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The moderating role of psychological resilience in the relationship between fear of COVID-19 and psychological distress, in a cohort of rural and regional healthcare workers. During major lockdowns in Victoria, Australia 2020–2021 在农村和地区医护人员队列中,心理复原力在对 COVID-19 的恐惧与心理困扰之间的关系中的调节作用。2020-2021 年澳大利亚维多利亚州大封锁期间
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-04-08 DOI: 10.1111/inm.13333
Georgia Petrou, Angela Crombie, Stephen Begg, Timothy Skinner, Peter Faulkner, Anne McEvoy, Carol Parker, Kevin Masman, Laura Bamforth, Gabriel Caccaviello, Evan Stanyer, Mark McEvoy

The emergence of the COVID-19 pandemic resulted in substantial pressures for healthcare workers across the world. The association between fear of COVID-19 and psychological distress, and the role of psychological resilience have gained research interest. The current study aimed to investigate the cross-sectional association between fear of COVID-19 and psychological distress, in Australian rural/regional healthcare workers and determine whether resilience modifies this association. Most participants were nurses (38.0%), mean age was 44.9 years, and 80.5% were female (N = 1313). An adjusted logistic regression analysis showed that the highest tertile of the Fear of COVID-19 scale was associated with higher odds of moderate to severe symptoms of anxiety (OR = 3.72, 95% CI = 2.27, 6.11; p < 0.001) and depression (OR = 3.48, 95% CI = 2.30, 5.28; p < 0.001). Healthcare workers with high level of fear of COVID-19 and low level of resilience were much more likely to report moderate to severe symptoms of anxiety (OR = 12.27, 95% CI = 6.65–22.65, p < 0.001) and depression (OR = 12.21, 95% CI = 6.93–21.50, p < 0.001) when compared to healthcare workers with low level of fear of COVID-19 and high level of resilience. A cross-sectional design was used and therefore cause and effect between fear of COVID-19 and psychological distress cannot be inferred. Longitudinal research is needed to investigate the possible causal relationship. These findings highlight the potential mental health effects of fear of COVID-19 on HCWs and demonstrate the importance of resilience as a possible moderator of these effects.

COVID-19 大流行的出现给全球医护人员带来了巨大压力。对 COVID-19 的恐惧与心理困扰之间的关联以及心理复原力的作用受到了研究人员的关注。本研究旨在调查澳大利亚农村/地区医护人员对 COVID-19 的恐惧与心理压力之间的横断面关联,并确定抗压能力是否会改变这种关联。大多数参与者为护士(38.0%),平均年龄为 44.9 岁,80.5% 为女性(N = 1313)。调整后的逻辑回归分析表明,COVID-19恐惧量表的最高三分位数与中度至重度焦虑症状(OR = 3.72,95% CI = 2.27, 6.11; p <0.001)和抑郁症(OR = 3.48,95% CI = 2.30, 5.28; p <0.001)的几率较高相关。与对COVID-19恐惧程度低和复原力高的医护人员相比,对COVID-19恐惧程度高和复原力高的医护人员更有可能报告中度至重度焦虑症状(OR = 12.27,95% CI = 6.65-22.65,p <0.001)和抑郁症状(OR = 12.21,95% CI = 6.93-21.50,p <0.001)。该研究采用的是横断面设计,因此无法推断对 COVID-19 的恐惧与心理困扰之间的因果关系。需要进行纵向研究来调查可能的因果关系。这些研究结果突显了对 COVID-19 的恐惧对高危职业工人心理健康的潜在影响,并证明了抗逆力作为这些影响的可能调节因素的重要性。
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引用次数: 0
The weather as a determinant of farmer's mental health: A dependent, interacting, cumulative and escalating model (DICE) of the effects of extreme weather events 天气是农民心理健康的决定因素:极端天气事件影响的依存、交互、累积和升级模型(DICE)
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-04-04 DOI: 10.1111/inm.13328
Kylie Rice, Kim J. Usher

This perspective paper presents a conceptual, theoretical framework of the weather as a determinant of mental health for farmers. This model proposes that the effects of extreme weather events have interacting and cumulative effects for farmers, who are dependent on the land.

