人文护理模式在社区舒缓疗护中的实践

目的：探讨人文护理模式在社区舒缓疗护护理中的实践效果。方法：对入住社区舒缓疗护病区的61例癌症临终患者实施人文护理模式,即营造人文服务环境、倡导人文服务模式、丰富人文服务内涵。效果：临终患者的心理状况改善、满意度及生命质量提高。结论：通过护士实施人文护理模式,减轻了临终患者的身心痛苦,提高生命质量。     

闵行区某社区舒缓疗护病房服务效益评价

目的:评价闵行医某社区开展舒缓疗护住院和居家服务的服务效益.方法:对该社区2014-2015年接受舒缓疗护住院病房和家庭病床服务的68名晚期恶性肿瘤患者进行住院费用分析和服务效益评估,比较服务前和服务2周后患者疼痛水平、焦虑状况和抑郁状况的变化.结果:研究对象平均住院日24.1天,人均费用2726.76元,日均费用116.48元.服务前和服务后,研究对象的疼痛水平、焦虑状况和抑郁状况差异比较有统计学意义(P＜005).讨论:社区舒缓疗护住院和家庭病床服务,能有效减轻肿瘤晚期患者的痛苦,提高其生活质量,且费用低廉.     

晚期癌症患者及家属舒缓疗护接受度调查分析朱菁菁 朱彤华 徐卉 唐清

【】 目的 调查晚期癌症患者及家属对舒缓疗护的接受度及影响因素 ,为有针对性的舒缓疗护服务提供理论依据。 方法 应用自行设计的一般资料及舒缓疗护服务接受度调查表对门诊晚期癌症患者50例及其陪伴家属76名, 以问卷方式进行调查。 结果 66.0％的晚期癌症患者愿意接受舒缓疗护、27.6％的患者家属愿意接受舒缓疗护。 结论 为晚期癌症患者及家属提供舒缓疗护服务还存在认知偏差,主要是忌讳“临终”和讨论“死亡”,尤其是患者家属的认知,为了更好地为晚期癌症患者及家属该类人群服务,应积极开展死亡教育活动。     

护士进行居家安宁疗护服务体验质性研究的Meta整合

目的系统评价护士进行居家安宁疗护服务体验的质性研究, 为提高居家安宁疗护服务质量, 完善该护理服务体系提供依据。方法计算机检索Cochrane Library、PubMed、Web of Science、EBSCO、Medline、中国知网、中国生物医学文献数据库、万方数据库、维普数据库中关于护士进行居家安宁疗护服务体验的质性研究文献, 检索时限为建库至2022年4月1日。采用澳大利亚循证卫生保健中心(JBI)质性研究质量评价标准(2016)进行文献质量评价, 运用Meta整合方法对结果进行汇总分析。结果共纳入9篇文献, 提炼出23个研究结果, 归纳为8个新类别, 形成3个整合结果:护士认可开展居家安宁疗护服务的意义;护士提供居家安宁疗护服务时正负性情绪并存;实施居家安宁疗护服务所面临的挑战。结论居家安宁疗护服务的开展有助于为临终患者提供连续性照护并提高其临终生命质量, 但同时应进一步提高护士的居家安宁疗护服务能力并完善相关政策保障, 以促进我国居家安宁疗护事业稳步发展。     

居家安宁疗护服务模式概述及发展思考

居家安宁疗护是安宁疗护服务的主要模式。本文在介绍、比较国内外常见居家安宁疗护服务模式的基础上，提出对我国居家安宁疗护服务发展的思考，包括融合多种居家安宁疗护模式、探索城乡二元服务模式、建设区域智慧平台等，旨在促进我国本土化居家安宁疗护服务模式建设与发展，为相关临床实践与研究的开展提供参考。     

