Calarco M M, Krone K P
University of Michigan Medical Center, Ann Arbor.
Nurs Clin North Am. 1991 Sep;26(3):573-84.
Accumulating evidence suggests that cognitive processes or stimuli associated with a stressor may influence the neurochemical state. In addition, it has been suggested that a person's coping responses may protect him or her from the biologic dysregulations implicated in depression. From a nursing care perspective, the proposed model suggests the following practice components. First, assessment not only should include the symptom profiles of each client but should address both physical and psychosocial stressors. Second, once identified, individualized care needs to incorporate a variety of interventions that focuses on the target components (i.e., cognitive interventions for negative thought patterns, interventions to build interpersonal skills, sleep hygiene principles, pharmacologic interventions, and so forth). Finally, one needs to address how having experienced episodes of depression may influence the client's self-perception and ongoing quality of life. Nurses must begin to understand how the experience of having a depressive episode itself may serve as an ongoing stressor for the client. The factors that maintain depressive behavior and influence recurrence need to be the central focus of mental health nursing from a research and clinical perspective. It is this attention to integration and recurrence that will define nursing's unique contributions to this important area of mental health.
越来越多的证据表明，与应激源相关的认知过程或刺激可能会影响神经化学状态。此外，有人提出，一个人的应对反应可能会保护其免受与抑郁症相关的生物调节紊乱的影响。从护理角度来看，所提出的模型表明了以下实践要素。首先，评估不仅应包括每位患者的症状概况，还应涉及身体和心理社会应激源。其次，一旦确定，个性化护理需要纳入各种针对目标要素的干预措施（即针对消极思维模式的认知干预、培养人际交往技能的干预、睡眠卫生原则、药物干预等等）。最后，需要解决经历过抑郁发作如何可能影响患者的自我认知和持续生活质量的问题。护士必须开始理解经历抑郁发作本身如何可能成为患者持续的应激源。从研究和临床角度来看，维持抑郁行为和影响复发的因素需要成为心理健康护理的核心关注点。正是这种对整合和复发的关注将界定护理在这一重要心理健康领域的独特贡献。
