加强临终关怀护理

阐明了临终关怀的理念及服务重点，指出疼痛控制和死后家属的情绪支持是目前临终关怀的重点内容。建议根据中国国情，实施临终关怀护理。首先，要建立临终关怀机构；其次，加强对病人、家属以及医护人员自身的死亡教育；第三，对护士进行抚慰知识和技能的培训；第四，培养护士的高尚道德情操，加强临床技能训练，开展心理学教育、掌握心理学的护理技能，做好临终关怀工作。     

北京东城区朝阳门医院临终关怀病人分析

本文对北京东城区朝阳门医院临终关怀病区的30名现住病人(文中简称住院组)和调查之日前在该病区死亡的30名病人(文中简称死亡组)的一般状况、接受临终关怀的原因、经费及满意度进行了分析。60名病人中女性占63.3％,70岁及以上占68.3％,50.0％的病人丧偶,文盲占21.1％,95.0％为退休或无职业者。75.0％的病人享受公费医疗或劳保医疗。接受临终关怀的原因以其他医院拒绝接收为最高,占40.0％,其中死亡组占66.7％。而住院组以家庭成员工作忙无法照顾和信任临终关怀医院为两个主要原因,各占43.0％。病人的病种死亡组经癌症和脑血管病后遗症为主,各占40.0％。住院组以脑血管病后遗症为主,占63.3％。死亡组平均住院17.6天,平均日住院费用117.74元,住院组平均住院254.7天,平均日住院费用53.42元。病人对临终关怀服务比较满意(4.50分)。更难能可贵的是死亡组家属对临终关怀给予高度评价(4.86分)。通过分析,我们对发展临终关怀事业,提高生命垂危人群的保健服务质量和满足不同人群的服务需要进行了粗浅的探讨。     

临终关怀的理论及研究概况

临终关怀作为一门新兴学科，是为临终病人及其家属提供全面的照顾与支持，旨在提高病人的生命质量，维持病人的尊严，使临终病人舒适地渡过人生。本文介绍了临终关怀的创始，临终关怀组织的工作内容、工作人员、环境设计、临终关怀组织形式中的居家护理方案等基本理论，同时也介绍了美国临终关怀组织的成长和临终关怀研究的基本情况。     

基层医院临终关怀病人对优质护理与人文关怀需求分析

目的:探究基层医院临终关怀病人对优质护理与人文关怀的需求,分析基层医院临终关怀病人相关的优质护理与人文关怀的现状,发现问题,并对基层医院的临终关怀事业提出合理化建议。方法:选取2016年7月-2018年7月我院收治的50位晚期恶性肿瘤患者进行观察问卷,分析研究基层医院临终关怀病人对优质护理与人文关怀的需求度和对现阶段相关服务的满意度。结果:在本次调查对象中,处于农业或无业情况的有46例(46/50)92%,28例(28/50)56%使用农村合作医疗承担医疗费用。33例(33/50)66%患者承受着中重度以上的疼痛,生活不能自理的患者占了76%,有数据可分析出大部分患者对临终关怀的优质护理和人文关怀具有非常强的需求度,占据56%以上,反而对就医期间的活动需求度比较低,仅占20%;患者家属哀伤期为(13.35±3.47)d,护理满意度为98.00%。结论:临终关怀病人对优质护理与人文关怀具有非常高的需求度,提高基层医院临终关怀病人的优质护理与人文关怀服务,能够有效的提高病人和家属对护理的满意度,减少家属的哀痛时间,改善病人剩余时间的生活质量,值得推广和完善。     

临终交谈的障碍与对策

研究表明，目前，临终关怀日益受到人们的重视。然而，许多方面还存在着大量未解决或有待解决的难题。临终交谈或讨论就是摆在病人及其家属，医疗保健提供者以及医疗保健系统面前的一个重大课题。文中详述了临终关怀中交谈的障碍与对策，以及病人和医生对临终关怀的一些看法，这将有助于今后有效地常规对临终或危害病人进行包括相互交谈在内的临终关怀。     

肿瘤病人临终关怀护士的职业倦怠及其心理症状

目的探讨肿瘤病人临终关怀护士的职业倦怠、心理症状及其之间的关系,为制定干预措施和提高临终关怀服务质量提供依据。方法采用随机抽样方法,对西安市3所三级甲等医院肿瘤科从事临终关怀工作的178名护士的职业倦怠和心理症状进行测评,并采用皮尔逊相关检验方法分析变量之间的关系。结果护士的职业倦怠程度得分为176.6±7.9,抑郁和焦虑症状得分分别为59.7±5.7和56.3±6.9。职业倦怠和抑郁症状、焦虑症状呈正相关,相关系数(r)分别为0.67、0.65,P0.01。等级线性模型分析结果表明,抑郁症状是导致护士职业倦怠的主要原因(Beta=0.45)。结论肿瘤病人临终关怀护士群体呈现出较高程度的职业倦怠,并伴有明显的抑郁和焦虑症状,抑郁症状是导致其职业倦怠的主要原因。     

