目的 探究临床护士工作不安全感、积极应对、领悟性社会支持与心理困扰关系的作用机制.方法 采用一般资料调查表、心理健康评定量表(K10)、工作不安全感量表、领悟社会支持量表(PSSS)、简易应对方式量表(SCSQ)对三级综合医院的462名临床护士进行调查.结果 临床护士工作不安全感对心理困扰具有正向预测作用(P<0.01);积极应对可以部分中介工作不安全感与心理困扰的关系,间接效应的95％CI为0.0165～0.1324;社会支持调节了工作不安全感影响心理困扰中介模型的后半段(P<0.01).结论 积极应对作为中介变量可以影响工作不安全感与心理困扰的关系,且社会支持增强了积极应对心理困扰的影响,工作不安全感对心理困扰的影响是有调节的中介效应.

Objective:To investigate the stigma in families of schizophrenic patients and explore the relationship between stigma and psychological distress and self-esteem.Methods:A total of 150 family members of patients with schizophrenia who visited Shandong Mental Health Center from May 2018 to May 2019 were randomly selected to conduct a questionnaire survey.The basic information and general data of patients' family members were sorted out, and the characteristics of population and sociology were analyzed.The Link stigma scale, Kessler10 scale and self-esteem scale were used to evaluate stigma, psychological distress and self-esteem of patients' family members.A total of 150 questionnaires were sent out and 134 were recovered with effective recovery rate of 89.33%.SPSS 21.0 software was used for statistical analysis of the data of each scale.Results:Most of the family members of the 134 patients were 31-50 years old, most of them were farmers or employees, 81.34% (109/134) were married, 61.94% (83/134) were in general economic condition, and most of them were parents or spouses.The average Link scale score of the patient′s family members was (2.68±0.45), of which less than 2.5 points accounted for 58.21% (78/134). The average score of Kessler10 scale was (19.57±6.23), and over 16 scores accounted for 70.90% (95/134). The mean score of self-esteem scale was (30.12±3.86). Through Pearson correlation analysis, stigma of relatives of schizophrenia patients was positively correlated with psychological distress ( r=0.364, P<0.05). Stigma was negatively correlated with self-esteem ( r=-0.220, P<0.05). Psychological distress was negatively correlated with self-esteem ( r=-0.421, P<0.05). Conclusions:The families of schizophrenic patients often have great psychological distress due to stigma, and self-esteem is the protective factor of stigma and psychological distress.Medical staffs should pay more attention to the families of patients with high stigma and low self-esteem, and take intervention measures to relieve or relieve their psychological distress.

目的 探讨精神科护士情绪智力、临床沟通能力和人文关怀的路径关系.方法 选取山东省某精神卫生机构临床精神科护士275名为研究对象,采用一般情况调查表、人文关怀能力量表(CAI)、临床沟通能力量表、情绪智力量表(WLEIS)进行测量.结果 精神科护士CAI总分及各维度得分与护士临床沟通能力、WLEIS总分及各维度得分均呈正相关(P<0.01).情绪智力对人文关怀能力有直接正向预测作用(P<0.01),路径系数0.21,临床沟通能力可作为中介作用对人文关怀能力和情绪智力产生影响(P<0.01),中介效应值为0.20.结论 护理管理者可通过训练护士的情绪智力水平,提高临床沟通能力,提升精神科护士人文关怀素养.

目的:探讨品管圈(QCC)质量管理方法对心理科住院患者晚间熄灯后使用手机时间的影响。方法:对使用智能手机的15～40岁住院患者310例进行目的性抽样，于2017年10月10～23日进行现状调查，用鱼骨图进行原因分析，经真因验证后拟定对策，并干预12 w；于2018年3月19日至4月1日对使用智能手机15～40岁的住院患者298例进行调查，分析干预效果。结果:住院患者晚间熄灯后手机使用时间由活动前每人每天1.62 h下降为活动后每人每天0.53 h晨间患者按时服药率和圈成员综合能力得分高于活动前，差异均有统计学意义( P<0.05)。 结论:运用QCC质量管理方法制定的护理干预措施能有效降低心理科住院患者晚间熄灯后使用手机时间、人数，增加患者晨间按时服药率，利于疾病的快速康复，为其节约时间成本和经济成本。

目的 探讨应对方式在精神分裂症患者家属病耻感与领悟社会支持间的中介作用,为临床制定有效干预措施,减轻其病耻感提供依据.方法 采用方便抽样法对2019年4-11月在山东省精神卫生中心住院的155例精神分裂症患者及其家属(均选取1位与患者有血缘关系的家属),应用一般资料调查表、病耻感系列量表中的贬低-歧视感知量表、简易应对方式问卷和领悟社会支持量表进行调查,并使用AMOS 22.0建立结构方程模型进行验证分析.结果 患者家属病耻感均分为(2.59±0.50)分;积极应对均分为(1.86±0.52)分,消极应对均分为(1.24±0.45)分;领悟社会支持总分为(59.77±13.39)分,其中家庭支持(20.50±4.82)分、朋友支持(19.32±4.73)分、其它支持(19.94±4.87)分.精神分裂症患者家属病耻感与积极应对、家庭支持、朋友支持及其它支持呈负相关(r=-0.650～-0.356,P<0.01),与消极应对呈正相关(r=0.232、0.183、0.159、0.215,P<0.01),积极应对与家庭支持、朋友支持、其它支持呈正相关(r=0.363～0.314,P<0.01),家庭支持与朋友支持和其它支持成正相关(r=0.741、0.784,P<0.01).结构方程模型显示:领悟社会支持→消极应对→病耻感"的中介效应不显著(β=0.025,P=0.268),予以剔除."领悟社会支持→积极应对→病耻感"间接效应显著,领悟社会支持可直接负向预测病耻感,路径系数为-0.25,领悟社会支持也可通过积极应对间接影响病耻感,效应值为-0.331,中介效应比例占总效应的56.64％.结论 积极应对在精神分裂症患者家属病耻感与领悟社会支持间起中介作用,关注精神分裂症患者家属的领悟社会支持和应对方式,有助于降低其病耻感水平.