这篇视角论文提出了天气作为农民心理健康决定因素的概念性理论框架。该模型提出,极端天气事件的影响对依赖土地的农民具有交互和累积效应。
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引用次数: 0
Shared Trauma: An evolutionary model concept analysis in light of COVID-19 共同的创伤:根据 COVID-19 进行进化模型概念分析
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-04-02 DOI: 10.1111/inm.13326
April Hutto, Phyllis Raynor, Beverly Baliko

Shared trauma (ST) is a term historically applied to social work experiences, but other healthcare professionals (HCP) also experience ST. With the occurrence of COVID-19, ST has impacted HCP globally and has led to new discoveries and more questions regarding its scope, impact and duration. This article aims to explore the concept of ST applied to nurses in light of COVID-19 using the Rogers and Knafl Evolutionary Model for Concept Analysis. Further examination and evolution of ‘shared trauma’, particularly during COVID-19, has led to the development of an adapted model to explore the implications of ST on health-related outcomes for nurses.

共享创伤(ST)历来是社会工作经历中的一个术语,但其他医疗保健专业人员(HCP)也会经历共享创伤。随着 COVID-19 的发生,ST 在全球范围内对医护人员产生了影响,并引发了有关其范围、影响和持续时间的新发现和更多问题。本文旨在利用罗杰斯和 Knafl 概念分析进化模型(Rogers and Knafl Evolutionary Model for Concept Analysis),根据 COVID-19 探索适用于护士的 ST 概念。对 "共同创伤 "的进一步研究和演变,特别是在 COVID-19 期间的研究和演变,促使我们开发了一个经过调整的模型,以探讨 ST 对护士健康相关结果的影响。
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引用次数: 0
Conceptualisation of personal recovery in a private hospital mental health service 私立医院心理健康服务中个人康复的概念化。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-29 DOI: 10.1111/inm.13321
Leonie M. Lorien, Sarah Blunden, Vivian Romero, Diana MacNevin

There has been limited research on personal recovery during a hospital admission. However, studies in this setting indicate that consumers' experiences of personal recovery, during an inpatient admission, may not mirror the experiences of consumers living in the community, which has been conceptualised by the CHIME processes of Connectedness, Hope, Identity, Meaning and Empowerment. Findings to date posit that inpatients may be more likely to experience disconnection and hopelessness. To investigate this further, staff working in a private hospital mental health service designed and implemented a research project to understand personal recovery from patients' perspectives. The method comprised four consumer focus groups (n = 16 participants). Researchers analysed the data using inductive thematic analysis, identifying three themes: different pathways reflecting each patient's individual journey to personal recovery; challenges including experiencing hopelessness and distress, ups and downs, it not being easy, isolation and lack of support; and living well including wanting to return to everyday living, hope and acceptance, and feeling empowered. The findings suggest that the CHIME conceptualisation of recovery may need to be revised to include the experiences of hospital patients. The conceptualisation of recovery as a dynamic spectrum, with recovery moving up and down between challenges and living well may better represent hospital patient experiences. Patients also talked about a process not included in CHIME, of returning to ‘everyday living’ which was about getting back to doing everyday activities that most of us take for granted.

关于住院期间个人康复的研究十分有限。然而,在这种情况下进行的研究表明,消费者在住院期间的个人康复经历可能与生活在社区中的消费者的经历不尽相同。迄今为止的研究结果表明,住院病人可能更容易经历断裂和绝望。为了进一步研究这个问题,一家私立医院心理健康服务部门的工作人员设计并实施了一个研究项目,从病人的角度来了解个人康复情况。研究方法包括四个消费者焦点小组(n = 16 名参与者)。研究人员使用归纳式主题分析法对数据进行了分析,并确定了三个主题:反映每位患者个人康复历程的不同路径;挑战,包括经历绝望和痛苦、起伏、不容易、孤立和缺乏支持;以及美好生活,包括希望回归日常生活、希望和接受,以及感觉有力量。研究结果表明,CHIME 的康复概念可能需要修改,以纳入医院病人的经历。将康复概念化为一个动态谱系,康复在挑战和良好生活之间上下波动,可能更能代表医院病人的经历。患者还谈到了 CHIME 中未包含的一个过程,即恢复 "日常生活",这是指恢复我们大多数人认为理所当然的日常活动。
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引用次数: 0
Nursing students’ mental health: How does eco-anxiety effect? 护理专业学生的心理健康:生态焦虑有何影响?
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-28 DOI: 10.1111/inm.13320
Seda Er, Merve Murat, Elvan Emine Ata, Selmin Köse, Sevim Buzlu

