临终关怀之探讨

临终关怀的宗旨是减少临终病人的痛苦,增加病人的舒适程度,提高病人的生命质量,维护病人的尊严,同时对病人家属予以精神上的支持,临终关怀的实施有其必要性及迫切性。肿瘤病人的急剧增多,晚期癌症病人精神,肉体,经济上的困扰,使其成为临终关怀的主要对象,根据我国的国情,宜发展在医院内附设的临终关怀单位。在推行过程中可能遇到的社会习俗,死亡观念的影响,经费筹措困难以及医护人员本身的阻力,建议加强死亡教育,纠正     

癌症晚期病人的临终护理

癌症晚期病人经过长期的、肉体和精神的痛苦折磨后，越来越感到死亡的临近，这个时期他们更加需要医护人员的临终关怀。不能忽视他们精神、人格、心理方面存在的问题，不能单纯地把精力集中在执行医嘱、机械完成治疗操作上。医护人员要给予病人抚慰，尽量满足病人的需求，利用有限的时间去为病人争取治疗时机，减轻病人的痛苦，延长其生命，提高生命质量。     

医护人员对临终关怀知识需求的调查分析

在我国临终关怀学科还处于起步阶段，医护人员关于此方面知识了解较少。为了更好开展这项教育，对436名医护人员进行了临终关怀知识需求的调查。结果表明：医护人员对临终关怀知识明显缺乏，对开展临终关怀的认识不足，而且目前医院临终关怀服务远远不能满足患和家属的需要。被调查中对“临终关怀知识的需求”肯定的占绝大多数，反映了医护人员对临终关怀知识有自觉的要求。根据调查结果，提出应采取多种形式对医护人员进行死亡及临终关怀教育。     

我国临终关怀的存在问题与护理

临终关怀是为那些生命即将结束的病人创造良好的人际关系、舒适的环境和提供坚强的精神支持,帮助病人走完人生旅途的最后历程,并对其家属给予安慰和关怀的一种综合性卫生服务行为。在我国临终关怀存在着医护人员没有树立正确的死亡观,护理人员缺乏系统、全面的临终关怀知识,混淆临终关怀与安乐死的概念等问题。对此,作者提出对临终病人应做好重视病人的心理问题,有效地控制疼痛,给予家属心理支持及做好基础护理等措施。     

医护人员对死亡的态度及影响因素的调查分析

随着人类社会的不断进步和科学技术的迅速发展，人们的生命观发生了巨大变化，对死亡有了新的认识，人们不仅希望生活得美好，也希望在死亡到来时，能够无痛苦地走完生命的最后过程。而对临终病人生存质量的重视，促进了临终关怀学的发展。在临终关怀工作中，医护人员是直...     

医护人员对临终关怀照护态度的研究

目的:了解医护人员对病人和家属实施临终关怀照护的态度,提高临终病人和家属的生命质量,为有针对性地开展临终关怀服务提供客观依据。方法:采取分层随机抽样的方法,对一、二、三级医院700名医护人员进行有关临终关怀照护态度的问卷调查。结果:大多数医护人员具有良好的职业素质和积极的临终关怀照护态度,愿意为临终病人和家属提供照护。医护人员普遍缺乏系统的临终关怀照护知识的专业培训,缺乏与临终病人及家属沟通的知识与技巧。护士临终关怀照护态度明显比医生积极。结论:建议加强医护人员临终关怀教育,进一步改善医护人员临终关怀照护态度,促进临终关怀事业的发展。     

山东省综合医院肿瘤专业医护人员从事临终关怀意愿调查分析

目的:了解山东省综合医院内从事肿瘤专业的医护人员对开展临终关怀工作的意愿现状。方法:采用医护人员开展临终关怀工作意愿调查表,对山东省31家二级及以上医院的肿瘤科医护人员进行问卷调查。结果:在982名医护人员中,32.4%愿意从事临终关怀事业。其中愿意从事临终关怀事业原因:58.8%认为"能够体现医护人员的人文关怀价值",53.8%认为"可以帮助临终患者平静面对死亡";不愿意从事临终关怀事业原因:59.3%认为"心情会比较消极",40.5%认为"自己的知识技能水平不够"。3%的医护人员认为自己的临终关怀知识水平很高,51.7%认为缺乏临终关怀技能是"心理治疗",48.8%认为缺乏"死亡教育能力";5.8%的医护人员认为所在医院基本有条件开展临终关怀,27.2%表示医院已经开展了临终关怀服务。结论:对于选择愿意从事临终关怀工作的医护人员,提高其工资待遇是做好临终关怀工作的关键;综合医院应积极创造条件,普及开展临终关怀工作;应对不同人口学资料的医护人员进行临终关怀普及教育,加强临终关怀技能培训,特别是心理知识及死亡教育能力的培训势在必行。     

