多元文化护理理念在肿瘤病人临终关怀中的应用

综述了不同文化、信仰、价值观、习俗的肿瘤病人的临终关怀情况,为在肿瘤病人临终关怀中开展多元文化护理提供借鉴。     

综合性医院肿瘤病房开展临终关怀的思考

<正>临终关怀是一门新兴学科,据美国统计资料显示,在接受临终关怀服务的病人中,有60%是恶性肿瘤患者[1]。随着肿瘤发病率和死亡率的不断上升,以及中国传统文化的影响,选择在综合医院内住院的病人越来越多,对临终关怀服务的需求不断增加。本文就如何在综合医院肿瘤病房内开展临终关怀进行探讨。     

社区肿瘤病人的家庭护理

从肿瘤病人的环境要求、基础护理、特殊护理、心理干预、康复指导、临终关怀方面叙述肿瘤病人的家庭护理,提出有效的家庭护理在肿瘤病人的康复中起着重要的作用.     

社区肿瘤病人的家庭护理

从肿瘤病人的环境要求、基础护理、特殊护理、心理干预、康复指导、临终关怀方面叙述肿瘤病人的家庭护理,提出有效的家庭护理在肿瘤病人的康复中起着重要的作用。     

郴州市不同人群对临终关怀的认知调查

[目的]了解郴州市病人、家属及社会人员对临终关怀的认知和态度。[方法]采用自编的临终关怀调查问卷于2011年7月—10月对郴州市600名不同人群(肿瘤病人200人,病人家属200人,社会人员200人)进行问卷调查。[结果]郴州市肿瘤病人及其家属、社会人员对临终关怀的认知和态度总体得分为(71.20±10.86)分;肿瘤病人得分为(73.33±7.16)分,家属得分为(71.25±7.15)分,社会人员得分为(69.02±7.09)分,三者比较差异有统计学意义(P<0.05);大学及以上学历者得分(75.26分±6.36分)高于高中及以下学历者(69.70分±7.15分);男性居民得分(72.29分±7.35分)高于女性居民(70.21分±8.98分)。[结论]郴州市居民对临终关怀的态度总体是积极的,能普遍认识到临终关怀的意义、接受临终关怀服务,但对死亡存在明显的忌讳和恐惧心理。     

临终关怀对晚期恶性肿瘤病人生命质量的影响

目的探讨临终关怀技术对晚期恶性肿瘤病人生命质量的影响效果.方法将71例晚期恶性肿瘤病人随机分为对照组(30例)和观察组(41例),对照组采用传统的整体护理手段,观察组采用临终关怀技术,比较2组病人对癌症死亡的恐惧、药物的依赖性.结果对照组66.6%病人存在对肿瘤死亡的恐惧.观察组接受临终关怀技术后,病人对死亡的恐惧、药物依赖性减少,与对照组比较,P＜0.01,差异有显著性.结论临终关怀技术使晚期恶性肿瘤病人顺利度过临终状态,提高了病人的生命质量.     

县级医院护士对临终关怀知识的了解程度调查

临终关怀是一种以临终病人的生理和心理特征以及相关的医学、护理、心理、社会等问题为研究对象的一门新兴交叉学科。它要求从事临终关怀的医护人员及其他人员,要有强烈的责任感和高度的道德水准。随着肿瘤病人的日益增多,从事临终关怀的医护人员也越来越多。为此,我院举办了一次“临终关怀知识讲座”。为了了解县级医院护士对临终关怀知识的了解程度,作者进行了问卷调查,现将调查结果报道如下。     

临终关怀之探讨

临终关怀的宗旨是减少临终病人的痛苦，增加病人的舒适程度，提高病人的生命质量，维护病人的尊严，同时对病人家属予以精神上的支持。临终关怀的实施有其必要性及迫切性。肿瘤病人的急剧增多，晚期癌症病人精神、肉体、经济上的困扰，使其成为临终关怀的主要对象。根据我国的国情，宜发展在医院内附设的临终关怀单位。在推行过程中可能遇到社会习俗、死亡观念的影响；经费筹措困难以及医护人员本身的阻力。建议加强死亡教育，纠正医护人员的传统生理治疗观念。国家立法保证资金的筹措使用。     