Climate change is recognised as one of the fundamental determinants of human health. Anxiety experienced in response to an ecological crisis is defined as eco-anxiety. This study aims to determine the eco-anxiety levels of nursing students and the relationship between eco-anxiety and their mental health. The sample of the cross-sectional correlation and descriptive study consisted of nursing students (N = 609) from two different universities in Istanbul. Data were collected with Personal Information Form, Eco-Anxiety Scale and Depression Anxiety Stress Scale (DASS-21). The data were analysed with SPSS (v.28) by using the Mann–Whitney U and Kruskal–Wallis tests, the Spearman correlation test and general linear model. It was determined that 84.2% of the participants were women and 60.8% were 18–20 years old. The participants' total Eco-Anxiety Scale score was 25.65 ± 7.49, and the total DASS-21 score was 21.24 ± 14.76. There is a statistically significant and positive relationship between the Eco-Anxiety Scale and DASS-21. Mental health nurses can play a key role in planning and raising awareness of interventions for eco-anxiety.

气候变化被认为是人类健康的基本决定因素之一。因生态危机而产生的焦虑被定义为生态焦虑。本研究旨在确定护理专业学生的生态焦虑水平以及生态焦虑与其心理健康之间的关系。这项横断面相关描述性研究的样本包括来自伊斯坦布尔两所不同大学的护理专业学生(N = 609)。通过个人信息表、生态焦虑量表和抑郁焦虑压力量表(DASS-21)收集数据。数据采用 SPSS(v.28)进行分析,使用了 Mann-Whitney U 和 Kruskal-Wallis 检验、Spearman 相关性检验和一般线性模型。结果表明,84.2% 的参与者为女性,60.8% 的参与者年龄在 18-20 岁之间。参与者的生态焦虑量表总分为(25.65 ± 7.49)分,DASS-21 总分为(21.24 ± 14.76)分。在统计学上,生态焦虑量表和 DASS-21 之间存在明显的正相关关系。心理健康护士在规划和提高生态焦虑干预意识方面可以发挥关键作用。
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引用次数: 0
Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study 测试以恢复为导向的护理沟通框架,以鼓励合作和讨论预防侵犯:混合方法研究。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-26 DOI: 10.1111/inm.13325
Laura Scheirich, Tessa Maguire, Michael Daffern

Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.

以康复为导向的实践在医疗保健中至关重要,但探索将以康复为导向的原则融入法医心理健康环境的方法的研究却很有限。本研究包括与精神健康护理护士和一位生活经验专家共同开发和测试以康复为导向的脚本,供法医精神健康护士在与面临即将发生攻击行为的高风险消费者沟通时使用。目的是研究当脚本中具体提及移情时,与未包含移情语句的同等脚本相比,护士是否认为脚本更具移情性,并探讨护士对脚本是否有助于预防攻击行为的看法。在一家安全的法医精神病院工作的护士(n = 54)被随机分配到阅读一份脚本,脚本中包含代表九项以康复为导向的原则的语句,其中还包括移情语句,或者一份不包含移情语句的等效脚本。阅读完脚本后,参与者填写了一份问卷,其中包括由作者开发的康复导向实践量表,测量脚本反映康复导向原则的程度,以及关于脚本预防攻击潜力的开放式问题。结果显示,护士对两种脚本的移情认知没有明显差异。内容分析表明,护士认为脚本有助于预防侵犯行为。
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引用次数: 0
Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review 护士在心理健康环境中通过与患者和家属的互动感受到的种族主义:系统回顾。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-22 DOI: 10.1111/inm.13317
Anuson Wijayaratnam, Olga Kozlowska, Amani Krayem, Satinder Kaur, Helen Ayres, Rebecca Smith, Jane Paterson, Rola Moghabghab, Cathy Henshall

Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.

