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.     

以评估为基础开展安宁缓和医疗实践

安宁缓和医疗在我国刚刚起步,迫切需要结合各个地区的实际情况来开展相关实践.确认安宁缓和医疗的服务内容,有效评估患者的预期寿命、评估患者"身、心、社、灵"各方面的需求,根据不同的需求给予合适的干预,是开展安宁缓和医疗实践的关键.恰当的评估可有助于高效开展安宁缓和医疗工作.     

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.     

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。     

生命的终曲音乐治疗与安宁缓和医疗

音乐治疗在缓和医疗与临终关怀领域中的应用已被许多国家认可.人类自胎儿期听觉开始发育后,就能接收到来自自己、母体以及外界各种声音的刺激,即便至生命的最终,听觉也通常是最后丧失的功能.对于临终患者而言,在面对死亡的过程中承受着身体与心理的巨大挑战.音乐治疗中将音乐作为一种治疗的媒介工具,通过专业、科学的方式进行治疗干预,协...     

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。     

三级医院院内缓和医疗会诊服务实践探讨

在缓和医疗理念逐渐为更多人知晓的时候,各级医疗机构如何将这个一理念顺利引入实践是很多医护人员迫切关注的问题.笔者结合自己在三级综合医院的实践,分析了开展院内缓和医疗会诊所需具备的条件和遇到的困难,希望能够为临床实践提供借鉴和参考.     

濒死患者及家属心理状态调查与临终关怀护理

目的：探讨让濒死患者无痛苦、舒适、平静、安详、尊严离世的方法。方法：对120例濒死患者及家属心理状态进行分类,护理过程中给予相应的身心护理及临终关怀护理。结果：120例濒死患者在生命的最后时刻全部安祥、平静、尊严的故去,获得患者及家属的认可。结论：在生命最后时期,让患者获得医疗、心理、生活护理等全方位的特殊关爱,使生命质量得以提升。     

西南少数民族地区人群离世地点的选择与影响因素调查

目的 调查中国西南少数民族地区居民对于离世地点的选择及其影响因素,为推进中国安宁疗护服务提供参考.方法 采用自行设计问卷在西南地区进行方便抽样调查,收集受调查者的一般资料,对不可治愈疾病的救治意愿,以及对离世地点的偏好.结果 收回有效问卷3950份.3950例调查对象中,男性2170例(54.9％);1815例(45....     

Supportive palliative treatment,psychological care and the hospice movement in Hungary

The authors summarize the developments that have taken place in supportive care in Hungary over the past 20 years. Special emphasis is put on psychological care and care for the terminally ill.     

Ethical dilemmas in hospice and palliative care

In order to understand some of the ethical dilemmas that face hospice programs in the United States, one must understand the Medicare Hospice Benefit, which is the model by which hospice programs provide palliative care to terminally ill patients in the United States. Unlike palliative care programs outside the United States, patients must have a prognosis of 6 months or less to receive hospice care under the Medicare Hospice Benefit. Care is reimbursed on a per diem basis, and inpatient care is restricted to pain and symptom management that cannot be managed in another setting. Ethical dilemmas that face physicians referring patients to hospice programs include the ability of clinicians to predict accurately a patient prognosis of 6 months or less, and to what extent hospice programs and clinicians are obligated to provide patients with full information about their illness, as the Medicare Hospice Benefit requires that patients sign an informed consent in order to elect the hospice benefit. There are ethical dilemmas that affect day-to-day patient management in palliative care programs including physician concern over the use of morphine because of possible respiratory depression in the advanced cancer patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat near the end of life, and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. By following current research dogma, and only considering patient-generated data as valid, the patient population that most needs to be studied is excluded. A new methodology specifically for palliative care research is needed to provide information on the patients who are cognitively or physically impaired and unable to provide input regarding their needs near the end of life.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Cognitive assessment of palliative care patients

Cognitive impairment is prevalent among cancer patients receiving palliative care. It affects both clinical management and research with these patients. Cognitive impairments can often be reversed by appropriate therapeutic intervention, but many cases of cognitive impairment among palliative care patients will remain undetected by clinical staff unless formal assessment is conducted. Selection of an appropriate method of assessment should be guided by the goal for which assessment is undertaken, the ways in which the special characteristics of palliative care patients constrain the gathering of information, the type of information and the scale of measurement required, the validity, reliability and standardisation of the tests available, and the significance attached to test outcomes.

A wide variety of methods for assessing cognitive competence is available. They differ in the type of information provided, the scale of measurement, and the breadth of the skills assessed. Each is most suitable for particular purposes. The variety ensures that cognitive performance can be assessed in palliative care patients despite constraints imposed by budgets, limited relevant staff expertise, and patient characteristics.     

对临终关怀期患者家属心理支持的探索

我国已经加速进入老龄化社会，与之相适应的医疗养老卫生服务的需求也大大增加。介于昆明市社会福利院福利医院"医养结合"的性质和"生物-心理-社会"现代医学模式理念，心理科开展了临终关怀的临床实践。对于老年患者的躯体疾病的支持治疗是主要医护服务，同时对患者家属的心理支持也是工作的重要部分。经过临床心理科医护人员长期的临床工作，总结和发展出的适合临终老年患者家属的心理支持服务，逐渐探索形成了比较成熟的模式和经验，得出如下结论：对临终关怀期患者家属的心理支持非常具有必要性、可行性和重要性，能有效的提高临床服务水平和医患沟通的满意度。同时为了促进临终关怀服务的发展，临终关怀服务需要医学、护理学、心理学、社会学、法学、伦理学、教育学等多学科的共同参与。     

临终患儿居家临终关怀方法的研究

目的 探讨临终患儿的居家临终关怀护理方法.方法 对58例临终居家患儿采用个性化的临终护理计划和临终关怀方式,采用调查问卷对相关指标进行调查,并对结果进行分析.结果 在居家临终关怀中,家长对患儿疼痛管理和症状护理的满意度最高.不同学历的家长,在临终关怀中对心理支持,游戏娱乐支持和死亡教育这3项上,认同程度有显著的差异.通过居家临终关怀,家长的焦虑、抑郁心理得到显著的缓解.结论 开展个性化居家临终护理,能够提高临终患儿的生活质量,改善家长的不良情绪,值得推广.     

Pulse oximetry in supportive and palliative care

Pulse oximetry is a valuable, non-invasive method used for estimating oxyhaemoglobin saturation. It can give a bedside indication of the oxygenation and thus provide a valuable insight into the cause of breathlessness. Its use can help palliative care teams to determine the need to prescribe or to withhold oxygen therapy. The technology is well established and relatively inexpensive. Factors that influence readings include low perfusion states at the end of life. With a thorough understanding of its uses and limitations, pulse oximetry can assist multi-disciplinary teams in providing better care to ill patients in the palliative care setting.