以家庭为中心的护理及延续性护理在非重症哮喘患儿中的应用

[目的]观察以家庭为中心的护理及延续性护理在非重症哮喘患儿中的应用效果。[方法]将110例非重症哮喘患儿分为对照组和观察组各55例,对照组采用儿科常规护理,观察组采用“以家庭为中心”的护理及延续性护理照护,比较两组哮喘患儿住院时间、住院费用、治疗效果、家长焦虑自评、生命质量等。[结果]两组患儿在住院时间、住院费用、家长焦虑自评、生命质量方面比较,差异有统计学意义（P〈0.05）。[结论]实施“以家庭为中心”的护理及延续性护理,可以缩短住院时间、减少住院费用、缓解家长焦虑心理、提高患儿生命质量。     

Associations between successful palliative trajectories,place of death and GP involvement

Abstract

Objective. General practitioner (GP) involvement may be instrumental in obtaining successful palliative cancer trajectories. The aim of the study was to examine associations between bereaved relatives’ evaluation of palliative cancer trajectories, place of death, and GP involvement. Design. Population-based, cross-sectional combined register and questionnaire study. Setting. The former Aarhus County, Denmark. Subjects. Questionnaire data on GPs’ palliative efforts and relatives’ evaluations of the palliative trajectories were obtained for 153 cases of deceased cancer patients. Main outcome measures. A successful palliative trajectory as evaluated retrospectively by the relatives. Results. Successful palliative trajectories were statistically significantly associated with home death (PR 1.48 (95% CI 1.04; 2.12)). No significant associations were identified between the evaluations of the palliative trajectory at home and GP involvement. “Relative living with patient” (PR 1.75 (95% CI: 0.87; 3.53)) and “GP having contact with relatives” (PR 1.69 (95% CI 0.55; 5.19)) were not significantly associated, but this may be due to the poor number of cases included in the final analysis. Conclusion. This study indicates that home death is positively associated with a higher likelihood that bereaved relatives will evaluate the palliative trajectory at home as successful. No specific GP services that were statistically significantly associated with higher satisfaction among relatives could be identified, but contact between GPs and relatives seems important and the impact needs further investigation.     

晚期癌症病人家庭临终护理的研究进展

综述近年来国内外晚期癌症病人家庭护理模式的研究进展,探讨我国开展晚期癌症病人家庭临终护理存在的问题和解决方法,指出未来应着重培养专业的家庭临终医护人员,健全家庭临终护理的模式,从而为病人和家属提供全面、专业的照护与支持;逐步将家庭临终护理加入医保范围,加大对家庭临终护理的政策和财力支持,普及和推广家庭临终护理;加大宣传,帮助人们更新思想观念,关注人的基本权利。     

以家庭为中心护理模式在儿科的应用现状

对以家庭为中心护理的概念及原则、在儿科的应用现状、存在的问题进行综述,希望为我国实施以家庭为中心的儿科护理提供借鉴,提高儿科护理质量。     

以家庭为中心护理模式在儿科的应用现状

对以家庭为中心护理的概念及原则、在儿科的应用现状、存在的问题进行综述,希望为我国实施以家庭为中心的儿科护理提供借鉴,提高儿科护理质量。     

Development of palliative care in India: an overview

India is a land of ancient civilizations with cities and villages, cultivated fields and works of art dating back 4,000 years. Currently, it is sharing the position of the second largest population in the world. Two-thirds of the population live in rural areas and only one-third live in urban areas. Because of these disparities in the population locations, the health-care system faces significant problems of adequate provision in rural areas. A lack of resources, illiteracy, poverty, lack of awareness about the types of available health care make developing palliative-care services a major challenge in India.     