舒缓疗护在社区居家晚期肿瘤病人中的应用

[目的]探讨舒缓疗护对社区居家晚期肿瘤病人护理干预效果。[方法]选择上海市某社区卫生服务中心某居委会管辖内的晚期肿瘤病人50例为研究对象,通过建立居家舒缓疗护"蒲公英护理团队",评估病人及家属需求,根据需求每月提供1次或2次上门个体化护理,每周1次电话随访,为期6个月。运用舒适度调查表、团队服务满意度调查表及家属焦虑自评量表(SAS)对研究对象进行服务前后效果评价。[结果]护理干预后晚期肿瘤病人舒适度提高(P0.05),家属焦虑程度下降(P0.05),对蒲公英护理团队的服务满意度达到100.00%。[结论]对社区晚期肿瘤病人开展居家舒缓疗护能有效提高晚期肿瘤病人舒适度、减轻家属焦虑程度、提高病人生活质量。     

癌症临终病人尊严维护影响因素的现象学研究

[目的]从护士视角深入了解癌症临终病人尊严维护的影响因素。[方法]选取上海市13家社区卫生中心舒缓疗护机构的护士,采用质性研究的现象学研究方法,对18名护士进行半结构式访谈并进行资料分析。[结果]癌症临终病人尊严维护的影响因素析出6个主题和2个亚主题,依次为理念冲突(民众理念,照护者理念)、疼痛控制、医院环境、人力配置、病情告知、尊严感知。[结论]目前已开展的舒缓疗护服务在开展过程中存在诸多阻碍性因素,深入了解这些阻碍因素,可为舒缓疗护服务真正实现维护癌症临终病人尊严提供参考依据。     

应用Delphi法构建社区舒缓疗护准入标准

目的应用Delphi法构建社区舒缓疗护的架构,体现国内舒缓疗护的服务特点,确立舒缓疗护的准入标准。方法通过文献回顾研究法并根据研究主题遴选28名专家进行两轮Delphi专家咨询。于2014年9—11月采用自制的问卷进行电子邮件征询调查,主要包括专家基本情况;舒缓疗护准入标准,其中一级指标5项(服务对象、状态评估、社会心理、症状与体征及多维评估),二级指标18项和三级指标49项;专家对问卷内容熟悉程度评价表。结果两轮函询问卷回收率均为100%,专家的积极性好,权威程度处于较高水平,专家的协调程度良好。完善后的舒缓疗护准入标准共确立一级指标5项、二级指标21项、三级指标61项。结论应用Delphi法构建的社区舒缓疗护准入标准,筛选的条目符合社区舒缓疗护切合实际,可为我国社区开展舒缓疗护提供借鉴和参考。     

医联体视域下“医院-社区-居家”安宁疗护服务模式的探索与实践

目的 ：探索构建医联体视域下“医院-社区-居家”安宁疗护服务模式并运行实践,以促进本地区安宁疗护学科发展。方法 ：通过明确医联体内各级医疗机构在安宁疗护实践中的功能定位,组建安宁疗护多学科团队,在医联体视域下逐步构建形成“医院-社区-居家”安宁疗护服务模式。在此过程中,通过安宁疗护服务同质化管理、转介管理、科普宣传等方式,推动该服务模式的运行。结果 ：目前在医联体范畴内共有18家医疗机构,其中的三级医院、二级医院、社区卫生服务中心均有1家已开展安宁疗护服务,累计服务1.21万余人次,“医院-社区-居家”双向转介100余人次;累计培训5 200余人次。结论 ：构建的医联体视域下“医院-社区-居家”安宁疗护服务模式切实可行,可为推进区域内安宁疗护协同发展、探索构建适合我国国情的安宁疗护服务模式提供参考。     

综合肿瘤科安宁疗护病床的建立与运行模式探讨

目的 探讨综合肿瘤科安宁疗护病床的建立与运行模式,为中国安宁疗护的发展模式提供新的思考,以期为普及安宁疗护理念,推行安宁疗护病床起示范借鉴作用。方法 结合医院优势与科室自身特点,注重安宁疗护病房的基础设施建设和专业团队人员培训,通过明确组织构架和职责,开展安宁疗护相关知识培训,制定工作制度,确立准入标准、服务原则、服务内容、服务流程、质量监控等,逐步确定安宁疗护病床模式。结果 在安宁疗护团队的努力下,通过不断的理论循证和临床工作总结,进一步补充和优化模式,使得综合肿瘤科安宁疗护病床的工作取得了一定的成效。结论 综合肿瘤科安宁疗护病床的建立与实施,让临终患者及家属得到了全方位照护,同时提升了医院的服务品牌。团队通过探索也发现存在问题,如医疗保险制度的尚待完善,医联体转接不流畅和居家照护薄弱,终末期患者接受安宁疗护比例较少等,这些对病房的建立与运行提出了挑战。     

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants’ accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.     