青年医护人员对病人生存权力及价值的临床思维

临终关怀是具有强烈人道主义特征,集临床医学、医学社会学、医学伦理学等多学科有关问题在内的广义医学。随着人口平均寿命的延长,生命质量的研究已为世人特别是医务人员所关注。病人生存权力与生存价值问题是近十年临终关怀的重要课题。本文通过对110名35岁以下的青年医护人员进行涉及病人生存权力及价值等问题的临床思维进行了调查分析,结果反映了青年医护人员绝大部分(81％)是注重病人生命质量,但对病人生存价值(恶性病晚期等特殊病人)问题的临床思维方面分岐较大,对特殊病人有否死亡权力一题,两种相反认识各占同等人次的39％与41％。并因各自临床思维有异而导致对精神病人的医疗护理意识及行为不同,故我们认为有关部门宜对青年医护人员进行临终关怀知识教育,使其得到正确的临终关怀知识的导向,去指导其临床思维,更好地为特殊病人进行临床性特殊关怀服务。     

癌症晚期病人的临终护理

癌症晚期病人经过长期的、肉体和精神的痛苦折磨后,越来越感到死亡的临近,这个时期他们更加需要医护人员的临终关怀.不能忽视他们精神、人格、心理方面存在的问题,不能单纯地把精力集中在执行医嘱、机械完成治疗操作上.医护人员要给予病人抚慰,尽量满足病人的需求,利用有限的时间去为病人争取治疗时机,减轻病人的痛苦,延长其生命,提高生命质量.     

浅谈癌症病人的临终关怀

1临终关怀的含义临终关怀是一种特殊的卫生保健服务,是由多学科、多方面的专业人员组成临终关怀团队,临床关怀是医护人员为当前医疗条件下尚无希望治愈的临终病人及其家属提供生理、心理、社会全面的舒适疗护。临终关怀团队的任务并不能使病人康复,而是使病人在有限的生存期间内,在充满人间温暖的氛围中,安详平和、舒适而有尊严,无憾无怨地离开人世。2临终关怀的原则2.1以舒缓疗护为主的原则当病人处于临终状态时,一般观念所强调的“治疗”已失去了意义,因为任何的治疗都不会起到疾病好转或痊愈的效果,所以对于病人临终阶段的一切处置称之为…     

Palliative medicine and the hospice movement in Taiwan

 Taiwan is an island country, with a small area and a dense population. Cancer has been the leading cause of death for over 15 years, and the number of cancer deaths is increasing year by year. The hospice movement started in 1983, and the first hospice was set up in 1990. There are more than ten hospices at present. Three foundations and one other organization have joined in with the hospice movement. The capacity of the hospice service cannot meet the needs for care. Education together with training is becoming necessary. Research is highlighted with an indigenous model. The curriculum for palliative medicine has recently been confirmed for education in the future. The Government has been a great help in the development of palliative care, and more service needs are identified. The situation with the hospice movement in Taiwan is positive and promising.     

肿瘤科护士工作疲溃感与临终关怀态度的调查与分析

目的了解肿瘤科护士工作疲溃感及其对临终关怀的态度,探讨工作疲溃感与临终关怀态度之间的关系。方法对某肿瘤专科医院的91名护士进行问卷调查,内容包括对临终关怀的态度和行为、Maslach工作疲溃感问卷（MBI）等。结果肿瘤科护士情绪耗竭得分高于常模,个人成就感低于常模;分别有48．3％,34．1％和62．6％的人在情绪耗竭、去人格化和个人成就感方面处于高度疲溃;临终关怀态度与行为呈正相关,工作疲溃感与临终关怀态度和行为存在负相关。结论有必要对肿瘤专科医院护士进行死亡及临终关怀知识的教育,重视工作疲溃感对其临终关怀态度和行为的影响,促进临终关怀工作的深入开展。     

Keeping the hospice spirit alive in client satisfaction surveys

Funding bodies and accreditation organizations now demand objective data from hospice evaluations, and quantitative measures assessing outcomes. This is despite the fact that the goals and outcomes of hospice practice are not reductionist and are not easily quantified. One alternative to this bureaucratic challenge that does not necessitate compromise to hospice ideology is to develop an assessment tool through qualitative research using phenomenological data on carers' insights with regard to hospice practice. In this article, the findings from the qualitative research that preceded the development of the assessment tool provide an insight into the key issues that carers give priority in evaluating a hospice. These findings provide valuable baseline data for understanding aspects of hospice practice that are valued by carers. The information gathered is a significant affirmation of the success of the hospice ideology and highlights the need to protect this precious philosophy. In short, it is an important statement about the need to keep the hospice spirit alive in client satisfaction. The findings from the qualitative study for the questionnaire can be interpreted as an affirmation to hospice workers that their vision and beliefs are valued and appreciated by those they serve.     

Hospice use before death: variability across cancer diagnoses.