Abstract The gene – environment (G × E) interaction effect is involved in severe mental disorders. However, whether the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism participates in the childhood-abuse influenced schizophrenic symptoms remains unclear. We examined the interaction between BDNF Val66Met, and childhood trauma (ChT) on psychotic symptoms in a Chinese Han population. To estimate the G × E interaction, psychiatric interviews, self-report questionnaires for ChT, and genotyping for BDNF Val66Met were carried out on 201 schizophrenic patients. G × E interactions were analyzed by generalized multifactor dimensionality reduction (GMDR). Among all patients, 11.9%, 19.4%, 23.4%, 26.4%, and 73.6% reported emotional abuses, physical abuses (PA), sexual abuses (SA), emotional neglects (EN), and physical neglects (PN), respectively. Significant negative correlations were observed between anxiety/depression factors, and ChT total scores. Patients with 3 different BDNF genotypes showed significant differences in anxiety/depression scores. Significant 2-way interactions were found for Val66Met × PN, 3-way interactions were found for Val66Met × PN × PA, and four-way interactions were found for Val66Met × PN × PA × EN with regard to the excitement scores. Our findings suggested an involvement of BDNF Val66Met polymorphism after ChT in terms of risk for schizophrenia symptoms.

Objective To investigate the burden and influencing factors of quality of life of caretaking relatives of insenile dementia patients.Methods 91 relatives of dementia inpatients from a mental health center were assessedby general questionnaire, the brief questionnaire of World Health Organization Quality of Life (WHOQOL-BREF)and Zarit Burden Interview (ZBI).Results Patients' marital status and caretakers'WHOQOL-BREF total score and psychological field scores were positively correlated (P＜0.05).The patients' age was positively correlated with caretakers'WHOQOL-BREF total score and scores of the physiological, social, psychological, and environmental fields (P＜0.05).The patients' course of disease was negatively correlated with the caretakers'WHOQOL-BREF total score and each dimension score ( P ＜0.05).The patients' income was positively correlated with the caretakers'WHOQOL-BREF total score and each dimension score (P＜0.01).The patients' income was negatively correlated with caretakers'ZBI total score and the individual burden and liability burden ( P＜0.01).The caretakers' WHOQOL-BREF total scores and each dimension score were negatively correlated with the ZBI totalscores andeach dimension socre ( P ＜0.01 ).Multiple linear regression showed that patients 'marital status, course of disease, income, and the ZBI total score had predictive effects on WHOQOL-BREF total scores and psychological field scores (P＜0.01); Patients' course of disease, income, and the ZBI totalscoreshad predictive effects on WHOQOL-BREF physiological social field, and environmental fields (P＜0.01).Conclusion The relevant medical and health departments and all sectors of the social sector should take measures to reduce the burden on the main caretakers of senile dementia patients , improve their quality of life, and thereby enhancing the level of medical care services.

目的 讨论希望理论运用于慢性精神分裂症患者康复的临床价值。 方法 将患有慢性精神分裂症康复期的患者94例，随机分为研究组和对照组各47例，对照组患者给予常规的治疗方案，研究组在对照组的基础上进行了希望理论治疗。 结果 两组患者在护理干预后3个月和6个月时积极态度（T）、积极行动（P）、与他人的关系（I）及希望水平总分评分明显高于对照组，研究组在护理干预后6个月对生活质量评分明显高于对照组[（43.2±7.30）比（38.8±7.70）]，差异有统计学意义（P<0.05）。 结论 希望理论运用于慢性精神分裂症患者的康复期明显提高了患者希望水平，促进患者对情境的适应能力，有效的应对健康问题，促进与人之间的交流，更早的回归社会。

精神科护理管理对病人的病情恢复具有重要促进作用。在新时期，精神科病情状况日趋复杂化，因此，要不断加强精神科护理管理，积极探索现代化护理管理模式，改进管理办法，实现科学化、现代化护理管理，满足精神科护理的现代化要求。本文主要对新时期几种精神科的护理管理模式进行探讨和思考，并对几种管理模式进行基本的应用阐述。

Objective:To explore the effect of team interaction nursing intervention on family members of children with schizophrenia . Methods:The 10-week team interaction nursing intervention was conducted to 112 family members of children with schizophrenia accord-ing to the self-designed questionnaire survey and SCL -90 was used to assess the effect before and after the intervention .Results:The to-tal score of SCL-90 and the score of each factor like somatization ,compulsion,interpersonal relationship ,depression,anxiety,hostility, phobia ,paranoid ideation of the family members were significantly lower after the intervention than those before the intervention through 10-week team interaction nursing intervention (P<0.05).Conclusion: The team interaction nursing intervention can effectively improve the mental health level of the family members and find the way and the methods to coping with the disease ,which has positive effect on the rehabilitation of children with schizophrenia .

目的：探讨在家属中实施系统性健康教育对精神分裂症患者生活质量的影响。方法：选择60例精神分裂症患者按住院顺序随机分为实验组和对照组各30例。对照组行传统健康教育，实验组在此基础上针对影响生活质量的因素对家属实施系统的健康教育，在患者入院时、出院6个月，采用生活质量指数评定表分别对两组生活质量评分进行比较。结果：实验组干预后，生活质量在躯体功能、角色功能、情绪功能、社会功能、总体生活质量优于对照组（P ＜0.05）。结论：对精神分裂症患者家属进行系统性健康教育，有助于提高家属的照护水平，提高患者的生活质量。