延续护理对改善老年压疮高危患者照顾者居家护理行为的研究

目的探讨医院联合社区的延续护理模式,对改善社区老年压疮高危患者照顾者居家护理行为的效果。方法根据压疮高危患者入院顺序按照随机数字表分为干预组35例与对照组33例。对照组采用常规治疗及护理,干预组采用医院联合社区的延续护理,具体措施包括构建压疮管理网络,成立压疮管理督导小组与随访小组,建立信息沟通交流平台,对随访小组人员进行相关培训并考核,患者出院后由随访小组成员按要求随访,对照顾者照顾行为进行评估及指导。结果 3个月后照顾者照顾行为得分干预组明显高于对照组(P0.05),干预组患者压疮发生率明显低于对照组(P0.05)。结论医院联合社区的延续护理模式有利于改善照顾者照顾行为,降低压疮高危患者压疮的发生率。     

延续护理在压疮高危病人中的应用效果评价

[目的]探讨医院联合社区的延续护理模式在老年压疮高危病人中的应用效果。[方法]将156例住院压疮高危病人随机分为两组,观察组76例,对照组80例。对照组采用常规治疗及护理,观察组采用医院联合社区的延续护理,具体措施包括建立压疮管理网络,成立皮肤管理小组,对小组人员进行专业知识培训和考核,病人出院后按要求随访,对照顾者照顾行为进行评估及指导。比较两组照顾者干预前后压疮相关知识、翻身技能、照顾行为得分、病人出院1个月后Bradeny压疮危险因素评分、病人出院2个月后压疮治愈率及总有效率。[结果]观察组照顾者出院2个月后相关知识水平与相关技能水平高于对照组(P0.05);两组病人出院1个月后在感觉、活动方式、活动能力、营养摄取比较,差异无统计学意义(P0.05),而潮湿度、剪切力/摩擦力和总评分升高,两组比较差异有统计学意义(P0.01);观察组出院2个月后压疮治愈率、总有效率高于对照组(P0.01)。[结论]医院联合社区的延续护理模式,改善了照顾者的行为,提高了压疮高危病人治疗效果,提高了病人的生活质量。     

内科压疮高危病人出院后延续性护理效果评价

[目的]对内科压疮高危病人出院后延续性护理的效果进行评价。[方法]选择164例内科压疮高危病人及其主要照顾者分为干预组和对照组,对照组采取常规出院健康指导,干预组在常规出院指导的基础上进行延续性护理,出院后6个月,比较两组压疮高危病人的压疮发生率,以及干预组病人主要照顾者出院时和出院后6个月对压疮知识、照顾行为及翻身技能操作的考评结果。[结果]干预组压疮的发生率低于对照组,干预组主要照顾者压疮知识、照顾行为及翻身技能操作得分高于出院时,差异有统计学意义(P0.05)。[结论]延续性护理可有效降低内科压疮高危病人的压疮发生率,提高病人主要照顾者的护理能力。     

个体化教育方案对压疮患者居家照顾者照顾行为的影响

目的探讨个体化教育方案对改善压疮患者居家照顾者照顾行为的作用。方法采用方便抽样法选取2010年3-11月复旦大学附属华山医院伤口造口护理门诊就诊患者的照顾者46例作为研究对象,以随机数字表法将其分为干预组和对照组各23例。对照组接受门诊常规护理教育;干预组在门诊常规护理教育的基础上,实施个体化教育方案,为期3个月。以主要照顾者照顾行为、照顾者为患者翻身和换药行为、患者压疮愈合率和再发生率作为评价指标,分别于干预后1周、1个月和3个月进行效果评价。结果干预后1周,干预组照顾者为患者翻身和换药行为总均分明显高于对照组,差异有统计学意义(P0.01);干预后1、3个月,干预组照顾者照顾行为优于对照组,差异均有统计学意义(均P0.01);干预后3个月,干预组患者压疮愈合率和再发生率与对照组差异均无统计学意义(均P0.05)。结论个体化的教育方案可有效改善压疮患者居家照顾者的照顾行为,但其对促进压疮愈合、降低再发生率的效果需延长干预时间进一步评价。     