综合医院肿瘤科医务人员临终关怀认知的质性研究

[目的]了解综合医院肿瘤科医务人员对临终关怀的认知程度,为更好开展临终关怀工作提出对策。[方法]对某综合医院肿瘤科的14名医务人员进行面对面深入半结构式访谈,对获得的资料采用Colaizzi分析法进行分析、整合。[结果]医务人员对晚期肿瘤病人实施临终关怀的态度是积极的,但对临终关怀工作的相关内容知晓不全面;强烈呼吁加强对临终关怀知识,特别是心理知识的培训;在对待病人的善终和死亡问题上,往往由医生告知家属,不会向病人直接谈及死亡;病人去世后对家属的帮助仅限于医院内,缺乏家庭延伸服务的内容;医院对临终关怀病房的硬件设施投入不足。[结论]医院需要建立专门的临终关怀团队,以满足临终关怀工作的需要;对医务人员加强临终关怀知识的培训,特别是心理知识的培训势在必行;选择最佳病情告知方式,使临终病人能够坦然接受死亡;对病人家属的帮助与支持应更全面、更持久。     

临终关怀之探讨

临终关怀的宗旨是减少临终病人的痛苦,增加病人的舒适程度,提高病人的生命质量,维护病人的尊严,同时对病人家属予以精神上的支持,临终关怀的实施有其必要性及迫切性。肿瘤病人的急剧增多,晚期癌症病人精神,肉体,经济上的困扰,使其成为临终关怀的主要对象,根据我国的国情,宜发展在医院内附设的临终关怀单位。在推行过程中可能遇到的社会习俗,死亡观念的影响,经费筹措困难以及医护人员本身的阻力,建议加强死亡教育,纠正     

Patterns of Care for Patients with Cancer before and after the Establishment of a Hospice Ward

A majority of people die in acute hospital care, in a culture of quickness primary aimed at curing. There are indications that hospice care in various forms will spread during the present decade in Sweden. The hospice philosophy contributes to a culture of slowness, where the patient is not only allowed but is encouraged to live at his own pace. As a first step in establishing for whom hospice inpatient care is the best alternative, patient flow to a newly started hospice ward was studied. All patients (n = 1464) who died at the Medical Centre Hospital with a primary diagnosis of cancer during the period of study were compared regarding place of death, diagnosis, gender, age and length of the last period of care. The year before the ward was established, 82% of patients died in acute hospital care compared with 59% during the hospice ward's third year of operation. A total of 315 patients (22%) died in the hospice ward during the study period. The percentage of these patients over the age of 80 was significantly higher (p = 0.0001), and they also had a longer continuous final period of care. More women (57%) than men (43%) were cared for at the hospice ward. The hospice ward has in this way influenced the pattern of care in the hospital.     

基于不同理论的安宁疗护实践研究进展

对不同理论下实行的安宁疗护进行总结，有利于为研究者提供多样化的干预方法。本文在简要回顾癌症现状、安宁疗护的概念等的基础上，重点介绍了基于不同理论框架下，对癌症患者实施安宁疗护的不同形式，比较各理论之间的特点和优势，为癌症患者及安宁疗护相关性研究提供理论指导。     

A qualitative study of caring in hospice wards in Shanghai

Despite the large number of people with cancer who need hospice care, utilization rates at community hospice service in Shanghai are low. This study aimed to review the care provided in these hospice wards and examine the difficulties in delivering service. Fourteen hospice care providers were interviewed, and the data analyzed using qualitative content analysis. Three themes emerged from the interviews: (i) characteristics of hospice patients, mostly cancer patients at the end‐of‐life stage (within 3‐months of life expectancy) who were admitted without awareness of their condition; (ii) components of care, from physicians and nurses who focused mainly on physical problems as psycho‐spiritual care stagnated at a superficial level; and (iii) difficulties in care, including a lack of patients as well as inadequacies in service, along with suggestions for the future. Efforts at improvement should be made in both the health care system and society. To address the lack of patients, doctors in secondary/tertiary care hospitals need improved skills in discussing end‐of‐life care, while the general public needs better awareness and acceptance of hospice care. Solutions should respect the perspective of patients and their families, while hospice care providers must also enhance their skills of communication and psycho‐spiritual care.     

Impact of availability of an inpatient hospice unit on the parent hospital's quality of palliative care for Taiwanese cancer decedents, 2001-2006

Context

Hospice care has increasingly been shown to affect quality of palliative care at both the individual and institutional levels. However, an institutional effect has only been addressed in single comprehensive cancer centers/selected community hospitals.

Objectives

To investigate the impact of an inpatient hospice unit on the parent hospital’s quality of palliative care.

Methods

This was a retrospective cohort study using administrative data from the entire population of 204,850 Taiwanese pediatric and adult cancer patients who died in 2001–2006. Outcome variables were adjusted by multivariate logistic regression for five groups of confounding variables: 1) patient demographics and disease characteristics, 2) primary hospital characteristics, 3) primary physician specialty, 4) health care resources at the hospital and regional levels, and 5) historical trend.