The SAMOT supportive care programme in Southern Italy

Since 1988 a palliative care programme has been in development in Palermo, a large town in Southern Italy. The main objective is to provide home palliative care in conditions in which no other facility exists to meet the needs and reduce the distress of terminal cancer patients. This programme has been implemented and extended to other cities and villages in Sicily. A team composed of physicians, nurses, social workers and volunteers looks after patients at home.This model has been recognized as highly effective. The activities, the problems related to the development of such programme, including those concerned with the sociocultural environment and the family doctor, the needs of specific hospital departments, and the scientific and educational activities, are pointed out.     

“一专多能”医护整合模式在家庭医生责任制服务中的探索

【】: 目的 评价“一专多能”医护整合模式在本社区家庭医生责任制服务中的效果,探索社区家庭医生责任制服务中个体化的慢病特色服务和社区适宜技术推进新模式。方法 自2017年1月在“1+1+1家庭医生团队”签约的基础上,本中心组建了糖尿病、高血压、脑卒中、腹膜透析、社区压力性损伤、PICC维护六大领域的专科医护整合团队,目的为每个家庭医生团队这六大领域中高危签约居民通过专科医护整合团队进行个体化的干预,从疾病专科诊疗、专业性的健康咨询、针对性的健康照顾、权威性的健康指导和持续性的健康关怀和社区适宜新技术推进。结果 以“一专多能”医护整合团队在一年中的干预,慢病患者中的糖尿病护理门诊教育和高血压自我管理同伴教育,对改善血压、血糖效果明显(P<0.05)；四大适宜技术的并发症率明显减低、治愈率和普及率明显提升(P<0.05)。结论 “一专多能”医护整合团队在家庭医生制服务中的模式得到同行认可和居民的肯定,四大社区适宜技术真正做到方便百姓,惠及居民。     

Managing family centered palliative care in aged and acute settings

This paper reports on the management of family centered palliative care in different aged care and acute Australian inpatient settings, following the integration of palliative care with mainstream services. Eighty-eight semistructured interviews were conducted and 425 questionnaires (Palliative Care Practices Questionnaire--PCPQ) were returned, completed from 12 regional and metropolitan locations. Transcribed interviews were analyzed using QSR NVivo and mean PCPQ scores from the four settings were compared. Scores on items from the PCPQ related to family centered care confirmed the analyses. Interviews revealed that factors contributing to the level of support for families offered in the various settings included the core business of the unit; the length of stay of the patients or residents; the acuity or symptom burden; and the coordinated involvement of the multidisciplinary team. Strategies for improving supportive family care are proposed.     

专业人员对开展居家姑息照护服务内容必要性的认知调查

目的 针对晚期癌症患者家庭,探讨开展居家姑息照护服务具体内容的必要性。方法 采用自制问卷调查法,对64名社区专业人员和57名三级医院肿瘤科专业人员就开展居家姑息照护服务具体内容必要性进行了调查。两组研究对象平均年龄分别（39．02±10．66）岁、（29．82±5．36）岁;两组在年龄、工作时间、受教育水平均存在差异（P〈0．01）。结果 社区及医院医护人员均以女性为主;两组均积极支持社区开展姑息照护;在对姑息照护熟悉度方面,医院组以熟悉为主,社区组则以了解为主（χ^2=54．55,P〈0．01）;在对社区卫生熟悉度上,社区组以熟悉为主,医院组以了解为主（χ^2=21．31,P〈0．01）。两组在除气管切开护理、胸腹腔抽吸积液、协助处理善后事宜外的28项服务内容认为有必要开展的专业人员所占比例都在79％以上,两者在7项项目上差异有统计学意义（P〈0．05）。结论 社区组与医院组整体上认为有必要开展31项服务内容,但在部分具体内容上意见相左。提示在制定居家姑息照护服务内容相关政策和将其付诸实践时,要综合社区与医院肿瘤专业人员两者的意见。     

