【作者】 王媛；

【导师】 赵丽晶；

【作者基本信息】 吉林大学 ， 护理学（专业学位）， 2021， 硕士

【摘要】 研究目的:了解脑卒中后言语功能障碍患者的主要照护者对言语功能障碍及治疗方法的认知情况与态度,明晰言语障碍对患者及照护者造成的困扰。为改善照护者对言语障碍及治疗方法的认知情况,提高患者言语障碍的康复效果提供思路。研究方法:采用现象学研究方法,使用目的性抽样中的最大差异抽样法进行抽样,于2020年4月至12月选取长春市及包头市3家三级甲等医院14名脑卒中后言语功能障碍患者的主要照护者作为研究对象,采用一对一、半结构化访谈的形式收集资料。借助质性研究软件NVivo编码,采用Colaizzi 7步分析法对访谈资料进行主题分析,资料的分析与收集同步进行(访谈结束后24小时内)。研究结果:根据14名脑卒中后言语功能障碍患者的主要照护者对言语功能障碍的认知情况访谈的结果,总结出三个核心主题:“对言语功能障碍的认知”、“对言语治疗方法的认知”、“对患者疾病及治疗的态度”。1.“对言语功能障碍的认知”包括三个次主题(1)日常交流的障碍(2)心理状况的变化(3)生活方面的困扰2.“对言语治疗方法的认知”包括四个次主题(1)获得治疗方法相关信息的途径:医护人员、网络、其他(2)治疗内容:不了解、不满意、感到获得的信息不足、希望获得相关信息(3)预期目标(4)治疗效果反馈3.“对患者疾病及治疗的态度”包括四个次主题(1)信心的重建(2)对未来的担忧:经济压力、患者与社会脱节、照护者活动受限、负担加重(3)对疾病和治疗的重视程度(4)责任感增加结论:脑卒中后言语功能障碍患者的主要照护者对言语障碍认知情况不足,进而导致患者及其照护者对言语治疗及护理的不理解与不重视,使得患者的治疗依从性受到影响。另外,言语障碍对患者和照护者的身心健康造成巨大的影响,患者的需求难以得到满足,生活质量明显下降,照护者对于未来患者回归社会及疾病带来的经济负担充满担忧。照护者的角色发生转变、压力剧增、活动受限,健康状况受到影响。以上原因导致患者及照护者对言语障碍的治疗及护理存在消极情绪,影响了治疗效果与效率。患者与照护者对疾病的相关知识以及治疗方法的了解程度有待提高。未来应该加强对患者及家属言语功能障碍及治疗方法的健康教育。医护人员应接受更加系统且专业的康复治疗及护理培训,护理人员应在常规护理的基础上,关注言语功能障碍患者和家属生活上存在的困难并给予适当健康教育和心理干预。根据不同患者的需求,提供针对性的护理服务。另一方面,通过各种平台向社会普及相关知识,帮助社会接纳患者,提供合适的工作,减轻照护者的负担。更多还原

【Abstract】 Objective:This paper aims to study qualitative cognitive conditions to key caregivers of stroke patients with speech dysfunction and their attitudes so as to give some suggestions for improving the conditions and rehabilitation effect.Methods:The phenomenological qualitative research method was used,and with the maximum difference sampling method,the purpose sampling was done.14 caregivers were selected from three hospitals in Changchun and Baotou in the term of July to December,2020.The data were collected in the form of one-to-one and semi-structured interviews.With the qualitative software NVivo,Colaizzi’s 7-step method was used to analyze the data,and the data analysis and collection were carried out simultaneously(within 24 hours after interview).Results:Based on the interviews of 14 subjects,three themes were summarized,namely,"cognition of speech dysfunction","cognition of speech therapy","attitudes to the disease and its therapy".1."Cognition of speech dysfunction" was involved in three subthemes as follows:(1)Barriers to daily communication(2)Psychological changes(3)Life troubles2."Cognition of speech therapy" were involved in four subthemes as follows:(1)Access to treatment and dysfunction-related information: medical staff,network,and others(2)Treatment: unsatisfied,unclear,lacking of health education,eager to getrelevant information(3)Expectations(4)Feedback3."Attitudes to the disease and its therapy" were involved in four subthemes as follows:(1)Confidence regained(2)Concerns about the future: economic pressure,isolation of patients from society,limited activities of caregivers,and increased burden(3)Emphasis on the disease and its treatment(4)Increased sense of responsibility Conclusion:The key caregivers had insufficient cognition of speech dysfunction and treatment,which leads to the patients’ and their caregivers’ ignorance and neglect of speech therapy and nursing,which affects patients’ compliance.Speech dysfunction has a huge impact on mind and body of patients and caregivers.It is difficult to meet the needs of patients,and the quality of life has declined significantly.Caregivers are worried about being back to society,family financial burden,and their disease in future.The role of caregivers changed,the pressure increased sharply,the activity was limited,and the health was threatened to a certain extent.The above reasons made patients and caregivers be negative for recovery and treatment of speech dysfunction,resulting in poor effect and efficiency.Patients and caregivers should be active to learn about their disease and treatment.In the future,the education on speech dysfunction should be strengthened.More professional and systematic rehabilitation treatment and nursing training should be done to the medical staff.In addition to regular nursing,nurses were advised to care for patients with speech dysfunction and their families as well as in health education and psychological intervention.Various nursing services should be offered just the way patients wanted.On the other hand,various platforms should be added to popularize relevant knowledge,help patients be back in society so as to relieve caregivers.更多还原