Results

Taiwanese cancer patients who received primary care in a hospital with an inpatient hospice unit (whether or not they received hospice care) were significantly less likely to be intubated (adjusted odds ratio [AOR]: 0.71; 95% confidence interval [CI]: 0.58, 0.86) and use mechanical ventilation support (AOR: 0.70; 95% CI: 0.56, 0.87) in their last month of life. They also were more likely to use hospice care before death (AOR: 3.51; 95% CI: 1.57, 7.86). Furthermore, if they used hospice care, they tended to be referred earlier than cancer patients being cared for in a hospital without an inpatient hospice unit.

Conclusion

Integrating both acute care and palliative care approaches to caring for terminally ill cancer patients in the same hospital may influence the quality of palliative care throughout the hospital as evidenced by our findings that these patients have lower likelihood of being intubated with mechanical ventilation support in the last month of life, greater propensity to receive hospice care in the last year of life, and a trend toward earlier referral to hospice care. The generalizability of these results may be limited to patients who died of a noncancer cause and by the two groups not being exactly matched for patients’ characteristics.     

King达标理论对癌症病人临终关怀的启示

临终关怀是人类社会文明发展的一个重要标志,同时也是社会发展的需要。为癌症病人实施临终关怀,可以使临终病人安详地走过人生最后旅程。将达标理论运用到对癌症病人的临终关怀中,可以通过护患之间积极的互动,促使病人参与到对自身护理的决策中来,护士与病人共同工作,更好地维护病人的尊严,满足病人生理及心理需要,为临终病人提供更人性化的护理。     

Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study

ContextThe impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied.ObjectivesTo determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer.MethodsThis nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006–2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression.ResultsOf 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio [AOR]: 0.70; 95% CI: 0.69–0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118–0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199–0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260–0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727–0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84–0.88).ConclusionHospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer.     

肿瘤患者安宁疗护护理质量评价标准的构建及应用研究

目的：建立安宁疗护护理质量评价标准,探讨其合理性及可操作性,为客观评价安宁疗护护理质量提供依据与检测工具。 方法：采用理论研究与临床调研相结合的方法初步拟订安宁疗护护理质量标准,应用德尔菲专家咨询法对 20 名专家进行两轮问卷咨询,定量分析各指标的权重。将该评价指标应用于临床,比较使用该指标前后护理质量的改善情况。 结果：护理质量标准包括Ⅰ级指标4条、Ⅱ级指标27条。将肿瘤患者安宁疗护质量评价指标应用于临床,比较应用后与应用前患者临终护理质量、患者及家属对护理的满意度,都有显著提高（P＜0.05）,具有统计学差异。 结论：安宁疗护护理质量标准指标体系各级指标的条目专家意见集中,研究结果可信度高,对安宁疗护护理质量的评价提供了客观、可量化的依据,值得在临床推广应用。     

肿瘤患者安宁疗护护理质量评价标准的构建及应用研究

目的 建立安宁疗护护理质量评价标准,探讨其合理性及可操作性,为客观评价安宁疗护护理质量提供依据与检测工具.方法 采用理论研究与临床调研相结合的方法初步拟订安宁疗护护理质量标准,应用德尔菲专家咨询法对20名专家进行两轮问卷咨询,定量分析各指标的权重后确定.将该评价指标应用于临床,比较使用该指标前后安宁疗护护理质量的改善情...     

Hospice and Heart Disease: Missed Opportunities

ABSTRACT

A relatively low percentage of eligible heart disease patients receive hospice care in the United States. In 2005, the most recent year with complete reporting, only 18.36% of patients who were dying of heart failure and were hospice eligible actually received hospice care. Reasons for this include the lack of reliable prognostic indicators, the lack of a consensus on when to stop life prolonging therapies, and the relatively high cost of life-prolonging (versus life-enhancing) pharmacotherapy such as dobutamine. In addition, most studies and case reports that address symptom management in hospice care focus on cancer patients, not those with nononcologic diagnoses. This lack of evidence may discourage practitioners who care for cardiac patients from referral to hospice programs, and may keep some hospice practitioners from aggressively targeting this population. Strategies to increase hospice program utilization by heart disease patients are discussed.     

基于精神关注的安宁疗护护理在乳腺癌患者中的应用效果

目的:研究分析基于精神关注的安宁疗护理在乳腺癌患者中的应用效果.方法:选择本院自2019年2月至2020年2月收治的88例乳腺癌患者为本次研究观察对象,应用计算机随机数字法将之分为两组,即对照组与观察组,每组中患者各占44例,对照组患者采用常规护理,观察组患者基于精神关注实施安宁疗护理,比较不同护理模式对于患者心理情绪...