主要照顾者压疮类现场管理平台在高龄压疮高危患者中的应用

目的 观察主要照顾者压疮类现场管理平台在高龄压疮高危患者中的应用效果。 方法选择主要照顾者压疮类现场管理平台应用前(2016年7-12月)和应用后(2017年1-6月)于我院出院并诊断为高龄压疮的高危患者作为研究对象,分别设为对照组与观察组各40例。对照组接受常规护理,观察组在此基础上加用主要照顾者压疮类现场管理平台干预,比较2组压疮发生率及主要照顾者压疮知识和压疮照顾行为。 结果 出院6个月时,观察组照顾者的压疮知识与压疮照顾行为评分均显著高于对照组(t=10.240,P<0.001; t=10.513,P<0.001),观察组出院后6个月内压疮发生率低于对照组(χ²=4.507,P=0.034)。 结论 采用压疮类现场管理平台对高龄压疮高危患者的照顾者施加干预,可显著提高照顾者压疮知识水平与压疮照顾行为能力,降低压疮的发生率。     

远程护理联合家庭访视对社区压疮高危人群居家护理的效果评价

目的:评价远程护理联合家庭访视对社区压疮高危人群居家护理后的效果。方法:采用便利抽样法在社区选取符合压疮高危人群的患者及主要照顾者120对,分为实验组和对照组各60对,实验组实施远程护理和家庭访视,对照组发放压疮相关资料。3个月后,对两组干预前后效果进行评价。结果:实验组与对照组在主要照顾者压疮基础知识知晓率及相关知识知晓率、照顾行为改变率、高危患者压疮发生率方面比较差异有统计学意义(P0.05)。结论:远程护理联合家庭访视可提高照顾者压疮知识水平,改变其不良照顾行为,降低社区压疮高危人群压疮的发生率。     

综合护理干预对压疮高危病人压疮发生情况及其照顾者的影响

[目的]探讨以Orem自护理论为基础的综合护理干预方案对压疮高危病人压疮发生情况及其照顾者压疮知识、照顾行为、照顾负担的影响。[方法]选取即将出院、Braden压疮风险评估表评分≤12分的压疮高危病人252例及主要照顾者252人为研究对象,并用随机数字表法分为观察组和对照组。对照组接受常规出院指导,观察组在常规出院指导的基础上,实施为期6个月的以Orem自护理论为基础、参照2013版《中国压疮护理指导意见》制定的综合护理干预措施。出院时、出院后6个月比较两组照顾者压疮知识、照顾行为、照顾负担及病人压疮发生率、愈合率。[结果]干预6个月后,观察组病人照顾者的压疮知识和照顾行为得分高于对照组,照顾负担得分低于对照组;观察组病人压疮愈合率高于对照组、压疮发生率低于对照组,差异均有统计学意义(P0.05)。[结论]以Orem自护理论为基础的综合护理干预方案有利于提高压疮高危病人照顾者的压疮知识水平和照顾行为,减轻照顾者照顾负担,促进病人压疮愈合,降低压疮发生率。     

社区-家庭一体化护理对长期卧床老年人压疮的预防效果观察

目的探讨社区-家庭一体化护理在预防长期卧床老年人压疮中的应用效果。方法选取96例出院后需要居家照顾的长期卧床老年人为研究对象,分为对照组和观察组,对照组由家属提供护理,观察组实施社区-家庭一体化护理。比较2组照顾者有关压疮的知识、技能和行为状况,以及压疮风险评分和发生情况。结果观察组照顾者在患者出院2个月后的压疮相关知识、照顾行为及翻身技能评分均高于对照组(P0.05);观察组出院后2个月的Braden评分高于对照组,随访6个月压疮的发生率高于对照组(P0.05)。结论社区-家庭一体化护理能够提高长期卧床老年人照顾者的压疮护理能力,减少压疮发生风险。     