BACKGROUND: There is little information available about patterns of hospice use before death for patients with a diagnosis of cancer. OBJECTIVE: To examine whether rates of hospice use before death are different for persons dying of specific cancers or vary across age, sex, or racial groups. METHODS: Information about cause-specific hospice use received by elderly Medicare beneficiaries was obtained from Medicare hospice administrative (claims) data. Information regarding cause-specific numbers of deaths was obtained from the National Center for Health Statistics. Rates of hospice use were calculated using direct standardization adjusted for age, sex, and race. Length of stay in a hospice was calculated as the median number of days between entry into the hospice and death. RESULTS: Rates of hospice use before death ranged from 42.0 hospice users per 100 deaths for breast cancer to 48.1 hospice users per 100 deaths for pancreatic cancer. Across all cancers, blacks received approximately 82% of the hospice use as nonblacks. Men entered hospices at almost the same rate as women (overall male-to-female ratio = 0.97). Median length of stay in a hospice ranged from 21 to 27 days. CONCLUSIONS: A great deal of consistency was observed regarding hospice-use rates across cancer diagnoses. This consistency is greater than might be expected given differences in prognosis across cancers. The results suggest that there may be greater than previously predicted consistency across end-stage cancer patients in the ability to determine prognosis or patient preferences for hospice services.     

The positive impact of hospice care on the surviving spouse

The study discussed here examined the possible indirect benefits of hospice care for older adults whose terminally ill spouses received hospice care. Surviving spouses whose husband/wife received hospice care had lower mortality rates 18 months after the spouse's death compared to older adults whose spouse had not received hospice care. The impact was larger for bereaved wives and the effect was statistically significant. The results illustrate that hospice care benefits patients and their spouses thereby mediating the effects of caregiver burden and the widow/er effect.     

Spaces and Silences

Abstract

Background

There is a paucity of studies which explore palliative care patients’ involvement in research. The involvement of patients with a life-limiting illness in research raises numerous ethical concerns for researchers keen to take account of their views and experiences of service provision. Assumptions are readily made about whether participation is appropriate for this patient group due to their perceived vulnerability.

Aim

To explore the views of hospice users regarding their motivations for taking part in a study, designed to inform the delivery of care, and ensure ongoing service improvement.

Methods

Based on a larger pilot study to examine patients’ satisfaction with hospice care, and using a qualitative interview approach, twenty-one patients under the care of three hospices in the Auckland region of New Zealand took part. Interviews were recorded and transcribed verbatim. Data were analysed using a thematic analysis technique.

Results

The involvement of hospice users in research is important and has the capacity to produce a diverse, but significant impact on those involved. Not only does their involvement demonstrate the potential to shape service provision, it also reveals the therapeutic benefits to individuals with a life-limiting illness of simply taking part. Of particular importance is the view that participation enables a sense of personhood to be maintained circumventing the potential of a ‘social death’. Unless they are unable to consent, palliative care patients should be regarded as autonomous individuals and given the opportunity to participate in research.     

Honing an advance care planning intervention using qualitative analysis: the Living Well interview

Advance care planning requires an explicit and comprehensive discussion of patient values and conceptualization of quality of life. The Living Well open-ended interview intervention was developed to help patients and their health care agents to engage in a meaningful discussion of values so that decisions made in the last year of life are made with the patients' values in mind. We used qualitative and quantitative analysis to streamline this 10-question interview, and to generate hypotheses for future research. Interviews with 52 terminally ill patients were coded according to methodological weaknesses and content (support, spirit/feelings, palliative care, and quality of life). Node analysis revealed that three primary and three backup/probe questions yielded information that minimized misinformation, sampled from all four content areas, led to discussions of importance for good planning and decision-making, and may have led to earlier hospice admission than the national average. Two emerging themes, Generativity (passing on values or assets to the next generation) and essence (simple pleasures in everyday life), and were then quantitatively analyzed. People who mentioned generativity tended to be older, had a longer length of hospice stay, and a longer time to death after interview, compared to those who did not mention the theme. People who mentioned essence also tended to be older, but tended to have a shorter length of hospice stay and a shorter time to death after the interview. We conclude that this interview may improve access to hospice, and that generativity and essence are worthwhile themes for future research.     

Dignity,Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death

The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.     

199名安宁疗护护士职业悲伤现状及影响因素分析

目的 调查安宁疗护护士职业悲伤现状,并分析其影响因素.方法 采用便利抽样法,于2021年7—8月在广州、上海及北京设立安宁疗护病房或开展安宁疗护服务的6所医院、4所社区卫生服务中心和2家养老机构选取199名安宁疗护护士作为研究对象.采用一般资料调查表、修订版悲伤体验量表、护士安宁疗护知识量表、安宁疗护照护态度量表、心理...     

Nurses and health support workers' views on cardiopulmonary resuscitation in a hospice setting

This paper reports on a study which took place in a 15-bed hospice and provides an account of the views of registered nurses (n = 12) and health support workers (n = 10) in relation to cardiopulmonary resuscitation (CPR) within a hospice setting. The study was part of a larger ethnographic research project being conducted in the hospice when the British Medical Association/Royal College of Nursing and the Resuscitation Council UK (Resuscitation Council UK, 2001) published guidelines urging all establishments that face decisions about attempting CPR to develop local policies. The guidelines provided the impetus for the present study, the aim of which was to explore staff responses to the introduction of a CPR policy in the hospice. Semi-structured interviews were conducted on a purposive sample of hospice staff. The findings raise issues about the implementation of CPR in a context where it was felt that the patient should be allowed to die a natural death.