| Objective:To construct and implement a scientific and operable clown care plan suitable for the elderly in Taiyuan elderly care institutions,to explore the effects of clown care on the elderly's cognition,negative psychological emotions and quality of life,and to analyze the influence which is clown care for health care workers in elderly institutions and clown care practitioners who are nursing graduate students.Methods:(1)Form a clown care plan through action research.Set up a clown care team.During the planning stage,retrieve domestic and foreign literature to extract data,analyze and organize to form a preliminary clown care plan.During the action and observation phase,use the convenience sampling method to select 12 elderly people who are willing to receive intervention as the intervention object,and observe the existence.In the reflection phase,semi-structured interviews were conducted with the elderly,their families,medical workers and volunteers,and the data was improved using the Colaizzi 7 step analysis method.(2)Quantitatively evaluate the impact of clown care plan on cognition,negative psychological mood and quality of life of elderly people in nursing homes through the design of similar experimental research.The purpose sampling method was used to select 116 elderly people in the elderly care institution from March 2019 to January 2020 as the research object.They were divided into intervention group and control group according to the hospitalized area,each of 58 people.The intervention group received 2 weekly,1.5-2 hours each time,a total of 8 months of clown care,the control group received routine care in the nursing home.Geriatric Depression Scale(GDS),Loneliness Scale(ULS-6),Positive and Negative Emotional Scale(PANAS),Changsha Montreal Cognitive Assessment Scale(MoCA)and Quality of Life Scale(QOL-AD)are the evaluation tool used to compare before and after intervention.P <0.05 was considered statistically significant.(3)Through semi-structured interview-type qualitative research design,evaluate the impact of clown care on the elderly in nursing homes,medical workers and nursing graduate students in nursing homes.Fifteen elderly people,four elderly family members,four medical workers and four nursing graduate students who were willing to be interviewed were selected for interviews.The Colaizzi 7 step analysis method was used to summarize and code the interview data to form a theme.Results:(1)Form a clown care planThis plan includes the implementer,the object,the form of implementation,the frequency of implementation,the implementation process,and precautions.Persons who have received training in clown care and passed the assessment will conduct an individual or group of senior citizens without severe cognitive impairment twice a week.For clown care activities(except holidays),the implementation process includes three phases: preparation phase,implementation phase and reflection improvement.(2)General information for the elderlyA total of 111 elderly people participated in the study,55 males(49.55%)and 56 females(50.45%),55 elderly patients in the intervention group,27 males(49.09%),28 females(50.91%),and the average age(78.82 ± 7.21)years old,56 elderly people in the control group,male 28(50%),female 50(50%),average age(77.02 ± 7.57)years old;after analysis,the two groups of elderly people in terms of age,gender,marital status,There was no significant difference in basic information such as education level and self-care level of ADL(P> 0.05),and they were comparable.(3)Changes in cognitive function before and after intervention by the elderlyBefore the intervention,the cognitive assessment score of the elderly in the intervention group(23.78 ± 3.213)and the cognitive assessment score of the elderly in the control group(23.96 ± 2.828).There was no significant difference in the cognitive level of the elderly in the two groups before intervention(P = 0.751).After the intervention,the cognitive evaluation score of the elderly in the intervention group(24.24 ± 2.854)and the cognitive evaluation score of the elderly in the control group(23.45 ± 3.021).There was no significant difference in the cognitive level of the elderly in the two groups after intervention(P = 0.160).(4)Psychological and emotional changes of the elderly before and after interventionBefore the intervention,the depression evaluation score of the elderly in the intervention group(15.93 ± 5.036),the loneliness score(17.69 ± 2.142),the positive emotion score(22.78 ± 3.599),and the negative emotion score(24.49 ± 5.388);the depression evaluation score of the elderly in the control group(16.34 ± 3.709),loneliness score(17.30 ± 2.256),positive emotion score(21.48 ± 3.771),negative emotion score(23.43 ± 4.385).No difference in levels of depression,loneliness,positive emotions,and negative emotions before intervention between the two groups statistical significance(P = 0.625;P = 0.356;P = 0.066;P = 0.257).After the intervention,the depression evaluation score of the elderly in the intervention group(13.51 ± 4.889),the loneliness score(15.09 ± 3.032),the positive emotion score(30.09 ± 3.653),and the negative emotion score(20.31 ± 5.676);the control group's depression assessment score(16.34 ± 3.640),loneliness score(17.50 ± 2.397),positive emotion score(21.54 ± 3.795),and negative emotion score(23.96 ± 4.620).There was no significant difference in the levels of depression,loneliness,positive emotions and negative emotions between the two groups of elderly people after intervention(P <0.01).(5)Changes in quality of life before and after intervention by the elderlyBefore the intervention,the quality of life evaluation score of the elderly in the intervention group(29.65 ± 32.952);the evaluation quality of life quality of the elderly in the control group(30.11 ± 3.478).There was no significant difference in quality of life before intervention between the two groups of elderly(P = 0.462).After the intervention,the quality of life assessment score of the elderly in the intervention group was(31.98 ± 3.783);the evaluation score of the quality of life of the elderly in the control group was(29.52 ± 3.871).The difference in quality of life before intervention between the two groups was statistically significant(P = 0.001).(6)After the evaluation of the qualitative research results,the impact on the elderly,volunteers for clown care,medical staff in nursing homes,and current activities are four themes and 11 sub-themes.It has the effect of getting respect for the elderly,satisfying social interaction,and self-realization;it has the effect of increasing the emphasis on life and deepening the awareness of elderly care for nursing graduate students;it has the effect of reducing working pressure,active working atmosphere,and improving the relationship with the elderly for nursing staff in nursing homes There are currently problems of weak team strength,lack of rich themes,and insufficient performance of intervening personnel.Conclusion:(1)The clown care plan obtained through the action research method in this study is operable and practicable,and the sample size and practice place need to be increased later.But there is still room for improvement and it is not universal.(2)The clown care plan can have a positive impact on the physical,psychological,and social functions of the elderly in the nursing home,and it also has a positive effect on the medical workers in the nursing home and nursing graduate students. |
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