A survey of commitment and compassion among nurses in residential aged care

AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.     

老年血管性痴呆病人的护理

介绍了血管性痴呆病人的心理护理、饮食护理、生活护理、安全护理、皮肤护理、用药护理、并发症预防、睡眠护理、康复护理，强调全面正确的护理。可促进病人智能恢复，改善血管性痴呆病人的生活质量。     

老年血管性痴呆病人的护理

介绍了血管性痴呆病人的心理护理、饮食护理、生活护理、安全护理、皮肤护理、用药护理、并发症预防、睡眠护理、康复护理,强调全面正确的护理,可促进病人智能恢复,改善血管性痴呆病人的生活质量。     

人文关怀在优质护理服务工作中的应用

目的探讨人文关怀在优质护理服务中的运用,强化护理责任感、落实基础护理,提高护理质量,提高患者满意度。方法通过营造良好的病区环境,增强护士综合素质和主动服务的意识,夯实基础护理,提供安全的护理,实施出院后的延续护理等措施,为患者提供优质护理。结果人文关怀在优质护理服务中的运用,切实提高了护士主动服务的意识,患者满意度和护理质量得到了提高,护理纠纷减少,患者满意度由85.77%提高到97.50%(P<0.01)。结论人文关怀在优质护理服务活动中,提升了护士与患者主动沟通的能力,促进患者的恢复,达到真正意义上的护患和谐、医患和谐和社会的和谐。     

Admission and discharge guidelines for the pediatric patient requiring intermediate care

During the past three decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units being opened across the country. Many patients who are admitted to the hospital require a higher level of care than the routine inpatient general pediatric care, yet not to the degree of intensity as pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multiple disciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions but usually do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to the institution's resources and capacity in caring for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and improve the healthcare affordability for patients receiving intermediate care.     

The FOOTPRINTS model of pediatric palliative care

Little is known about the optimal context in which to provide care for the more than 53,000 children who die each year in the United States. Poor training in pediatric palliative care contributes to care that is often fragmented and may neglect the physical, psychosocial, and spiritual needs of the child and family. Pediatric hospice care is frequently not available or not chosen by the family or health care providers. In response to a critical need to move beyond the disease oriented, hospital-based model with a lack of continuity between hospital and community-based medical services, we developed FOOTPRINTS, an innovative program of advanced care planning and care coordination. A continuity physician directs the treatment plan regardless of site of care. Staff members coordinate follow up and communication among hospital and community-based care providers. Spiritual support continues through bereavement. Education in the hospital and community supports provision of excellent palliative care by current providers. Satisfaction with this model of care has been high. More than 90% of health care providers and families perceived that the child and family needs as well as the health care provider needs were met by the advanced care planning process and written care plan. All continuity providers would refer another patient. The FOOTPRINTS program promotes quality of care and family and health care provider satisfaction with care. It has been developed to serve as a "best practice" model for care at life's end.     

唑来膦酸联合放疗治疗恶性肿瘤骨转移性疼痛的护理

目的:回顾性总结使用唑来膦酸联合放疗的方式治疗恶性肿瘤骨转移性疼痛的护理要点。方法:选取我院2009年1月～2011年6月肿瘤科确诊治疗的80例恶性肿瘤骨转移的患者为研究对象,对有恶性肿瘤骨转性疼痛的患者给予唑来膦酸联合放疗治疗骨性疼痛,回顾性分析疼痛护理、用药护理、基础护理、心理护理、饮食护理、骨髓抑制护理和病理性骨折的预防及护理等多方面护理方式对患者治疗和预后的积极影响。结果:经过积极的治疗及护理,患者的恶性肿瘤骨转移性疼痛症状得到明显的改善,对所有出院患者进行调查问卷评分,患者的生活质量有显著的提高,在院期间对护理服务满意度高达97.50%。结论:有针对性的对唑来膦酸联合放疗治疗恶性肿瘤骨转移性疼痛的患者进行疼痛护理、用药护理、基础护理、心理护理、饮食护理、骨髓抑制护理和病理性骨折的预防及护理等多方面护理对患者的预后和治疗都有着积极的影响和良好的效果,值得临床推广使用。     

End-of-life Nursing Education Consortium (ELNEC) Training Program: improving palliative care in critical care

The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones.     

论中国的全科医学

全科医学是一门新兴的医学学科,其核心是提供基本的医疗保健。全科医疗模式是以全科为基本,协调各专科,为患者提供连续性和融合性的医疗的模式。中国的医疗模式原始来源于苏联的专科医学模式,缺乏基本医疗保健,医疗质量降低。中国政府认识到了全科医学的重要性,决定实行全科医学体制。全科医学模式要求理想的全科医生比例应占医生总数的50%左右,而目前中国的全科医生数只占医生总数的3%。中国的全科医生培训面临许多困难。社区医疗服务中心对推行全科医学体制是心有余而力不足。三甲医院必将充当全科医学发展的火车头才能使全科医学体制在中国实现。     

A comparison of nursing care requirements of patients in long-term geriatric and acute care nursing units

It is commonly assumed that elderly patients in long-term care facilities require less total care and less professional care than patients in active 'treatment' settings. However, no objective data have been available to support or refute these assumptions. This study examined patient classification data obtained from eight acute care medical and surgical units and four long-term care geriatric units over a 1-year period. Results indicated that geriatric patients in long-term care units had differing (as opposed to similar) nursing care needs, nursing care requirements of geriatric patients in several long-term care units differed from those of patients in another long-term care unit, geriatric patients in the selected long-term care units required at least as much nursing care as those in the medical surgical units, and the long-term care units had many patients with extensive nursing care requirements but no patients with very complex requirements when compared with the medical/surgical units. The potential impact of these findings on staffing of long-term care units is considerable. Issues relating to reliability, validity and comparability are discussed. There is a great need to utilize standardized, state-of-the-art methods for nursing workload measurement to facilitate comparisons of nursing care requirements of geriatric long-term care patients with those of patients in other areas.     

