患者和照护者一致性：心力衰竭照护中双体的重要性。

Patient and caregiver congruence: the importance of dyads in heart failure care.

机构信息

Public Health Systems and Service Research, University of Colorado Denver School of Public Affairs, Colorado, USA.

出版信息

J Cardiovasc Nurs. 2013 Mar-Apr;28(2):129-36. doi: 10.1097/JCN.0b013e3182435f27.

DOI:10.1097/JCN.0b013e3182435f27

PMID:22343213

Abstract

BACKGROUND

Informal (family) caregivers are integrally involved in chronic heart failure (HF) care. Few studies have examined HF patients and their informal caregiver as a unit in a relationship, or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with HF and HF care. Incongruence or lack of communication could impair disease management and advance care planning.

OBJECTIVES

The purpose of this qualitative study was to examine for congruence and incongruence between HF patients and their informal (family) caregivers. Secondary analyses examined the relationship of congruence to emotional distress and whether dyad relationship characteristics (eg, parent-child vs spouse) were associated with congruence.

METHODS

Thirty-four interviews consisting of HF patients and their current informal caregiver (N = 17 dyads) were conducted. Each dyad member was asked similar questions about managing HF symptoms, psychosocial care, and planning for the future. Interviews were transcribed and analyzed using the general inductive approach.

RESULTS

Congruence, incongruence, and lack of communication between patients and caregivers were identified in areas such as managing illness, perceived care needs, perspectives about the future of HF, and end-of-life issues. Seven dyads were generally congruent, 4 were incongruent, and 6 demonstrated a combination of congruence and incongruence. Much of the tension and distress among dyads related to conflicting views about how emotions should be dealt with or expressed. Dyad relationship (parent-child vs spouse) was not clearly associated with congruence, although the relationship did appear to be related to perceived caregiving roles.

CONCLUSIONS

Several areas of HF clinical and research relevance, including self-care, advance care planning, and communication, were affected by congruence. Further research is needed to define how congruence is related to other relationship characteristics, such as relationship quality, how congruence can best be measured quantitatively, and to what degree modifying congruence will lead to improved HF patient and caregiver outcomes.

摘要

背景

非正式（家庭）护理人员是慢性心力衰竭（HF）护理不可或缺的一部分。很少有研究将 HF 患者及其非正式护理人员作为一个整体进行研究，也很少有研究将他们视为一种关系或一个对偶。对偶一致性，或观点的一致性，与 HF 患者的生活和 HF 护理的许多方面都有关。不一致或缺乏沟通可能会损害疾病管理和提前护理计划。

目的

本定性研究的目的是检验 HF 患者及其非正式（家庭）护理人员之间的一致性和不一致性。二次分析检验了一致性与情绪困扰的关系，以及对偶关系特征（例如，父母与子女与配偶）是否与一致性相关。

方法

对 34 名 HF 患者及其当前非正式护理人员（N=17 对）进行了访谈。每个对偶成员都被问到关于管理 HF 症状、心理社会护理和规划未来的类似问题。访谈内容被转录并使用一般归纳方法进行分析。

结果

在管理疾病、感知护理需求、对 HF 未来的看法以及临终问题等方面，患者和护理人员之间存在一致性、不一致性和缺乏沟通。7 对对偶总体上是一致的，4 对是不一致的，6 对则表现出一致性和不一致性的混合。许多对偶之间的紧张和困扰与处理或表达情绪的观点冲突有关。对偶关系（父母与子女与配偶）与一致性没有明确相关，尽管关系似乎与感知的护理角色有关。