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双相信息和支持计划-痴呆或轻度认知障碍患者和家庭照顾者:一项可行性研究。

A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study.

机构信息

School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.

Centre for Health Services Research, The University of Queensland, Herston, Queensland, Australia.

出版信息

J Adv Nurs. 2024 Nov;80(11):4422-4435. doi: 10.1111/jan.16167. Epub 2024 Mar 24.

DOI:10.1111/jan.16167
PMID:38523304
Abstract

AIM

The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings.

DESIGN

A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility.

METHODS

Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators.

RESULTS

Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members.

CONCLUSION

Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months.

IMPACT

This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting.

REPORTING METHOD

The authors have adhered to the EQUATOR STROBE Statement.

PATIENT OR PUBLIC CONTRIBUTION

A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

摘要

目的

本研究旨在确定在两个初级保健环境中向(与痴呆症或轻度认知障碍患者共同生活的人以及家庭照顾者)双人组提供结构化的诊断后信息和支持计划的可行性。

设计

以鲍文可行性框架为指导的两阶段解释性混合方法方法,重点关注五部分计划的可接受性、实施、适应性、整合和疗效。在第 1 阶段,测量了计划对双人计划接受者的自我效能、生活质量、双人关系和护理量的定量影响。在第 2 阶段,对护士和双人参与者对计划的体验进行了归纳内容分析。对定量和定性数据进行了审查,以得出可行性的每个要素的结论。

方法

招募了在参与地点工作的 4 名注册护士,将他们培训为计划促进者,并支持他们提供计划。邀请在各自初级保健诊所就诊的合格双人组参与计划,并在三个时间点完成调查:招募、计划后和 3 个月随访。对双人组和计划促进者进行了计划后半结构化访谈。

结果

29 对双人组完成了该计划;大多数是夫妻对。该计划对双人组来说是可接受的,保留率和完成率都很高。该计划的实施和整合到常规实践归因于护士作为计划促进者的动机和能力。关于计划的效果,大多数双人组报告说,他们对未来的准备更好了,并与家人分享了他们在计划中制定的计划。

结论

实施结构化的信息和支持计划是可行的,但可持续性需要进一步的适应性或增加员工资源以保持计划的保真度。未来的研究应考虑选择对痴呆症患者的独特需求敏感的疗效措施,并将随访时间延长至 6 个月。

影响

本研究确定了注册护士在初级保健环境中为早期痴呆症或轻度认知障碍患者及其非正式照顾者提供诊断后信息和支持计划的可行性。作为计划促进者工作的护士的动机和能力确保了计划融入常规工作,但随着时间的推移,这被认为是不可持续的。家庭照顾者对报告了切实的结果,并对与家人和朋友分享诊断并寻求帮助充满信心。本研究的结果可用于为在初级保健环境中调查结构化信息和支持计划有效性的临床试验提供指导。

报告方法

作者遵守了 EQUATOR STROBE 声明。

患者或公众贡献

一家公立医院记忆诊所和普通医疗实践参与了项目设计、研究方案制定和实施支持。

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