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增强神经科学重症监护病房患者及其家庭照顾者二元组的恢复力:从威廉和劳拉身上学到的经验教训。

Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura.

作者信息

Meyers Emma E, McCurley Jessica, Lester Ethan, Jacobo Michelle, Rosand Jonathan, Vranceanu Ana-Maria

机构信息

Massachusetts General Hospital and Harvard Medical School.

Harvard Medical School and Massachusetts General Hospital.

出版信息

Cogn Behav Pract. 2020 Aug;27(3):321-335. doi: 10.1016/j.cbpra.2020.02.001. Epub 2020 Mar 12.

DOI:10.1016/j.cbpra.2020.02.001
PMID:32863700
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7454168/
Abstract

Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss "Recovering Together," a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad's experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.

摘要

中风,无论严重程度如何,都是一件改变生活且常常令人痛苦的事情,会导致幸存者及其家庭照顾者出现慢性抑郁、焦虑和创伤后应激反应。中风后针对情绪困扰的心理社会干预措施有限,这些措施强调心理教育而非技能,侧重于治疗慢性情绪困扰而非预防,并且要么针对患者,要么针对其照顾者,而没有考虑他们人际关系的背景。在此,我们讨论“共同康复”项目,这是一个针对中风患者及其家庭照顾者二元组的新项目,旨在通过运用认知行为原理,在神经科学重症监护病房住院期间开始教授恢复力和人际沟通技能,并在出院后通过远程医疗继续开展教学,以预防慢性情绪困扰。我们举例说明一个参与“共同康复”项目的试点二元组的案例,展示患者及其照顾者如何参与该项目并从中受益。这个二元组的经历表明“共同康复”项目是可信、可行且有用的。这种干预措施潜在的二元组益处不仅在于提供优化康复和预防长期情绪困扰的机会,还在于为两人共同面对并从重大疾病中找到意义创造空间。

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本文引用的文献

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Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients: A Randomized Clinical Trial.护士主导的预防性心理干预对重症患者创伤后应激障碍症状的影响:一项随机临床试验。
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Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers.预防脑卒中幸存者及其非专业照护者的慢性情绪困扰。
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Early Risk and Resiliency Factors Predict Chronic Posttraumatic Stress Disorder in Caregivers of Patients Admitted to a Neuroscience ICU.早期风险和适应因素预测神经科学 ICU 住院患者照顾者的慢性创伤后应激障碍。
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Update on the State of the Evidence for Stroke Family Caregiver and Dyad Interventions.中风家庭照顾者及二元干预证据状况的最新进展
Stroke. 2017 May;48(5):e122-e125. doi: 10.1161/STROKEAHA.117.016052. Epub 2017 Mar 28.
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Post-traumatic Stress Disorder and Complicated Grief are Common in Caregivers of Neuro-ICU Patients.创伤后应激障碍和复杂性悲伤在神经重症监护病房患者的照顾者中很常见。
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J Crit Care. 2016 Dec;36:154-159. doi: 10.1016/j.jcrc.2016.07.010. Epub 2016 Jul 16.