压疮高危患者居家护理相关因素的调查分析

目的：调查压疮高危患者居家主要照顾者对压疮预防知识、态度及行为的现状,分析家庭护理不当的相关因素。方法采用问卷调查法对抽取的108例压疮高危患者主要照顾者进行调查（一般资料调查、采用自行设计的压疮知信行评估问卷进行测评）。结果压疮高危患者居家主要照顾者对压疮的相关知识的认知程度不高,且缺乏正规的学习渠道。在压疮相关知识认知方面：大专及以上者优于大专以下者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。在防护压疮的态度和行为方面：大专以下主要照顾者优于大专及以上者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。结论压疮高危患者居家主要照顾者预防压疮的意识薄弱,应加强压疮防护知识的健康教育,广泛开展多种形式的健康宣教,降低压疮高危患者压疮的发生率,提高其生活质量。     

结构化干预对居家压疮患者照顾者的影响

目的:探讨结构化干预对居家压疮患者照顾者的影响。方法:将32例居家Ⅱ~Ⅳ期压疮患者的照顾者随机分为干预组和对照组各16例,对照组采用传统单一的压疮健康指导方法,干预组采用结构化干预,比较两组干预效果。结果:两组干预后心理状况、生活质量、照顾压力比较差异有统计学意义(P0.05)。结论:结构化干预可调整居家压疮患者照顾者的心理状态,提高生活质量,缓解照顾压力。     

Early Palliative Care Initiation: Role of the Primary Care Clinician

Palliative care provided to patients with chronic life-limiting illnesses shows improvement in symptom management, quality of life, and caregiver support while reducing cost of care. Early initiation of palliative care faces a multitude of barriers in the primary care setting, including provider confidence, coordination and implementation, education, and family and patient misconceptions. A team-based approach along with additional education, clear referral triggers, and resources for advanced-care planning discussions allows providers to overcome many of these barriers. With the population’s advancing age, it is essential that primary care providers are properly prepared for early initiation of palliative care.     

Advance care planning in Belgium and The Netherlands: a nationwide retrospective study via sentinel networks of general practitioners

Context

Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe.

Objectives

To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors.

Methods

A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present.

Results

Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient’s family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4-6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6-4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7-4.1), died of cancer (OR 1.46; 95% CI 1.1-2.0), or died at home (OR 2.16; 95% CI 1.5-3.0).

Conclusion

In these countries, ACP is done with approximately one-third of the studied terminally ill patient population. Most agreements are made only verbally, and care also is often planned with family only. ACP relates strongly both to patient factors and to health care measures performed at the very end of life.     

Sheltered housing compared to independent housing in the community

Background:  With elderly people desiring to live independently as long as possible, traditional homes for the elderly are increasingly being transformed into sheltered accommodations. In order to assess the importance of housing for frail elderly people, elderly people at risk for institutionalization were studied in two living conditions: sheltered accommodation and living independently in the community.
Methods:  A total of 317 elderly people at risk for institutionalization [91 men and 240 women, mean age = 83.3 (SD = 6.0)] were interviewed using a structured questionnaire with questions regarding home care and social service use, quality of life, subjective well-being, life satisfaction, autonomy, functional status, feelings of insecurity and loneliness.
Results:  Exactly 56.5% of the respondents were living in sheltered accommodation (n = 179) and 43.5% (n = 138) were living in regular houses. Although both groups were similar in demographic details and functional status, those in sheltered accommodation had a higher perceived autonomy, sense of security and quality of life. No differences were found with regard to subjective well-being or feelings of loneliness. Elderly people in regular houses needed more hours of housekeeping assistance. Those in sheltered accommodation participated more frequently in services like social activities and social restaurants, but made less use of day care facilities.
Conclusions:  Affordable, decent and suitable noninstitutional housing with service provision play a vital role in the lives of elderly people. Compared with independent living in the community, sheltered accommodations provide added value. Sheltered housing should therefore be an integral part of long-term care policy.     

