老年癌症患者临终关怀的护理效果

目的:探讨老年癌症患者临终关怀的护理干预措施及其效果。方法:选择32例老年癌症患者,其中综合患者及其家属的意愿及经济负担能力,分为12例临终关怀护理干预组及20例常规护理组,并探讨患者家属满意度。结果:临终关怀护理干预组患者家属满意度显著高于常规护理对照组(P<0.05)。结论:加强老年癌症患者临终关怀的护理,可显著提高患者临终生活质量,提高得患者及其家属的满意度,值得临床上推广应用。     

浅析晚期肿瘤患者的临终关怀护理

目的探讨临终关怀护理对完全肿瘤患者生命质量的意义。方法对本院收治的45例晚期肿瘤患者实施基础护理、肿瘤护理及心理护理,同时创造良好的就医环境,积极指导家属的护理方法。结果患者的身心获得了最佳的护理,人的尊严得到了最大程度的尊重,家属一致反映临终关怀护理减轻了患者及家属的痛苦。结论临终关怀护理体现了医学人道主义精神,使患者的身心病痛得以缓解,生命尊严得以维护。     

肺癌晚期患者的临终关怀

目的探讨肺癌晚期患者的临终关怀护理方法。方法对该院收治的34例肺癌患者进行临终关怀护理,包括一般护理、心理护理、疼痛护理和家属的心理支持。结果保证了患者的舒适,并减轻了患者精神上的压力,使患者基本保持了较为平稳的心态,患者去世后家属也对临终关怀护理工作表示肯定。结论临终关怀是现代化护理的重要部分,对肺癌晚期患者及其家属有重要的作用。     

探讨晚期肿瘤患者临终关怀的护理效果

目的分析对晚期肿瘤患者实施临终关怀护理的有效性。方法选取我院收治的40例临终晚期肿瘤患者作为研究对象,在征得患者及家属同意后,随机将40例患者分为观察组和对照组,每组20例;对照组行常规护理,观察组行临终关怀护理。结果两组患者在生活质量评分及家属满意度上比较,观察组明显占优(P0.05)。结论对晚期肿瘤患者实施临终关怀护理能够提升患者的生活质量及家属满意度,方法值得借鉴。     

临终关怀与护理

临终关怀是针对生命即将结束的患者及家属提供全面的心身照顾与支持的系统化护理措施。让临终患者在有限的时间内有尊严而无憾的、安详度过人生旅程的最后一站,是护理工作的一个重要方面。1 临终关怀护理的目的1.1 近年来肿瘤患者急剧增多,晚期癌症患者承受着精神、肉体、经济上的困扰和压力,作为一个特殊群体,他们是临终关怀的主要对象。虽然濒死的过程是短暂的,但是对患者及其家属的心理影响是深远的。因此,临终关怀的宗旨就是为濒死的患者及家属提供缓和性、     

老年患者临终关怀的护理体会

总结了在我科病房死亡的75例患者实施临终关怀护理体会,以期探索对临终患者的护理,使患者舒适安详地离世,患者家属得到了心理安慰.结果通过对临终患者的心理护理、基础护理、细致周到的专科护理及满足患者的生理、心理需求,对在患者实施临终关怀护理,让患者舒适安详地离世,让患者家属得到了心理安慰.     

晚期肿瘤患者临终关怀的护理效果

目的：探讨晚期肿瘤患者临终关怀的护理效果。方法：对55例肿瘤晚期患者的临终关怀护理进行回顾性分析。结果：55例晚期肿瘤患者通过给予临终关怀及相适宜的护理措施,增加了病人的舒适感,提高了生活质量,增加了患者及家属的满意度,15例死亡。结论：晚期肿瘤患者临终关怀护理能使患者减轻疾病的痛苦,并提高患者的满意度,在护理中起到关键作用。     

晚期乳腺癌患者的临终关怀护理

目的探讨晚期乳腺癌患者的临终关怀与护理,提高患者的生存质量,使患者安详的度过生命的最后阶段。方法对我科58例晚期乳腺癌患者实施临终关怀护理,针对晚期乳腺癌患者心理状况,给予基础护理,心理护理,皮肤护理,疼痛护理,营养支持,信仰护理及对家属的关怀等临终护理措施。结果通过关怀性的临终护理,减轻了患者及家属的悲痛,患者生存质量提高。结论对晚期乳腺癌患者实施临终关怀护理,既能减轻患者痛苦,又能维护其尊严,延长患者的生存时间,提高患者的生存质量。     

26例肝癌晚期患者的临终关怀护理

通过对26例肝癌晚期患者的临终关怀护理实践并总结分析得出,为临终患者提供生活照料和心理干预,为患者家属进行心理护理,可以改善临终患者的生存质量,解决家属的心理问题,提高临终关怀护理质量。     