When death precedes birth: experience of a palliative care team on a labor and delivery unit

BACKGROUND: With increasing recognition and availability of palliative care, interdisciplinary palliative care teams continue to discover novel opportunities to enhance patient-centered care and improve hospital staff satisfaction. As a new palliative care consultation service in a large urban academic tertiary care setting, we found unanticipated palliative care needs on the labor and delivery unit. Women experiencing sudden intrauterine death, and the health care providers who care for them, have unique palliative care needs. CONCLUSION: In some circumstances an interdisciplinary palliative care team, may help to address acute grief and provide ongoing staff support. Case examples of our palliative care team's experience are instructive.     

District nursing and social work: palliative and continuing care delivery

The growing number of older people has seen a concomitant increase in the number of people with chronic conditions who require continuing and palliative care increasing the need for the relevant professional groups and organizations to work together. This paper reports on a multiple case study which explores the different ways that district nurses and social workers work in delivering palliative and continuing care. Each professional group operationalized their care differently across five themes: assessment, care delivery, focus of care, place of care and funding of care. The balance between care organization and care delivery needs to be addressed within emerging primary care delivery structures as primary care nursing moves towards case management for long term conditions.     

Understanding Palliative Care and Hospice: A Review for Primary Care Providers

Palliative care provides invaluable clinical management and support for patients and their families. For most people, palliative care is not provided by hospice and palliative medicine specialists, but rather by their primary care providers. The recognition of hospice and palliative medicine as its own medical subspecialty in 2006 highlighted the importance of palliative care to the practice of medicine, yet many health care professionals harbor misconceptions about palliative care, which may be a barrier to ensuring that the palliative care needs of their patients are identified and met in a timely fashion. When physicians discuss end-of-life concerns proactively, many patients choose more comfort-focused care and receive care more aligned with their values and goals. This article defines palliative care, describes how it differs from hospice, debunks some common myths associated with hospice and palliative care, and offers suggestions on how primary care providers can integrate palliative care into their practice.     

End-of-life care in the intensive care unit: a challenge for nurses.

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.     

Discharge teaching. Work strategies of patients and families for care in the home.

PURPOSE: To better understand how care givers, and their care receivers who have experienced mobility limitations over a period of time, enhance the work of care in the home. DESIGN: The qualitative method of grounded theory was used to identify work strategies enacted by care dyads consisting of informal (family) care givers and their care receivers. SAMPLE: The sample consisted of 60 care dyads. METHOD: Data was collected via semi-structured interviews conducted in the care receiver's home. After leaving the home, interviewers completed end notes describing the care situation. MAIN RESEARCH CLASSIFICATION: Nursing Research, Orthopaedic Nursing, Home Health Nursing. FINDINGS: Content analysis revealed five interpersonal and informational work strategies, used by both care givers and care receivers, to facilitate the work of care: Sharing Ideas and Feelings, Delegating, Achieving a Common Goal, Identifying Sources of New Information, and Creative Problem Solving. End note data substantiated the benefits of using these strategies. CONCLUSION: Although providing care to a family member in the home is frequently thought of as "work," few analysts have described the nature of this work or considered the care receiver as a worker. This study identified the important role of the care receiver in the work of care in the home and delineated five specific Work Strategies used by informal care givers and their care receivers to facilitate such care. IMPLICATIONS FOR NURSING RESEARCH: Ongoing research is needed for further clarification of these strategies and for development of innovative ways to teach the strategies to informal care givers and their care receivers as they prepare to live with mobility limitations in the home setting.     

Monitoring and evaluation in the special care unit: the JCAHO ten-step process

Monitoring and evaluating the quality and appropriateness of patient care in the special care unit is the basis for quality assurance activities. To make the monitoring and evaluation process helpful, health care professionals in special care units must be involved in each step of the process. The focus must be on patient care, specifically on clinical aspects of care rather than on structural specifications or technical processes. In addition to assisting the special care unit to meet accreditation requirements, ongoing monitoring and evaluation assist that unit to assure high-quality care. Monitoring and evaluation activities also assist the special care unit manager in responding to demands of state and federal regulators by providing an objective assessment of the care provided to Medicare and Medicaid patients. These activities also can provide assistance in responding to concerns about lawsuits involving alleged negligence in provision of special care; and in meeting pressures from third-party payers to reduce costs associated with unnecessary treatment in special care units. This chapter describes how the ten-step monitoring and evaluation process can be used to help assure high-quality patient care in the special care unit.     

Patterns of care in patients utilizing both primary health care and psychiatric care in a Swedish health district

Patterns of care in all patients (N = 546) establishing contact with both primary health care and psychiatric care were studied during 1984 (N = 252) and 1986 (N = 294) in a Swedish health district. Utilization of primary health care was not affected by the sectorization of the psychiatric care organization, while there was a significant increase in utilization of outpatient psychiatric care. Patients with a higher number of visits in outpatient psychiatric care had a lower number of visits in primary health care. The utilization of care was unevenly distributed in the sample; 25% of the patients accounted for almost 60% of the visits in both care organizations. The mental health problems were identified in primary health care in 40% of the patients. This group of patients seemed to be defined as belonging neither to specialized psychiatric care nor to the general practitioner level of primary health care.     

Home care nursing in Japan: a challenge for providing good care at home

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.