终末期护理在整体护理中延伸

通过整体护理临床实践，提出了对终末期概念界定的新认识，讨论了终末期护理对象及护理方法，认为终末期不仅指住院重危病人（平均存活１７．５ｄ）而且包括昏迷，失去交流能力及存活不到２４ｈ的病人，护理上不仅终末期病人的护理，也包括死亡者的护理及亡者亲属的护理。     

终末期病人的护理方法探讨

随着现代医学的飞速发展和护理模式的转变，人们更加注重生命健康。护理以其对“人、健康、环境、护理”的独特见解，以其对生命健康的特有关爱，在护理工作中已逐渐得到推行和应用。作为生物人，死亡是不可避免的。一般认为终末期不仅指住院的重危患者，而且包括昏迷、失去交谈能力及存活不到2gh的患者。终末期病人面对自己生命即将结束时，难免会产生对生的渴望和对死的恐惧，难免会遭受巨大的悲伤和痛苦。     

肾移植病人家庭自我护理现状调查

同种异体肾移植是治疗不可逆性终末期肾病的有效手段。肾移植病人的长期存活不仅取决于良好的免疫配型、娴熟的移植技术、合理免疫抑制剂的应用 ,更有赖于病人出院后长期良好的家庭自我护理[1:2 81] 。否则 ,不但会影响移植肾的功能 ,甚至会危及病人的生命。鉴此 ,于 1999年 7月— 2 0 0 0年 6月对 2 48例带肾存活 3ａ以上的肾移植病人的家庭自我护理状况进行了问卷调查 ,以期较准确地掌握肾移植病人的家庭自我护理现状 ,并采取相应的措施。现将调查结果报告如下 :1　对象与方法1.1　调查对象　在我院行肾移植术并带肾存活 3ａ以上的病例 (…     

终末期糖尿病肾病肾移植病人护理重点

对３２例终末期糖尿病肾病（ＥＳＤＮ）肾移植患者的护理，取得较满意的效果。ＥＳＤＮ肾移植病人护理应把好术前预防，术后血尿、糖监测，感染预防，药物管理，饮食指导关，同时对影响ＥＳＤＮ肾移植患者移植肾长期存活的护理因素进行了讨论。     

终末期糖尿病肾病肾移植病人的护理重点

对３２例终末期糖尿肾病（ＥＳＤＮ）肾移植患者的护理，取得较满意的效果。ＥＳＤＮ肾移植病人护理应把好术前预防，术后血尿、糖监测、感染预防，药物管理，饮食指导关，同时对影响ＥＳＤＮ肾移植患者移植肾长期存活的护理因素进行了讨论。     

腹膜透析病人导管出口处感染的护理干预

对56例行腹膜透析的终末期肾脏病病人进行感染原因分析，术前、术中、术后操作过程缺陷及无菌操作不规范，针对原因采取相应护理干预，包括术前准备工作、术后切口护理，无菌操作培训。     

女性更年期尿毒症病人血液透析的护理体会

尿毒症是各种慢性肾衰竭的终末期,目前治疗尿毒症的可靠方法之一是血液透析,血液透析法使成千上万的病人得以存活或延长生命。针对女性更年期尿毒症病人具有其特殊的心理特点,对52例女性更年期尿毒症病人进行全面的护理,提高了病人的生活质量,延长了其生命。     

从六位患者的自杀看终末期肿瘤病人的护理

目的 总结和分析近年来我院6例(2例死亡)终末期肿瘤病人发生自杀行为的的基本情况，以指导今后提高终末期肿瘤病人的护理质量。方法 采用回顾性调查方法，自行设计调查问卷，通过查看病史，访谈医生、护士及病人家属进行调查，总结自杀行为发生的原因，并提出防范措施。结果 终末期肿瘤病人发生自杀行为的首要原因是心理问题和躯体疼痛，其次是病人家庭等支持不良。结论 对终末期肿瘤病人的护理旨在改善其生活质量，护理人员应主动为终末期肿瘤病人提供高质量的心理护理、提供缓解躯体疼痛的方法，鼓励建立病人家庭等支持帮助系统，还应加强安全预防措施。     

临终关怀中的人性化护理研究

护士如何在病人临终关怀中进行人性化护理研究，并制定出行之有效的终末期护理手册，是非常重要的。此强调了临终关怀时，病人无论是清醒、昏迷还是死亡，均应受到尊重。护士应该为病人、家属提供人性化护理。     

肾移植病人的观察及护理

同种异体肾脏移植是治疗终末期肾病的有效方法之一.我科于2003年1月至2006年1月收治同种肾脏移植病人26例,为了提高肾移植患者的存活率,我们充分作好手术前后的护理工作,包括术前对病人评估,心理护理,术后密切观察病情,及时发现与处理对移植肾存活的不利因素.经过医护人员的精心治疗和护理取得满意的效果,现将护理体会报告如下.     

养老院临终老人护理质量的研究

目的 探讨提高临终老人护理质量的方法。 方法 将2008年10月-2010年3月的60例临终老人设为对照组,按常规方法进行护理,2010年4月-2011年3月的35例临终老人设为实验组,根据老人生理、心理特点在临终病房进行护理。 结果 实验组患者基础护理达标率、护理记录及护理操作合格率、家属满意度均高于对照组。 结论 成立临终病房,将人文关怀融入临床工作,可以提高临终老人的护理质量,减少患者痛苦,使老人安宁、舒适地走完人生的最后阶段。     

护理人员掌握临终关怀知识情况的调查

为了解护理人员对临终关怀知识的掌握程度，对北京市一所综合医院和一所肿瘤专科医院的120名护理人员进行有关临终关怀知识的问卷调查。结果显示：61．7％护理人员的临终关怀知识处于一般水平，优秀率仅2．5％，以临终、临终关怀基本知识缺乏最严重。两所医院不同护龄、学历的护理人员掌握临终关怀知识程度无统计学意义。提示：临床护理人员普遍缺乏临终关怀知识。     