临终关怀护理对晚期恶性肿瘤患者及其家属负性情绪的影响

目的:探讨临终关怀护理对晚期恶性肿瘤患者及其家属负性情绪的影响。方法:选取2015年9月~2017年3月我院接收的晚期恶性肿瘤患者78例,并随机将其划分为观察组与对照组,每组39例。对照组行常规护理,观察组在对照组基础上实施人文关怀。比较2组患者及家属负性情绪缓解情况。结果:观察组患者及家属SAS、SDS评分均明显低于对照组(P0.05)。结论:为晚期恶性肿瘤患者及其家属实施临终关怀护理,可明显缓解患者及其家属负面情绪。     

国际视角下安宁疗护

安宁疗护是由多学科团队为患有不可治愈疾病的临终患者及其家属提供的一项特殊的照护方式。照护团队为患者提供躯体、心理、社会、灵性的全面照护,并帮助家属减轻丧亲痛苦。国际上,转诊安宁疗护要求患者预计生存期在6个月以内,同时根据患者需求和照护目标,选择最佳照护模式。通过对安宁疗护定义、服务对象、转诊过程、服务团队和内容、实施模式进行阐述,同时对比安宁疗护和缓和医疗的异同点,有助于医务人员更好地了解和认识安宁疗护。     

国内外安宁疗护准入标准的研究进展

安宁疗护可提高患者在生命终末阶段的生活质量，减轻患者和家属的身心痛苦。科学合理的安宁疗护准入标准可帮助医护人员识别出需要安宁疗护服务的患者，使其及时获得安宁疗护服务，因此明确安宁疗护的准入标准是推进安宁疗护发展的基础。本文就国内外安宁疗护准入标准的制定方法、具体内容及优缺点进行综述，以期为我国安宁疗护准入标准的构建提供参考。     

英国和美国社区居家安宁疗护服务模式及其对我国的启示

社区居家安宁疗护服务是安宁疗护服务的重要组成部分,以社区居家安宁疗护服务为中心是安宁疗护服务发展的方向。英国与美国作为开展社区居家安宁疗护服务较早的国家,在社区居家安宁疗护服务的患者准入标准、服务团队与服务内容、经费保障等方面都积累了较为丰富的经验,也建立起了相对健全的社区居家安宁疗护服务体系。我国可适当借鉴英国和美国社区居家安宁疗护服务的发展经验,制定适合我国的社区居家安宁疗护服务的患者准入标准,加强多学科安宁疗护团队建设,将非药物疗法纳入社区居家安宁疗护服务范畴,实行按床日付费的支付方式,使疾病终末期患者能在其熟悉的环境中安详、有尊严地离世,保障其善终权益。     

韩国安宁疗护立法经验及其对我国的启示

韩国于2016年制定了《关于临终关怀·缓和医疗及临终期患者的延命医疗决定的法案》（简称《安宁疗护法》），该法明确了安宁疗护的含义与前提，规定了国家和政府在安宁疗护发展中的责任和义务，搭建了韩国安宁疗护服务体系的框架，对推进韩国安宁疗护事业发展、保护终末期患者的善终权益具有重要意义。本文通过介绍韩国《安宁疗护法》的主要内容及其实施后取得的成效，旨在为推进我国安宁疗护立法工作提供建议。我国宜明确安宁疗护的权利属性，在条件成熟时制定安宁疗护单行法，构建政府主导型的安宁疗护体系，肯定"无效医疗"的理念，并规定安宁疗护服务利用的流程，以为安宁疗护事业的改革创新和高质量发展提供全方位、精细化的法治保障，进而助力实现终末期患者的健康临终。     

Internet Use by Hospice Families and Providers: A Review

This literature review explores the current evidence related to use of the Internet by hospice patients or families and palliative care/hospice professionals. The research questions guiding this study pertain to the current Internet-based interventions in hospice and palliative care and the evidence of their effectiveness. Six studies were identified as a result of an extensive literature review. These studies included research about web-based clinical interventions for patients, and patients’, caregivers’ and hospice/palliative care providers’ use of the Internet. The majority of interventions involve accessing information via the Internet. Participants among the studies included patients, caregivers/family members, and health care professionals. Findings overall indicate effectiveness of Internet-based interventions. Both patients and professionals are using the Internet to find answers to healthcare questions, communicate, and/or deliver healthcare interventions.     

The utilization of hospice care among patients with motor neuron diseases: The experience in Taiwan from 2005 to 2010

BackgroundThe nature and extent of how patients with motor neuron diseases (MNDs) utilize hospice care in Taiwan remains unclear. This study aims to investigate the use of hospice care in Taiwan by patients with MND, and those factors that affect the extent, the cost, and the quality of their hospice treatment and care.MethodsWe analyzed data from hospice care inpatient claims of MNDs, using the National Health Insurance Research Database of Taiwan during 2005–2010.ResultsThirty patients and 58 related discharges were enrolled into our study, which consisted of 13 males and 17 females, with a mean age 58.3 years. Of that total, 27 of them (90%) had amyotrophic lateral sclerosis, and four (13.3%) had comorbid cancers; 17 died during hospice care. Acute low respiratory conditions (31.0%) accounted for the most common acute comorbidity. Noninvasive ventilation care was performed in only 13 (22.4%) of the discharges. In contrast to nasogastric intubation (40 discharges, 69.0%), no gastrostomy/jejunostomy was noted. These procedures bore no relationship to results observed in the discharges. Family physicians provided most inpatient hospice services (74.1%). Respiratory problems were the major causes of death (70.6% of decedents). The mean inpatient costs of hospice care were noticeably reduced from previously established nationwide mean costs.ConclusionHospice care can save costs for patients with terminal MNDs, and family physicians play a valuable role in caring for these patients. However, respiratory and feeding problems are prevalent, yet there are proven benefits when noninvasive ventilation care and gastrostomy/jejunostomy are promoted.     

