综合医院安宁缓和护理的探索与实践

以北京协和医院为例,重点从护士在安宁缓和医疗服务中的作用、工作内容、护理实践模式、专科护理人才培养、志愿者团队建设、安宁缓和医疗理念传播等几个方面介绍综合医院开展安宁缓和医疗的护理实践,为推动安宁缓和护理在综合医院的发展提供参考。     

高年资内科医师对安宁缓和医疗的认知及需求

目的了解北京协和医院内科医师对安宁缓和医疗的认知、态度及相关需求。方法采用便利抽样法,对北京协和医院59名高年资内科医师进行问卷调查。结果半数以上的内科医师认为自己对安宁缓和医疗的认知不足,工作年限短、多次参加缓和医疗相关讲座、阅读死亡相关书籍、接受过死亡教育的医生认知度更高(P0.05)。近半数高年资内科医师面对终末期患者感到无力,对安宁缓和医疗相关培训的需求很高。结论高年资内科医师急需安宁缓和医疗的知识和实践能力,有必要尽快为他们安排相关培训,以助提高他们面对重病、终末期患者的能力。     

安宁缓和医疗中的预期寿命评估

预期寿命评估在安宁缓和医疗的研究与实践中占据重要位置。预测过程包括临床生存预测与精算判断两部分。临床预测和预测工具是生存期预测主要方法。本文对安宁缓和医疗患者预期寿命评估的可能、意义、相关方法和影响因素进行综述,以期为临床研究和实践提供借鉴。     

安宁缓和医疗中的心理及社会评估

心理社会评估是安宁疗护工作的核心内容之一。本文以北京市海淀医院安宁疗护病房开展心理社会评估的经验体会为基础,阐述了心理社会评估的意义以及有效开展评估工作的相关要点,供开展安宁缓和医疗的医护人员参考。     

安宁缓和医疗中的灵性照顾

灵性照顾是安宁缓和医疗实践的核心内容之一。本文以中国医科大学附属盛京医院宁养病房开展灵性照顾的实践经验为基础,阐述了灵性的概念和灵性照顾的意义,以及有效开展灵性照顾的相关要点,供安宁缓和医疗从业人员参考。     

安宁缓和医疗的躯体症状评估

在人口老龄化的背景下,安宁缓和医疗的重要性逐渐凸显,它是减少生命末期患者痛苦、提高生活质量的学科。生命末期患者常常出现多重躯体症状,如疼痛、呼吸困难、乏力等。为减轻患者痛苦,医护团队需迅速对躯体症状做出准确评估。本文就安宁缓和医疗躯体症状评估的一般流程进行综述。     

我国卫生健康体系亟需缓和医疗融入

随着医疗技术的快速发展,人类的死亡过程被技术化和医学化,但因衰老和疾病而引发的痛苦仍广泛存在,缓和医疗可缓解这一痛苦过程,提高终末期患者的生活质量。我国已从立法层面将安宁疗护列入国家卫生健康体系,但缓和医疗相关国家政策仍为空白。因缓和医疗学科建设滞后,绝大多数医疗工作者仍缺乏对缓和医疗理念的认识和具体实践能力,导致我国重病、终末期患者的照护品质堪忧。缓和医疗融入卫生健康体系需逐步有序开展,通过统一定义与原则、发布国家及地方政策、倡导相关实践、开展医学生教育、发展基层缓和医疗网络、制定国家层面的发展标准,以及强调本土化发展,帮助人们在疾病终末期避免接受徒劳或失当的治疗。     

开展老年安宁缓和医疗之管见

老年人临床诊疗宗旨是维护个体功能而不是针对疾病。安宁缓和医疗对于罹患共病,失能,处于疾病末期、生存期有限的老年患者来说不可或缺。介绍老年安宁缓和医疗的特点,强调应将工作重点放在医院外,社区医务工作者应将社区初级保健和初级缓和医疗并重,该文对如何在我国发展老年安宁缓和医疗提出建议,探讨新型安宁疗护模式。     

我国麻醉医师对缓和医疗及缓和镇静的认知现状：一项全国横断面调查

目的 初步调查我国麻醉医师对缓和医疗及终末期患者缓和镇静的了解及相关临床能力。方法 2021年10—12月,采用便利抽样法,通过中华医学会麻醉学分会在全国麻醉医师中开展横断面问卷调查。问卷内容主要包括社会人口学信息、工作经验、是否熟悉缓和医疗、面对终末期患者的感受、是否给重症/终末期痛苦患者实施过缓和镇静及镇静药物选择。结果 来自全国29个省级行政单位的2536名麻醉医师完成了有效问卷,其中仅572名(22.6%,572/2536)医师表示熟悉缓和医疗。男性、有重症/终末期患者接触经历、参与疼痛临床诊疗、医院设立安宁缓和医疗组或相应部门/组织的麻醉医师更熟悉缓和医疗(P均<0.05)。超过40%的麻醉医师面对终末期患者时会感到无力、无助且对临床决策存在困惑,了解缓和医疗的麻醉医师面对重症/终末期患者时信心更足(9.8%比4.4%,P=0.001)。在734名有缓和镇静实施经验的麻醉医师中,151人(20.6%,151/734)曾仅使用阿片类药物作为镇静手段。结论 我国麻醉医师对缓和医疗及缓和镇静药物选择的认识尚不足。加强缓和医疗团队建设、开展缓和医疗及缓和镇静的教育培训或将有助于...     