Applying palliative care principles and practice to emergency medicine

Only recently has the potential (unmet) palliative care (PC) workload in the ED been recognised. While confident in PC symptom management, we underestimate the role of a palliative approach in non‐cancer diagnoses and seek education in areas such as individual patient care pathways, ethical and legal issues and difficult conversations at the end of life. PC is best introduced early for a range of life‐limiting cancer and non‐cancer diagnoses. Allowing patients time to tell their story with active listening, acknowledgement of suffering and a compassionate presence leads to treatment ‘success’ that is not defined by cure. This patient‐centred, rather than disease‐centred approach, is the essence of PC, and one that is easily incorporated into emergency practice. PC and disease‐specific treatments can comfortably coexist, and with meticulous symptom management, may actually prolong life. PC is everyone's business, and emergency medicine needs to be part of it.     

临终反向关怀在晚期癌症患者中应用的研究

目的 探讨临终反向关怀在晚期癌症患者中的应用.方法 选取2018年3月—2020年3月某市宁养院服务的临终患者60例,将不同病区治疗的患者分为对照组及试验组,每组各30例.对照组患者实施常规护理,试验组患者反向关怀干预,即临终患者作为主体对亲友、同事、照护工作者等客体做出的关心慰藉活动,干预时间1个月,比较两组临终患者...     

以家庭为中心的医疗护理模式在儿科急诊中的实施效果

目的探讨“以家庭为中心”的医疗护理模式在儿科急诊中的实施效果。方法在儿科急诊开展以家庭为中心的医疗护理模式,采取营造温馨的人文环境、APN排班、医护同管患者、开展人性化主题活动等优质护理方法,通过实验性研究方法比较干预措施实施前后患儿或家属对急诊护士工作和急诊就医服务的认同度。结果实施后患儿及家长对急诊护士工作、急诊就医服务满意度优于实施前（P=0.01）。结论实施以家庭为中心的医疗护理模式后,急诊护理工作质量显著提高,护理效果明显,患儿及家长满意度明显提高,值得临床推广应用。     

End-of-life care pathways in acute and hospice care: an integrative review

ContextOver the past decade, there has been widespread adoption of end-of-life care pathways as a tool to better manage care of the dying in a variety of care settings. The adoption of various end-of-life care pathways has occurred despite lack of robust evidence for their use.ObjectivesThis integrative review identified published studies evaluating the impact of an end-of-life care pathway in the acute and hospice care setting from January 1996 to April 2010.MethodsA search of the electronic databases Scopus and Cumulative Index of Nursing and Allied Health Literature as well as Medline and the World Wide Web were undertaken. This search used Medical Subject Headings key words including “end-of-life care,” “dying,” “palliative care,” “pathways,” “acute care,” and “evaluation.” Articles were reviewed by two authors using a critical appraisal tool.ResultsThe search revealed 638 articles. Of these, 26 articles met the inclusion criteria for this integrative review. No randomized controlled trials were reported. The majority of these articles reported baseline and post implementation pathway chart audit data, whereas a smaller number were local, national, or international benchmarking studies. Most of the studies emerged from the United Kingdom, with a smaller number from the United States, The Netherlands, and Australia.ConclusionExisting data demonstrate the utility of the end-of-life pathway in improving care of the dying. The absence of randomized controlled trial data, however, precludes definitive recommendations and underscores the importance of ongoing research.     

Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation

Palliative sedation is undergoing extensive debate. The aims of this study were to describe the practice of palliative sedation at a specialized acute palliative care unit and to study whether patients who received palliative sedation differed from patients who did not. We performed a systematic retrospective analysis of the medical and nursing records of all 157 cancer patients who died at the acute palliative care unit between 2001 and 2005. Palliative sedation, defined as continuous deep sedation prior to death, was used for 43% of all deceased patients. In 87% of the sedated patients, it was started in the last two days before death. Sedated and nonsedated patients did not differ in survival after admission (eight days vs. seven days, P = 0.12). Sedated patients were younger (55 years vs. 59 years, P = 0.04) and more often had malignancies of the digestive tract (P < 0.01). In both groups, common symptoms at admission were pain (79% vs. 87%, P = 0.23), constipation, (40% vs. 48%, P = 0.46), and dyspnea (32% vs. 29%, P = 0.77). On the day that palliative sedation was started, sedated patients more often suffered from dyspnea and delirium than nonsedated patients at a comparable day before death. The most important indications for palliative sedation were terminal restlessness (60%) and dyspnea (46%). We conclude that at the studied acute palliative care unit, patients who ultimately received palliative sedation did not have symptoms different than nonsedated patients at admission, but on the day at which the sedation was started, they suffered more often from delirium and dyspnea.     

