Bradbury Hospice, New Territories East Cluster, Hospital Authority, Hong Kong Special Administrative Region.
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Int J Nurs Stud. 2019 Mar;91:134-143. doi: 10.1016/j.ijnurstu.2018.12.007. Epub 2019 Jan 3.
A life review is a promising intervention to enhance spiritual well-being in older people. Conventional life review interventions are lengthy and often led by psychologists.
This is the first randomised controlled trial study to examine the effectiveness and applicability of a nurse-led short term life-review intervention in people with life limiting diseases, the purpose being to enhance their spiritual well-being and lower their anxiety and depression.
A sequential mixed method approach, randomised controlled trial and qualitative evaluation, was adopted. The intervention group received the short version life review, and the control group attention placebo. Participants were randomly assigned to either intervention or control groups by computerised randomisation. Both participants and outcome assessors were blinded to the group assignment.
The study was conducted in three publicly funded regional hospitals in Hong Kong.
The target population were people suffering from life-limiting diseases, and receiving hospitalised, day hospice or outreach home care from the palliative care team.
Two sets of questionnaires were used: the spiritual sub-scale of the McGill Quality of Life Questionnaire, Hong Kong version and the Hospital Anxiety and Depression Scale, Chinese version. The intervention process was assessed by means of observation log sheets and semi-structured interviews of 12 participants.
A total of 109 participants were recruited (54 in the intervention group, 55 in the control group). The intervention group showed significantly more improvement in spiritual well-being than the control group, with a Cohen's d-effect size of 0.65. Although there were improvements in both anxiety and depression levels in the intervention group, statistical significance in between-group comparisons was not reached. The process evaluation found that most participants were highly involved (92.6%), interested (77.8%) and participated in the intervention (79.6%). The participants described the intervention process as 'comfortable', 'relaxing' and 'interesting', and felt enlightened, with raised self-awareness, after it.
The nurse-led short term life-review intervention demonstrated significant improvement effects in spiritual well-being. Participant feedback on nurses' performance was positive, finding the intervention acceptable and useful. The setting of the intervention has now been extended from bedside to home. It is recommended to incorporate life review into palliative nursing specialty training, empowering more nurses to deliver the intervention in their daily practice.
生活回顾是一种有前途的干预措施，可以增强老年人的精神幸福感。传统的生活回顾干预措施时间较长，通常由心理学家主导。
这是第一项关于护士主导的短期生活回顾干预对患有生命限制疾病的人的有效性和适用性的随机对照试验研究，旨在增强他们的精神幸福感，降低他们的焦虑和抑郁水平。
采用了顺序混合方法，随机对照试验和定性评估。干预组接受简短的生活回顾，对照组接受注意安慰剂。参与者通过计算机随机分组被随机分配到干预组或对照组。参与者和结果评估者都对分组分配不知情。
该研究在香港的三家公立地区医院进行。
目标人群是患有生命限制疾病的人，他们正在接受姑息治疗团队的住院、日间临终关怀或上门家庭护理。
使用了两套问卷：香港版麦吉尔生活质量问卷的精神分量表和中文版医院焦虑抑郁量表。通过观察日志表和对 12 名参与者的半结构化访谈评估干预过程。
共招募了 109 名参与者（干预组 54 名，对照组 55 名）。干预组的精神幸福感明显改善，Cohen's d 效应量为 0.65。虽然干预组的焦虑和抑郁水平都有所改善，但组间比较没有达到统计学意义。过程评估发现，大多数参与者高度参与（92.6%）、感兴趣（77.8%）并参与了干预（79.6%）。参与者描述干预过程“舒适”、“放松”和“有趣”，并表示在干预后感到启发，自我意识提高。
护士主导的短期生活回顾干预在精神幸福感方面显示出显著的改善效果。参与者对护士表现的反馈是积极的，认为干预是可以接受和有用的。干预的设置现已从床边扩展到家庭。建议将生活回顾纳入姑息护理专业培训，使更多护士能够在日常实践中提供干预。