急诊患者安宁疗护需求筛查工具的研究进展

在急诊开展安宁疗护需求筛查是为可能受益的患者提供早期安宁疗护服务的关键。文章对国内外现有的急诊患者安宁疗护需求筛查工具的评估内容、心理测量学属性、适用人群、应用现状等进行综述,并对不同筛查工具进行比较分析,以期为我国急诊患者安宁疗护需求筛查工具的开发和临床应用提供思路。     

Current Best Practices for Sexual and Gender Minorities in Hospice and Palliative Care Settings

Although several publications document the health care disparities experienced by sexual and gender minorities (SGMs), including lesbian, gay, bisexual, and transgender (LGBT) individuals,1e4 less is known about the experiences and outcomes for SGM families and individuals in hospice and palliative care (HPC) settings. This article provides a brief overview of issues pertaining to SGMs in HPC settings, highlighting gaps in knowledge and research. Current and best practices for SGM individuals and their families in HPC settings are described, as are recommendations for improving the quality of such care.     

What it means to be a palliative care volunteer in eight European countries: a qualitative analysis of accounts of volunteering

This paper addresses the stories of volunteers in hospice and palliative care (HPC) from eight European countries. The aims of the paper are to explore the experiences of volunteers in HPC from their insider perspective, to understand why volunteers choose to work in this field and to understand what it means to them to be involved in palliative care in this way. Stories were collected by the European Association for Palliative Care (EAPC) Task Force for Volunteering contacts in each of the eight countries. The majority of stories (n = 32) came from volunteers involved in different settings including adult patient’s homes, hospices, hospitals and care homes. Twenty volunteers were female, six were male, and ten did not give their gender. Stories were translated into English, and a qualitative framework analysis was performed. Volunteers were asked two questions: ‘What do you do as a volunteer?’ ‘What does volunteering mean to you?’ Three themes were identified from the data: (i) What volunteers do (ii) How volunteers approach their work and (iii) What working in HPC means to volunteers. The analysis revealed that common approaches to addressing and describing HPC volunteering in terms of tasks and roles could be expanded. To volunteers, it is not about tasks, but about a part of their life, the impact upon which can be significant. The results of this paper, therefore, add to the understanding of volunteers, in the sense of giving attention, being with, and of compassion as a community resource to patients and families in difficult situations. Theories about presence and presencing might have value in further underpinning this contribution to palliative care. Understanding the extent and depth of the volunteers’ experience will help to prevent the undervaluing of their contribution and increase the impact of their involvement.     

Needs assessment for palliative care: three projects compared

Needs assessment remains an inexact yet evolving field of activity in palliative care. One reason for the variable quality of needs assessments in palliative care is the pragmatic orientation that comes from limited time and resources. Consequently a comprehensive approach to palliative care needs assessment is often not achieved. One route to its improvement lies in sharing experiences about techniques and methods in conducting needs assessment studies. In this paper we offer some thoughts on our own experience of conducting needs assessment for palliative care in three separate locations within a single English health region. We describe the context in which the projects were conducted; the background and origin of each study; the aims and methods used; the research process in each case; key findings; as well as the dissemination process and impact of the work. We show some of the different forms which palliative care needs assessment can take and conclude with some general principles intended to improve practice in this challenging area of health services research.     

运用Ridit分析法制订姑息照护培训内容

目的 分析不同层次医院护士对姑息照护培训内容的共性及个性需求.方法 采用姑息照护知识需求调查表调查某市各级医院护士340名,使用Ridit分析法分析结果.结果 在共性知识需求中,重要的有24项,不重要的有26项.个性需求:一级医院对培训内容的需求主要集中为姑息照护基本概念、基础护理中的生活护理和丧亲后护理;二级医院为姑息照护概述、基础护理及疼痛护理:三级医院为放疗、化疗护理及所涉及的道德伦理观念.结论 三个级别医院的护士对姑息照护培训内容既有共性需要又各有侧重,Bidit分析法可予以区分,据此开展培训可提高培训效果.     