在精神健康/法医住院环境中,护理人员很容易与病人和同事打交道。众所周知,这些环境中存在针对工作人员的工作场所暴力事件,其中包括种族主义。种族主义是工作场所暴力的一种形式,在这种复杂的环境中,我们必须对其有更好的理解和支持。完成一项系统性综述,将已有的研究和建议的干预措施结合起来,可为护士提供有益的支持。系统性综述遵循 PRISMA 指南。检索了 CINAHL、PsycInfo、Medline、英国护理数据库和 Web of Science 数据库。审稿人对论文进行了筛选(从 7146 篇文章中选出 29 篇纳入),并使用混合方法评估工具完成了质量评估。随后,完成了数据提取,并通过叙事综合法对研究结果进行了总结。种族主义的概念化方式影响了数据的收集、报告和解释;种族主义是沉默还是暴露取决于研究的开展方式。如果暴露了种族主义,则有证据表明种族主义是一个问题,但并不总是得到承认或采取相应行动。一些证据表明种族主义导致了与工作相关的负面结果。文献提供了有限的干预实例。这些干预措施包括改变对员工的教育/引导、公开讨论种族主义事件以及在同事和管理层中更好地规划病人。要提高员工队伍的多样性,就需要开展更多的研究,探讨和解决与针对护士的种族主义有关的问题。需要对精神卫生/法医环境中种族主义正常化和根深蒂固的说法提出质疑。
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引用次数: 0
Acceptability, engagement and exploratory outcomes and costs of a co-designed intervention to support children of parents with a mental illness: Mixed-methods evaluation and descriptive analysis 共同设计的干预措施的可接受性、参与度和探索性成果及成本,为父母患有精神疾病的儿童提供支持:混合方法评估和描述性分析。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-18 DOI: 10.1111/inm.13324
Annette Bauer, Javiera Cartagena-Farias, Hanna Christiansen, Melinda Goodyear, Mona Schamschula, Ingrid Zechmeister-Koss, Jean Paul

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long-term impacts. Child-centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre-post, mixed methods, single-arm evaluation of a co-designed social support intervention with parents and children (4–18 years) measured parents' mental health (PHQ-9), perceived social support (ENRICHD), parental self-efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen-27), and child service use (CAMHSRI-EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty-nine parents and 21 children completed baseline and follow-up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD −1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self-efficacy was potentially reduced (MD −0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent–child relationships. This study contributes to an emerging evidence base for co-designed child-centred interventions to prevent the transgenerational transmission of poor mental health.

父母患有精神疾病的儿童更有可能出现精神健康问题和其他长期不利影响。以儿童为中心的社会心理干预措施可能是有效的,但对于如何在不同环境下设计和实施这些干预措施却知之甚少。对一项由家长和儿童(4-18 岁)共同设计的社会支持干预措施进行了前后期、混合方法、单臂评估,在基线和 6 个月时测量了家长的心理健康(PHQ-9)、感知的社会支持(ENRICHD)、家长的自我效能(PSAM)以及儿童的心理健康(SDQ)、生活质量(Kidscreen-27)和儿童服务使用情况(CAMHSRI-EU)。我们还收集了 6 个月的定性数据,以了解家长和儿童对干预措施的体验。29 名家长和 21 名儿童填写了基线和随访问卷;22 名家长和 17 名儿童参加了访谈。结果显示,家长的抑郁程度(MD -1.36, SD 8.08)、感知到的社会支持(MD 1, SD 5.91)和儿童的心理健康状况都得到了潜在的改善,儿童使用服务的次数和费用也有可能减少(224.6 欧元对 122.2 欧元,MD 112.4)。家长的自我效能可能会降低(MD -0.11,SD 3.33)。由于样本太少,无法进行统计分析。结果显示,家长对干预措施的满意度很高,他们更加了解自己的心理健康问题对孩子的影响,亲子关系也得到了改善。这项研究为共同设计的以儿童为中心的干预措施提供了新的证据基础,以防止不良心理健康的代际传递。
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引用次数: 0
Pathways and transitions for patients admitted to an emergency department after self-harming events 自我伤害事件后急诊科收治病人的路径和转归。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-18 DOI: 10.1111/inm.13314
Malene Sandahl, Annmarie Touborg Lassen, Elsebeth Stenager, Christina Østervang

The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.

