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.     

护理实习生安宁缓和医疗认知和态度的调查分析与对策

目的了解护理实习生对安宁缓和医疗的认知和态度的现状,并提出相应的对策。方法采用缓和医疗态度量表对在深圳市具有安宁缓和医疗资质3家医院实习的380名护生进行调查。结果 380名实习护生中,有12.1%和18.2%的护生认为,护士有责任为死者家属提供照护和帮助病人面对死亡;18.9%的护生能够理解临终病人的心理痛苦,认为给予临终病人精神支持是重要的;88.7%护生认为照顾垂死病人令人沮丧;85.8%护生害怕处理终末期病人,同时认为照顾的病人去世后有负罪感。结论护理实习生对安宁缓和医疗认知和态度水平较低。加强护生安宁缓和医疗知识教育和死亡教育,对提高护生对安宁缓和医疗的认识度与接受度及形成正向死亡态度具有积极的意义。     

癌症患者家庭照顾者灵性需求的研究进展

综述了癌症患者家庭照顾者灵性及灵性需求的概念、灵性需求的种类、评估工具、优先排序以及影响因素, 旨在为安宁疗护团队识别癌症患者家庭照顾者灵性需求, 开展灵性关爱提供参考。     

安宁疗护护士灵性照顾能力与伦理敏感性及共情能力的关系研究

目的 调查安宁疗护护士灵性照顾能力、伦理敏感性及共情能力现状,分析护士伦理敏感性、共情能力对其灵性照顾能力的影响。方法 采用一般资料调查表、灵性照顾能力量表、伦理敏感性调查问卷、中文版杰弗逊共情量表对230名安宁疗护护士进行调查研究。结果 230名安宁疗护护士灵性照顾能力、伦理敏感性及共情能力得分分别为(70.59±13.35)分、(35.78±6.34)分、(105.06±14.95)分,三者两两呈正相关;多元线性回归分析结果显示,是否接受过灵性教育、伦理敏感性、共情能力是安宁疗护护士灵性照顾能力的主要影响因素(P<0.01),解释总变异的88.2%。结论 安宁疗护护士灵性照顾能力与伦理敏感性及共情能力关系密切,加大灵性教育,提高护士伦理敏感性和共情能力,能在一定程度上提高护士灵性照顾能力,进而提升安宁疗护质量。     

综合医院安宁缓和护理的探索与实践

以北京协和医院为例,重点从护士在安宁缓和医疗服务中的作用、工作内容、护理实践模式、专科护理人才培养、志愿者团队建设、安宁缓和医疗理念传播等几个方面介绍综合医院开展安宁缓和医疗的护理实践,为推动安宁缓和护理在综合医院的发展提供参考。     

安宁疗护护士职业悲伤、感知医院伦理氛围对灵性照顾能力的影响

目的调查安宁疗护护士灵性照顾能力、职业悲伤及感知医院伦理现状, 分析护士职业悲伤、感知医院伦理对护士灵性照顾能力的影响。方法 2021年3—6月采用一般资料调查表、灵性照顾能力量表、悲伤体验量表、医院伦理氛围量表对青岛市第八人民医院、青岛市市立医院和青岛市中心医院(青岛市肿瘤医院)230名安宁疗护护士进行调查研究。结果 230名安宁疗护护士灵性照顾能力、职业悲伤及感知医院伦理氛围得分分别为(70.59 ± 13.35)、(37.31 ± 6.67)、(100.88 ± 21.49)分。回归分析显示, 接受灵性教育(β=0.26, P<0.05)、职业悲伤(β=-0.08, P<0.05)、医院伦理氛围(β=0.63, P<0.05)是影响安宁疗护护士灵性照顾能力的因素。结论安宁疗护护士灵性照顾能力处于中等水平, 加大灵性教育, 采取措施减少职业悲伤, 创建和谐的工作氛围能在一定程度上提高护士灵性照顾能力, 以提高安宁疗护质量。     

安宁缓和医疗中的心理及社会评估

心理社会评估是安宁疗护工作的核心内容之一.本文以北京市海淀医院安宁疗护病房开展心理社会评估的经验体会为基础,阐述了心理社会评估的意义以及有效开展评估工作的相关要点,供开展安宁缓和医疗的医护人员参考.     

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。     

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。     

肿瘤专科医院安宁共同照护模式的探索与实践

本院探索适合肿瘤专科医院的安宁疗护服务模式,形成了以安宁共同照护为主的模式,即安宁共同照护团队与原治疗团队共同提供服务,构建弹性安宁共同照护病床,协同医联体单位共建安宁疗护病床、共同照护模式。安宁共同照护服务内容包括多学科团队协同症状管理,舒适照护,灵性照护,哀伤辅导,心理、社会支持等。安宁共同照护模式的实施为终末期肿瘤患者和家属提供多元医疗决策,全病程、全方位照顾终末期患者及家属的感受,为践行安宁疗护、探索适合我国国情的安宁共同照护模式积累了经验。     

Long-term care nurses' knowledge of end-of-life care

Long-term care (LTC) facilities usually contract with hospice agencies to provide palliative (comfort) care to their terminally ill residents, yet only 1% of nursing home residents enroll in hospice care. Integrating hospice services with nursing home services presents many challenges. One of the most critical challenges is the lack of education in palliative care among physicians, licensed nurses, and certified nursing assistants in LTC settings. A study of 164 licensed nurses from 24 LTC facilities in north central Texas found deficiencies in their knowledge of palliative care. The mean score on the Palliative Care Quiz for Nursing was 12.3 of a possible 20 (62%, SD = 2.7). Implications for practice include a critical need for in-service education on end-of-life content for practicing LTC nurses and integration of such content in all curricula for future nurses.     