综合性医院护士对安宁疗护的认知现状及培训需求调查

[目的]对某三甲综合性医院的护士进行安宁疗护认知情况及培训需求调查,为医院进一步开展相关教育、提高整体护理质量提供依据。[方法]采用罗明琴等人编制的《护理人员安宁疗护知识问卷》,以问卷星的方式发放电子问卷。[结果]护士对安宁疗护的认知总评分标准分为（71.08±15.05）,在心理护理知识方面掌握良好,在基本知识掌握方面较差。而不同的性别、年龄、学历、职称、工作年限,护士对安宁疗护认知无统计学差异（P>0.05）;不同职称、不同工作年限的护士在获取安宁疗护相关知识的途径上有差异（P<0.05）;护士对于与临终病人沟通方式和应对照护临终病人所产生的情绪压力方面培训需求较高。[结论]本院护士虽然对于安宁疗护的认知程度处于中等水平,但还是需要开展有针对性的教育培训,调动护士学习积极性,探索属于中国本土化的安宁疗护照护模式。     

Hospice palliative care volunteers: a Unique Care Link

In this research, we endeavoured to gain a clearer understanding of what impact hospice palliative care (HPC) volunteers have on family caregivers and the underlying factors that contribute to this. We conducted ten face-to-face interviews with bereaved women who had previously provided care for their spouses and who used HPC volunteers. We checked our interpretation through a feedback focus group. Using a methodological hermeneutic approach, we came to understand the unique position HPC volunteers occupy within the formal health care system. Our constitutive organizing theme was manifest throughout the women's stories in seven thematic areas that explicate the dimensions of the overarching theme: the Unique Care Link. We identified seven themes that exemplify specific ways in which HPC volunteers have a positive impact on the lives of spousal caregivers. This knowledge can be incorporated into the further development of training and support programs for HPC volunteers, and to increase the quality of volunteer HPC services provided to family members.     

Palliative care in non-malignant disease: a pragmatic response

With increasing requests for palliative care provision for all patients regardless of diagnosis, professionals within specialist palliative care services and palliative care nurse specialists need to consider how they will respond. Current palliative care is considered inequitable as the majority of palliative care services do not include those with non-malignant disease. This article examines a number of issues concerning the extension of palliative care to this patient population. It considers the needs of non-cancer patients, palliative care responsibilities, resource implications, professional knowledge and responsibilities, and possible action. Recommendations include the need for further research to explore these patients' needs and the role of specialist palliative care services. Suggestions regarding how Macmillan nurses could respond to the increased demand for palliative care services are offered. Within the current financial climate, the only realistic response for the Macmillan nurse is to act as a consultant working in collaboration with other health professionals outside the palliative care specialty.     

Palliative Care in the Greater China Region: A Systematic Review of Needs,Models, and Outcomes

ContextThere is rapidly increasing need for palliative care in Greater China because of rapidly aging populations.ObjectivesThis study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China.MethodsFour databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence.ResultsNineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence.ConclusionPalliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.     

Hospital doctors' attitudes towards palliative care in Germany

Experts from different areas strongly criticize the current level of palliative care in Germany, both inpatient and home care services. Apart from the experts' opinions, little is known in this context about the perspectives of hospital doctors working in different disciplines, such as surgery, internal medicine, gynaecology or anaesthesia. These doctors presumably treat many incurably ill patients with palliative care needs, but they usually have very little experience in palliative medicine. Their attitudes are particularly important because they are affected by the criticism and by future improvement strategies. To study their viewpoints, questionnaire surveys in five hospitals in the federal state of Brandenburg were performed, with 203 (69%) physicians participating. The results showed that the level of palliative care in hospitals was graded better than in the home care setting. Main needs for improvement were seen in the psychosocial support services and in the co-operation with outpatient services. In [corrected] the hospital physicians' view, palliative nursing care was of a higher standard than medical aspects [corrected] of care [corrected] The physicians showed great interest in improving their knowledge of [corrected] palliative care and in new specialist palliative care services. The conclusions were that three main strategies for improvement should be embarked on: (1) the establishment of integrated care systems to overcome financial and structural barriers between in- and outpatient care; (2) the establishment of further specialist palliative care services (eg, hospital-based palliative care teams); and (3) better education in palliative medicine.     

Palliative care for frail older people: A cross-sectional survey of patients at two hospitals in England

Abstract

Background

The majority of deaths in the UK occur in acute hospitals, and older people have the highest hospital death rates. Improved palliative care for older people has been identified as an international priority, yet little is known about the profile of older patients with palliative care needs in hospitals.

Objective

To describe the profile of older hospital inpatients (≥85 years), and to explore the prevalence and nature of palliative care needs among this group.

Methods

A cross-sectional survey of palliative care need in older people was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Patients (or consultees) completed assessments of palliative care need.

Subjects

Data were collected for 654 consenting patients/consultees. This paper describes data from 110 patients aged ≥85 years.

Results

Forty per cent of the older patients were identified as having palliative care needs according to GSF criteria. Frailty was the most common indicator of palliative care need (16.7%). The most common reason for admission to hospital was general frailty (25.5%).

Conclusions

While this study is limited by its small sample size, the results suggest that older people with frailty conditions constitute a substantial proportion of hospital inpatients with palliative care needs. However, it is unclear whether a specialist palliative care framework is the most appropriate model for this group. The care provided to older people at the end of life may best be provided by generalists such as geriatricians, as part of a comprehensive generalist-led palliative care framework.