The challenges in adopting care pathways for the dying for use in care homes

An increasing number of older people are requiring palliative care within the care home setting. There are currently a number of initiatives that are generally gaining approval and being implemented within health care in general with the goal of improving standards of palliative care. These are the Integrated Care Pathway for the dying person, the Gold Standards Framework and the Preferred Place of Care document. The Liverpool Care Pathway is being used across a wide range of care settings to improve care in the last 24–48 hours of life and is being implemented in care homes as part of a national rollout programme. This article aims to explore some of the issues associated with the use of the care pathways in care homes, particularly without the input of additional resources and support for the care homes. It also questions the appropriateness of the pathway in its current format without further work on the specific palliative care needs of the residents dying in care homes.     

Is integrated nursing home care cheaper than traditional care? A cost comparison

Background

It is generally assumed that integrated care has a cost-saving potential in comparison with traditional care. However, there is little evidence on this potential with respect to integrated nursing home care.

Aims and objectives

• • 

  To portray the costs of traditional and integrated nursing home care.

• • 

  To explore the cost-saving potential of integrated care.

Design/methods/settings/participants

Between 1999 and 2003, formal and informal caregivers of different nursing homes in the Netherlands recorded activities performed for residents with somatic or psycho-social problems. In total, 23,380 lists were analysed to determine the average costs of formal and informal care per activity, per type of resident and per nursing home care type. For formal care activities, the total personnel costs per minute (in Euro) were calculated. For informal care costs, two shadow prices were used.

Results

Compared to traditional care, integrated care had lower informal direct care costs per resident and per activity and lower average costs per direct activity (for a set of activities performed by formal caregivers). The total average costs per resident per day and the costs of formal direct care per resident, however, were higher as were the costs of delivering a set of indirect activities to residents with somatic problems.

Conclusions

The general assumption that integrated care has a cost-saving potential (per resident or per individual activity) was only partially supported by our research. Our study also raised issues which should be investigated in future research on integrated nursing home care.     

Pediatric palliative care

Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included.     

Use of Care by Home-dwelling Stroke Patients during Three Years following Hospital Discharge

Of 82 stroke survivors who had been discharged from hospital, 49 were still living at home after a three-year period. Thirty-three of these patients formed the population of the present study of the use of care at home. Sixty-one percent had received professional care and 88% had received family care. Although their overall functional status indicated only mild handicaps, after three years patients still reported a large number of disabilities and problems. The average weekly amount of family care was 37 h, and many family carers experienced a high burden of care and had emotional problems coping with the patients' disabilities. Concerning factors related to the use of care, in spite of the relatively small number of study patients, some interesting hypotheses can be advanced.     

ICUs worldwide: an overview of critical care medicine in South Africa

South Africa has undergone rapid changes in the political and social arenas since 1994. With new policy-makers in the Department of Health, the distribution of health care resources are being rationalised and redirected to benefit the majority of the previously disadvantaged population of the country. The role and rationalisation of intensive care medicine has to be re-evaluated to ascertain that it is at a level appropriate for a developing country. Despite progress made, the subspecialty of intensive care medicine faces challenges from changing disease patterns and from lack of human and financial resources as these are redirected to primary health care and other priorities facing the country.     

Consensus of the Millennium Conference on Teaching High Value Care

Issue: Healthcare costs have spiraled out of control, yet students and residents may lack the knowledge and skills to provide high value care, which emphasizes the best possible care while reducing unnecessary costs. Evidence: Mainly national campaigns are aimed at physicians to reconsider their test ordering behaviors, identify overused diagnostics, and disseminate innovative practices. These efforts will fall short if principles of high value care are not incorporated across the spectrum of training for the next generation of physicians. Implications: Consensus findings of an invitational conference of 7 medical school teams consisting of academic leaders included strategies for institutions to meaningfully incorporate high value care into their medical school, residency, and faculty development curricula.