How do cancer patients receiving palliative care at home die? A descriptive study

Context

Data regarding the circumstances of the process of death of terminally ill patients followed at home are lacking.

Objectives

The aim of this study was to describe the characteristics and assess the circumstances of the process of death of terminally ill patients followed at home.

Methods

This was a prospective survey to assess the dying process of advanced cancer patients followed at home. Within a week after death, the principal caregiver was interviewed. Information from the palliative home care team and the caregiver about expectation of death, time of death, professional and nonprofessional people present at time of death, emergency admission to hospital, and administration of drugs to resuscitate was gathered. The principal clinical issues in the last two hours also were recorded.

Results

In total, 181 of 222 caregivers provided information. Most deaths were expected. Palliative home care team physicians and nurses visited the patient on the day of death but were occasionally present at the moment of death. More than three people were generally present at time of death. More than two-thirds of patients died peacefully, without apparent suffering, and 35.7% of them received palliative sedation before dying. In the last two hours, the most frequent clinical issues were ranked as death rattle, dyspnea, and agitation. In 10 cases, emergency drugs for resuscitation were administered.

Conclusion

This study has shown how advanced cancer patients die at home and that palliative home care may be helpful in allowing a death at home, particularly when relatives are actively involved.     

The experiences of Chinese family members of terminally ill patients - a qualitative study

Aim. To describe and understand the experiences of Chinese family members of terminally ill patients during the end of life process in a palliative care unit. Background. Palliative care aims to provide care to dying patients and their family members. Skillful interventions are necessary to help family members cope with the impending death of the patient and maintain their emotional equilibrium. Hence, it is important to understand the experiences of family members of palliative care. Design. A phenomenological study was conducted. Data were collected by semi‐structured interviews. We interviewed a purposive sample of 20 family members of terminally ill patients in a palliative care unit in Hong Kong. The data were analysed following Colaizzi's phenomenological methodology. Results. Family members experienced anticipatory grief, with reactions that included anger, unease, sadness and helplessness. This was particularly acute when the patient was first admitted to the palliative care unit. However, the family members quickly accepted the reality and committed themselves to the care of the patient, seeking informational and emotional support from the nurses. The families wanted to be assured that the patient had been offered good care and suffered no pain. It was considered important to be with the patient during the dying process. Conclusion. This study demonstrated that Chinese family members were committed to the care of the patients in the palliative care unit. Cultural beliefs played a part in influencing family emotions and concerns. Relevance to clinical practice. This study offers a direction for family interventions that acknowledge the reactions of family members to the admission of a patient to a palliative care unit. It highlights that families need active informational and emotional support from nurses.     

老年鼻咽癌病人家庭照护者对缓和医疗需求及相关因素分析

[目的]了解老年鼻咽癌病人家庭照护者对缓和医疗需求的现状,分析相关因素。[方法]采用简单随机抽样法,于2018年2月—2019年8月选取广西医科大学附属第一医院老年鼻咽癌病人的家庭照护者为研究对象。采用自行设计的问卷,调查家庭照护者的一般资料及对缓和医疗的需求情况,分析影响家庭照护者对缓和医疗需求因素。[结果]老年鼻咽癌病人家庭照护者对缓和医疗需求总分为(89.11±14.78)分,其中以照护者精神心理需求的得分指标最高;拟合多元线性回归分析结果显示,年龄、有无照护经验及与病人关系是影响家庭照护者对缓和医疗需求的独立因素(P<0.05)。[结论]老年鼻咽癌病人家庭照护者对缓和医疗需求程度高,且需求愿望与照护者年龄、有无照护经验及与病人关系有关,应具有针对性进行专业知识宣教及心理健康教育,有助于改善家庭照护者的心理状态,优化病人的生活质量。