家庭式病房晚期癌症患者配偶照护感受的质性研究

目的了解家庭式病房晚期癌症患者配偶在照护患者过程中的真实感受。方法 2015年9月至2016年3月,采取立意抽样法选取在上海交通大学附属仁济医院老年科家庭式病房住院的10例晚期癌症患者的配偶为研究对象,采用现象学研究方法对其进行半结构式访谈,根据Colaizzi内容分析法分析资料,整理并提炼主题。结果家庭式病房的晚期癌症患者配偶的照护感受包括4个主题:抱怨和无助感;不确定感和丧失感;满足感和自我价值感;调整心态,接受事实。结论在护理家庭式病房的晚期癌症患者的同时,还需关注其主要照护者,尤其是配偶的身心健康,可以运用以家庭为中心的护理模式、临终关怀服务等为患者及其配偶提供医疗照护和心理支持;同时,呼吁政府构建完整的社会支持系统,减轻晚期肿瘤患者家属照护压力。     

护士安宁护理自我效能及其影响因素的调查分析

目的探讨护士安宁护理自我效能情况及其影响因素。方法采用方便抽样方法,选择260名护士,采用护士安宁护理自我效能调查问卷进行调查。结果影响护士安宁护理自我效能的主要因素是对死亡态度、过去所在科室、护理终末期病人的经验、自觉重要程度。护士过去经验和对安宁护理的自觉重要程度与自我效能呈正相关（均P〈0.001）。结论增加护士照护经验积累,提高心理与灵性照护能力,重视安宁护理的教育及培训,对提高安宁护理质量具有积极的意义。     

Nursing care of the terminal lung cancer patient.

Care of the terminal lung cancer patient will be more effective when a multidisciplinary approach is used. Planning for terminal care should not be delayed until the last few hours or days of life. Hospice care offers the terminal lung cancer patient an alternative to dying in a hospital or nursing home. Caring support to alleviate pain and prevent suffering is the goal of nursing care for the terminal cancer patient. Nursing interventions should be directed toward allowing the patient to retain decision-making authority in care for as long as possible.     

Advance Directives in Japanese Nursing Homes

ContextAdvance directives are poorly understood in Japanese nursing homes. In April 2006, additional funding for end-of-life care became available as the first support for terminal care at Japanese nursing homes.ObjectivesThe objectives of this study were to investigate the adoption of advance directives by Japanese nursing homes, the effect of additional funding for end-of-life care in nursing homes from long-term care insurance on the use of advance directives, and the types of directives used.MethodsA nationwide questionnaire survey of nursing homes was performed in Japan. The participants were 913 nursing homes. We investigated the prevalence of advance directives, details of the directives, and demographic data of the responders.ResultsAdvance directives were used in 58.4% of nursing homes. The timing of introduction of the directives and the results of multivariate analysis at the facility level suggested a relation between the availability of additional funding for end-of-life care and the adoption of advance directives. Most nursing homes used instructional directives, especially directives providing an explanation and informed consent for end-of-life care in the nursing home.ConclusionMore than half of Japanese nursing homes have introduced advance directives, and additional funding for end-of-life care is related to their introduction. Most nursing homes have adopted instructional directives, especially those providing an explanation and informed consent regarding end-of-life care at the nursing home.     

膝关节镜手术的临床观察和护理

目的 探讨膝关节镜术的临床观察和护理。方法 采集我科1999年4月－2001年7月间施行膝关节镜手术治疗的患40例，总结该手术前后的护理方法，并阐述了采用这些护理方法的机制。结果 本组患护理效果良好，心理状况稳定，伤口愈合I／甲，未发生并发症，伤愈出院。结论 膝关节镜术的护理，应整体护理出发，突出个体化的护理方案。早期正确进行主被动功能锻炼，尤其是持续被动活动（Continuous Passive motion,CPM)装置练习的护理，对膝关节康复起重要作用。     

Nursing needs of acutely ill older people

BACKGROUND: Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. AIMS: The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. METHODS: Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. RESULTS: Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. STUDY LIMITATIONS: The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. CONCLUSIONS: Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family carers about the particular roles they will play during the patient's hospital episode, the expectations they have of patients in the process of healing and recovery, and the reasons for the actions they take in aiding this process. The findings are useful in making nurses more aware of the expectations and needs of older hospital patients and their carers. They provide evidence for developing both new models of nursing care for this patient group, and nursing education programmes.     

颅内动脉瘤血管内治疗护理

本文通过对20例急症期颅内动脉瘤血管内治疗患者的护理进行了探讨,术前护理中避免诱发颅内动脉瘤再破裂的各种危险因素,加强心理护理,使患者对治疗充满信心以及术中合作,术后的护理,及早期发现和预防并发症,及对偏瘫患者在栓塞治疗满意,病情稳定后的早期进行被动功能锻炼,是提高治愈率及患者生存质量的关键。     

1例重症伪膜性肠炎患者行粪菌移植的护理

总结1例直肠癌根治术后并发肺部感染和伪膜性肠炎患者行粪菌移植的护理经验。护理主要内容如下：第1阶段预防感染加重,包括回肠造瘘口及造瘘液的观察与管理、呼吸功能锻炼、早期活动、营养支持、病情观察;第2阶段粪菌移植护理,包括前期准备、粪菌移植实施要点、粪菌移植后观察与护理。经过精心护理,患者康复出院,随访6个月,患者回肠造瘘液为560~1 050 ml/d,生活自理能力增强,焦虑、抑郁症状改善,生活质量提升。