Palliative care for patients with cancer: district nurses' experiences

AIM: This paper reports a study exploring district nurses' experiences of providing palliative care for patients with cancer and their families. BACKGROUND: There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experiences in palliative care. METHOD: A Husserlian phenomenological approach was adopted with a purposive sample of 25 female district nurses. Data were collected using unstructured, tape-recorded interviews and analysed using Colaizzi's seven stages of data analysis. FINDINGS: Four themes were identified: the communication web; the family as an element of care; challenges for the district nurse in symptom management and the personal cost of caring. CONCLUSIONS: District nurses' experiences of providing palliative care to family units was challenging but rewarding. The emotive nature of the experience cannot be under-estimated, as many district nurses were touched by the varying situations. Whilst acknowledging the need to maintain an integrated approach to care, district nurses should be identified as the key workers in the complex situation of palliative care.     

A model long-term care hospice unit: care, community, and compassion

The purpose of this study was to investigate the factors that influenced the quality of care of terminally ill nursing home residents on a hospice unit in a city and county long-term care facility. The findings disclosed that the hospice team had created a cultural environment in which care, community, and compassion were the predominant components of their philosophy of palliative care. Communication at all levels-among staff, family, friends, and residents-was found to be a core hospice value, essential to community development. The results of this study illustrate that exemplary palliative care can be provided when an interdisciplinary team is dedicated to creating an environment where the principles of palliative care can be fully implemented. The authors conclude that there is a developing role for geriatric nurses to participate in further defining and providing palliative care for older people in their homes, hospitals, nursing homes, and residential care.     

Dignity Therapy for older people in care homes: a qualitative study of the views of residents and recipients of ‘generativity’ documents

Aim. To report the findings of a study exploring the views and experiences of care home resident’s family on Dignity Therapy. Background. As the proportion of older people dying in care homes increases, it is important to enhance their dignity, reduce distress at the end‐of‐life, and provide bereavement support to their families. Pilot studies show that hospice patients and care home residents feel Dignity Therapy had or would help their families; however, there are no qualitative studies of their views. Design. Qualitative exploration. Methods. Qualitative interviews were conducted between January 2009–March 2010 with 14 family members of care home residents who had received Dignity Therapy. The Framework approach to qualitative analysis was used. Findings. Four categories are reported: views on the document: impact on residents; impact on family; and potential impact on care homes. While contact with the therapist provided much needed company for residents, Dignity Therapy helped residents reappraise aspects of their lives positively, while enjoying the opportunity to reminisce. Concerns focused on resident’s anxiety over document content. Memory problems and perceived lack of distress in some residents were viewed as factors affecting delivery and impact of Dignity Therapy. Family discovered new information and were prompted to discuss the content with them. For bereaved family members, documents provided comfort during their grief. If made available to carers, documents could enhance care delivery in homes. Conclusion. Family members felt Dignity Therapy had helped them and the residents. Findings suggest that Dignity Therapy may be useful for enhancing the end‐of‐life experience for residents and their families.     

Supportive and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service

OBJECTIVE: To obtain feedback from families of children receiving palliative and supportive care about their care needs in hospital and in community settings. DESIGN: A two-phase combined quantitative and qualitative study. SETTING: Western Australia. PARTICIPANTS: 134 parents and 20 service providers. RESULTS: Analysis indicated the concept of palliative care is poorly understood by health professionals and by parents. Many families are affected emotionally, financially and physically by the burden of caring for children with life threatening or chronic conditions requiring complex care at home. Parents indicated the need for clear and honest information about their child's condition and prognosis throughout the trajectory of illness and perceived this had been lacking. Families required financial and practical assistance with providing care from their children at home. Parents also wanted more practical resources and information to assist with the management of their child's nutrition and pain, as well as support for their other children. The level of respite (in home and residential) was perceived to be insufficient and inequitable. Parents also required access to, and advice from, multidisciplinary health professionals when caring for their child at home. There was a perceived lack of coordination between community services and the hospital. CONCLUSION: Education of health professionals and parents regarding the concepts and introduction of palliative and supportive care is required. Care for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and linked and integrated with the treating hospital in collaboration with community services. More inclusive criteria are required for community services including practical aids and respite care.