验证（第二轮），参与者在7点李克特量表上对其进行了两次评分（第三轮和第四轮）。获得了35个问题的紧迫性和可变性得分，并确定了问题的层次结构。此外，焦点小组访谈的定性数据被用于在慢性抑郁症患者长期护理的背景下阐述研究结果。
问题被细分为五个领域。患者复发、专业人员的悲观态度以及两者的士气低落是主要问题。还指出了慢性抑郁症的负面社会内涵以及心理健康护理中缺乏对治疗的连贯看法。
患者和专业人员可能都会否认抑郁症的慢性特征，导致过度强调治愈且护理质量有限。这些结果可作为构建最佳实践方案以改善长期护理的起点。