发生自我伤害事件后到急诊科(ED)就诊的患者越来越多。以往的研究表明,急诊科医护人员(HCPs)在处理因自我伤害事件而入院的患者时,可能会因其复杂的病症而束手无策。本研究旨在观察和调查急诊室收治的自残患者从转院到出院的过程。本研究选择了参与观察和访谈的方法,以深入了解自我伤害事件后被送入急诊室的患者的治疗路径。数据采用解释现象学分析法进行分析。分析样本量为 20 名患者,数据收集期间共进行了 213 小时的观察。分析结果显示了三大主题:(1) 患者的精神压力与高期望值;(2) 对如何解决自残事件的不确定性;(3) 系统混乱。发生自残事件后被送入急诊室的患者要承受难以承受的精神压力。尽管如此,他们仍被寄予厚望,希望自己能融入急诊室并与之合作。医疗保健系统的组织职责不明确,没有系统的方法来照顾自残患者,因此提供了混乱的患者路径。有必要提高跨部门的能力,在出院、转院和后续护理方面,与患者路径和护理相关的人员之间应达成相互协议并进行系统的沟通。
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引用次数: 0
Shame in patient-health professional encounters: A scoping review 患者与医疗专业人员接触中的羞耻感:范围综述。
IF 3.6 2区 医学 Q1 NURSING Pub Date : 2024-03-18 DOI: 10.1111/inm.13323
Michael A. Jaeb, Kristen E. Pecanac

Shame can arise during patient-health professional encounters when discussing traumatising and stigmatising topics and can contribute to negative patient outcomes. This review aims to summarise what is known regarding shame in patient-health professional encounters. We conducted a scoping review using Levac and colleagues' approach and reported the findings using the PRISMA Extension for Scoping Reviews. We searched four databases (CINAHL, PsychINFO, PubMed and SocINDEX) for empirical studies that involved shame in patient-health professional encounters contextualised by trauma or stigma and were published in English. We categorised what is known regarding shame in empirical studies using inductive content analysis. We also collected stakeholders' perspectives on the review findings through an online survey. Our initial search yielded 3658 articles, of which 37 were included. We summarised the literature into four categories: (1) What health professionals say they do in patient-health professional encounters, (2) What health professionals think patients feel in patient-health professional encounters, (3) Patients' descriptions of their own shame during patient-health professional encounters and (4) Health professionals' descriptions of their own shame during patient-health professional encounters. Shame can arise in a variety of circumstances during patient-health professional encounters. More research is needed to identify what specific communication strategies used by health professionals during patient-health professional encounters contribute to or avoid patient shame.

在患者与医疗专业人员接触过程中,当讨论创伤性和污名化话题时,可能会产生羞耻感,并可能导致患者的不良后果。本综述旨在总结有关患者与医疗专业人员接触时的羞耻感的已知信息。我们采用 Levac 及其同事的方法进行了范围界定综述,并使用范围界定综述的 PRISMA 扩展工具报告了研究结果。我们在四个数据库(CINAHL、PsychINFO、PubMed 和 SocINDEX)中检索了以创伤或污名为背景的患者与医疗专业人员接触中涉及羞耻感的实证研究,这些研究均以英语发表。我们使用归纳式内容分析法对实证研究中有关羞耻感的已知内容进行了分类。我们还通过在线调查收集了利益相关者对审查结果的看法。我们的初步搜索结果是 3658 篇文章,其中 37 篇被收录。我们将文献归纳为四类:(1)医护人员说他们在与患者-医护人员接触时做了什么;(2)医护人员认为患者在与患者-医护人员接触时感受到了什么;(3)患者在与患者-医护人员接触时对自身羞耻感的描述;(4)医护人员在与患者-医护人员接触时对自身羞耻感的描述。在病人与医疗专业人员接触过程中,羞耻感可能会在各种情况下产生。需要进行更多的研究,以确定医护人员在与患者和医护人员接触时所使用的具体沟通策略会导致或避免患者产生羞耻感。
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International Journal of Mental Health Nursing
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