The worldwide palliative care alliance: networking national associations

Hospice and palliative care has a history of collaboration. National associations of hospice and palliative care are now developing across the world and have produced a new partnership, the Worldwide Palliative Care Alliance. The alliance aims to support the scale-up of services across the world and share best practice across national associations. The alliance facilitates World Hospice and Palliative Care Day and advocacy activities such as the use of the Korea Declaration. There are a number of work groups covering areas such as education and training, organizational development, and quality and standards, which aim to assist national associations and hospice and palliative care services to develop. A third worldwide summit of national associations is planned for 2007.     

Hospice care and palliative care: a perspective from experience

The establishment of the first Department of Pain Medicine and Palliative Care in a Medical Center in the United States is noteworthy. Since the design of the Department integrates a full-functioning hospice program within it, that has both a dedicated inpatient unit and extensive home care program, this Department represents a milestone in the development of the hospice movement, with full interrelationship between palliative care and hospice care. This paper will explore this interrelationship, its implications, and some of the background.     

Developing a pain and palliative care programme at a US children's hospital

Although a number of successful adult combined pain and palliative care programmes exist worldwide, integrated paediatric pain and palliative care services are rare. This article reviews epidemiology, definition, symptom prevalence and myths in paediatric palliative care. It then describes the development of the Pediatric Pain and Palliative Care Programme at the Children's Hospitals and Clinics of Minnesota, USA. This paediatric service aims to control acute, chronic and recurrent pain in all in- and outpatients at the hospitals, with follow-up at home. The team also provides holistic, interdisciplinary care for children and teens with life-limiting or terminal diseases, and their families. It is the only paediatric hospice provider in the state of Minnesota. One of the advantages of an integrated Pain and Palliative Care Programme such as the one described in this article, may be the provision of care in a continuum from acute, chronic or recurrent pain to palliative care and hospice care. This example shows, that integrated paediatric pain medicine and palliative care programmes can be successfully implemented in a children's hospital setting.     

A global update on the development of palliative care services

On World Hospice and Palliative Care Day-8 October 2011-the Worldwide Palliative Care Alliance (WPCA) launched a global update highlighting the progress that has been made in hospice and palliative care over the past 5 years (Lynch et al, 2011; WPCA 2011). Encouragingly, the study shows that there has been a marked increase in the number of countries providing one or more hospice and palliative care services-from 49% of countries in 2006 to 58% in 2011. Here we explore some of the key factors behind this progress, focusing particularly on advocacy and policy.     

Neonatal palliative and end of life care: What parents want from professionals

An inductive study of parents experiences of palliative and end of life neonatal care, which yielded rich qualitative data in the form of ‘in vivo’ quotations from parents representing real experiences. Utilizing an internet parental support forum the researcher captured and collated the responses from parents to two key questions. Initial themes were discovered following a thematic analysis and confirmed by presentation to a multiprofessional body during a series of related conference events. In addition, email responses from other parents and subsequent comments and feedback that were captured at the conference days were added to the data set.The study concluded that feedback regarding clinical practice to care providers can positively effect changes in practice evidenced by for example appropriate referrals of at least two families to a hospice team in the antenatal stage.In addition this work has contributed to the evidence base supporting the newly published Midlands Newborn Networks Integrated Comfort Care Pathway (ICCP). Work is underway to develop a care pathway to facilitate the transfer of neonates from hospital to a hospice setting to receive palliative or end of life care, therefore supporting an additional option to families within the region.     

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     

Enhancing Hungarian palliative care delivery

Palliative care has been present in Hungary since 1991. However, the development of palliative care policy has lagged behind clinical and educational activities. In 2001, a media campaign was initiated to help raise public awareness for the hospice. This campaign stimulated growth and gave us the opportunity to begin a dialogue with policy makers on financing. The Open Society Institute's Palliative Care Policy Development Conferences held in 2004 and 2005 greatly assisted the change of palliative care financing and integration of palliative care into the Hungarian National Cancer Control Program.     

Predictors of oncology and hospice nurses' spiritual care perspectives and practices.

The purpose of this study was to identify factors that predict nurses' spiritual care perspectives and practices and compare these perspectives and practices between nurses in two subspecialties. The sample included 181 oncology nurses and 638 hospice nurses who completed the Spiritual Care Perspectives Survey and a demographic form by mail. The hospice nurses surveyed used traditional spiritual care interventions more frequently and held more positive perspectives regarding spiritual caregiving than oncology nurses. However, what determined spiritual care practices and perspectives most was the spirituality of the nurse. Nurses must continue to explore how their personal spirituality contributes to their caregiving.