Hospice use among Medicare managed care and fee-for-service patients dying with cancer

CONTEXT: For most patients aged 65 years or older with cancer, hospice services are uniformly covered by Medicare. Hospice care is believed to improve care for patients at the end of life. However, few patients use hospice and others enroll too late to maximize the benefits of hospice services. OBJECTIVES: Because type of insurance may affect use, we examined whether patients with Medicare managed care insurance enrolled in hospice earlier and had longer hospice stays than patients with Medicare fee-for-service (FFS) insurance. DESIGN AND SETTING: Retrospective analysis of the last year of life using the Linked Medicare-Tumor Registry Database in 1 of 9 Surveillance, Epidemiology, and End Results program coverage areas. PATIENTS: A total of 260 090 Medicare beneficiaries aged 66 years or older diagnosed with first primary lung (n = 62 117), colorectal (n = 57 260), prostate (n = 59 826), female breast (n = 37 609), bladder (n = 19 598), pancreatic (n = 11 378), gastric (n = 9599), or liver (n = 2703) cancer between January 1, 1973, and December 31, 1996, and who died between January 1, 1988, and December 31, 1998. MAIN OUTCOME MEASURES: Time from diagnosis to hospice entry and hospice length of stay for patients enrolled in FFS vs managed care plans after adjusting for patient demographics, tumor registry, year of hospice entry, and type and cancer stage. RESULTS: Of the 260 090 patients, most were men (59%), white (85%), and enrolled in FFS (89.7%). Only 54 937 patients (21.1%) received hospice care before death. Hospice use varied by type of primary cancer ranging from 31.8% of patients with pancreatic cancer to 15.6% with bladder cancer. Managed care patients were more likely to use hospice than FFS patients (32.4% vs 19.8%, P<.001). Among hospice patients, median (interquartile range) length of stay was longer for managed care vs FFS patients (32 days [11-82] vs 25 days [9-66], P<.001). After adjustment, managed care patients had higher rates of hospice enrollment (adjusted hazard ratio [HR], 1.38; 95% CI, 1.35-1.42) and had a longer length of stay (adjusted HR, 0.91; 95% CI, 0.88-0.94) vs FFS patients. Managed care patients were less likely to enroll in hospice within 7 days of their death (18.6% vs 22.6%, P<.001) and somewhat more likely to enroll in hospice more than 180 days before death (7.8% vs 6.1%, P<.001); the results for each of the 8 cancer diagnoses were similar. Hospice enrollment and length of stay among managed care vs FFS patients differed significantly by region. CONCLUSION: Medicare beneficiaries enrolled in managed care had consistently higher rates of hospice use and significantly longer hospice stays than those enrolled in FFS. Although these differences may reflect patient and family preferences, our findings raise the possibility that some managed care plans are more successful at facilitating or encouraging hospice use for patients dying with cancer.     

现代护理伦理学应用于临终护理的体会

对于一些恶性疾病,治疗已经没有意义,进行临终护理尤为重要。运用现代护理学开展临终护理工作,应满足患者及其家属的需要,充分尊重病人及其家属的选择权。在进行死亡教育时要适宜适度。在护理的过程中,还要注意与其他医务人员的沟通与协作。     

Access to palliative care and hospice in nursing homes

Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.     

国外全科医生参与居家安宁疗护实践经验与启示

安宁疗护可提高患者在生命末期的生活质量,减轻患者和家属的身心痛苦。近年来国外在该领域的发展中积累了较多的经验,且全科医生作为居家安宁疗护的主要提供者也已成为其突出特点。然而安宁疗护在我国发展起步较晚,基础建设薄弱,全科医生参与安宁疗护的研究尚处于起步阶段,面对日益增长的疗护需求,须加快安宁疗护服务体系的建设。本文通过分析、总结美国、英国和澳大利亚等国家全科医生参与安宁疗护的经验,结合我国现状和特点,提出相应的启示性建议,包括：可建立多层次的安宁疗护服务体系,辅以活动为基础的支付模式和医疗保障;制定居家安宁疗护服务指南,明确全科医生执业范围和责任划分;加强全科医生安宁疗护教育培训,提高疗护人员技能水平;利用有效宣传模式提高预立护理计划在医患双方的认知度,促进安宁疗护在我国的长足发展。