Which Cost Components Influence the Cost of Palliative Care in the Last Hospitalization? A Retrospective Analysis of Palliative Care Versus Usual Care at a Swiss University Hospital

ContextAlthough the number of studies on the economic impact of palliative care (PC) is growing, the great majority report costs from North America.ObjectivesWe aimed to provide a comprehensive overview of PC hospital cost components from the perspective of a European mixed funded health care system by identifying cost drivers of PC and quantifying their effect on hospital costs compared to usual care (UC).MethodsWe performed a retrospective, observational analysis examining cost data from the last hospitalization of patients who died at a large academic hospital in Switzerland comparing patients receiving PC vs. UC.ResultsTotal hospital costs were similar in PC and UC with a mean difference of CHF −2777 [95% CI −12,713 to 8506, P = 0.60]. Average costs per day decreased by CHF −3224 [95% CI −3811 to −2631, P < 0.001] for PC patients with significant reduction of costs for diagnostic intervention and medication. Higher cost components for PC patients were catering, room, nursing, social counseling, and nonmedical therapists. In sensitivity analyses, when we restricted PC exposure to three days from admission, total costs and average costs per day were significantly lower for PC.ConclusionStudies measuring the impact of PC on hospital costs should analyze various cost components beyond total costs to understand wanted and potentially unwanted cost-reducing effects. An international definition of a set of cost components, specific for cost-impact PC studies, may help avoid superficial and potentially dangerous cost discussions.     

军队医院护士自测健康与人口学因素的相关性研究

目的了解军队医院护士健康状况与人口学变量的关系,为促进护士健康水平提供依据。方法应用自测健康评定量表对965名护士进行调查分析。结果军队医院护士的自测健康状况得分为（7．54±1．01）分,处于中等偏上水平,护龄、人员类别是护士健康水平的影响因素。结论护理管理者可根据护士人口学特征,有针对性地采取措施,促进护士的身心健康。     

Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Pro re nata (PRN) medication is widely used and studied in psychiatric care, but our knowledge about patient participation in its administration is fragmented. The aim of this integrative review was to describe and synthesize previous knowledge of patient participation in PRN in psychiatric inpatient settings. We conducted both electronic and manual searches, using the CINAHL, Scopus, PsycINFO, and PubMed databases, and eight scientific journals. Searches were limited to the English language, to the years 2006–2016, and to selected papers using inclusion, exclusion, and quality criteria. We identified 16 relevant papers, and these showed that patient participation included patient‐related starting points, including the patients’ willingness to participate and their knowledge of the medication. The patients’ participation in PRN practices was demonstrated by the opportunity to request PRN and to refuse any PRN that was offered. Patient participation was shown to be linked to certain situations where PRN was recommended. The role that the professionals played in patient participation included interacting with patients, providing counselling and alternatives for PRN. Our results also revealed that coercion was used administering PRN. The existing literature exposed challenges that need to be addressed if patient participation in the use of PRN medication is to be effectively achieved in psychiatric inpatient settings. Equal partnerships between patients, nurses, and physicians are an essential part of this process, and further research into PRN medication is urgently needed, particularly studies that focus on patients’ experiences.     

中医医院护士组织气氛与职业获益感现状及其影响因素分析

目的：调查中医医院护士组织气氛和职业获益感的现状,分析其影响因素。方法：选择天津市 3所三级甲等中医医院在职护士共200名,采用一般资料调查表,护士组织气氛感知,护士职业获益感量表进行调查。结果：中医医院护士的组织气氛总分为（80.41±19.54）分,职业获益感为（100.79±21.38）分;多元回归结果显示,婚姻、工作年限、夜班是组织气氛感知主要影响因素（P<0.05）;职称、文化程度是职业获益感的主要影响因素（P<0.05）;Person相关分析结果显示护士组织气氛与职业获益感呈正相关（P<0.05）。结论：中医医院护士组织气氛和职业获益感均处于中等水平,积极的组织气氛有助于提升其职业获益感,护理管理者应根据护士不同工作年限、职称、文化程度采取不同的管理方式,发挥各层级护士潜能,提升中医临床护理质量,从而促进中医护理的发展。