英国临终关怀机构基本服务理念的启示

以英国小型独立临终关怀院——圣米歇尔临终关怀院(Saint Michael's Hospice)为例,介绍英国临终关怀院的高质量死亡、护理优先、支持生者、全民参与等服务理念,提出了应培育医务人员与民众科学理性死亡观、将临终关怀纳入基本公共卫生服务项目、建立以护理为核心的临终关怀服务模式、探索建立小型独立临终关怀机构等适合中国国情的临终关怀发展道路。     

晚期病人家属需求与照护

自1987年天津医学院临终关怀研究中心成立以来,临终关怀事业在我国有了长足的发展,全国各地纷纷创办了一些临终关怀医院或病房。临终关怀包括对病人(以晚期病人为主体)的关怀和对病人家属的关怀两个方面。以往我们的医疗与护理只侧重于病人本身,而忽视了对病人家属的     

我国临终关怀的现状和发展思考

临终是生命过程即将终结的阶段。临终关怀是指由社会各阶层组成的团体，为临终病人提供的生理、心理和社会的全面支持与照护。其目的既不是治疗疾病或延长生命，也不是加速死亡，而是改善病人余寿的质量，使病人能够安详而有尊严地走完人生最后的旅程。临终关怀同时为减轻其家属的失落和悲哀给予支持和鼓励，使临终的病人及其家属能够心平气和地迎接死亡。随着人类社会的进步，人生价值观的改变，临终关怀越来越得到社会的重视。我国的临终关怀也有了20年的发展经历，笔者通过对我国临终关怀现状的阐述，对其今后的发展提出思考和建议，以期临终关怀能够向规范化、标准化和系统化的方向发展。     

癌症患者的心理特点及临终关怀的实施

目的 探讨观察癌症患者的心理变化,实施心理干预。方法 了解癌症患者心理变化特点,给予临终关怀,以缓解病人对死亡的恐惧。结果 通过临终关怀,使病人安详走完生命的最后历程。结论 了解临终患者的心理变化,实施恰当的临终关怀,减轻病人躯体和心理上的痛苦,是护理工作的重要部分。     

Terminal care preferences: hospice placement and severity of disease

National Hospice Study data for 1981-82 were used to predict the location of care for terminal cancer patients. Sites of care were conventional care in hospitals, hospital-based hospice care, and hospice care in the home. Subjects were terminal cancer patients with a prognosis of less than 6 months of life who were attended by a primary concerned person. There were 1,732 patients 18-99 years old-293 conventional care, 612 hospital-based hospice care, and 827 hospice home care patients. Data sources were the patient, the primary concerned person, the family, and the medical record. Data were obtained at initial interview for the study, 1-week followup, reassessment every 2 weeks, and bereavement interviews. Information was grouped in the following categories: patient functional status, patient psychological outlook, symptomatology, medical condition, and characteristics of the primary concerned person and family. Conclusions were reached by univariate and multivariate analysis. First, a progression of functional disability was found to exist among care sites, from hospice home care for the least disabled to hospital-based hospice care to conventional care for patients with the greatest disabilities. The location of care was best explained by the patient's functional capacity. Second, the location of care was found to be poorly explained by extent of organ involvement or specific symptoms. Third, the primary concerned persons of patients under hospice home care experienced more stress but reacted no differently when compared with primary concerned persons at other care sites. Fourth, patients under hospice home care survived the longest and reported greater family closeness than other care groups.     

Coverage of cancer patients by hospice services, South Australia, 1990 to 1993

Abstract: A population-based observational study of South Australian cancer patients was used to identify: the level of coverage of cancer patients by hospice services; the types of patients who miss out on hospice care; and the place of death of hospice and other cancer patients. We reviewed patients who died in 1990 and 1993 using the Central Cancer Registry database together with an identifier of hospice involvement. In 1990, 56 per cent of cancer patients who died had care from a hospice service, and this proportion increased to 63 per cent in 1993. Elderly patients, rural residents and those with a haematological malignancy were less likely than other patients to receive care from a hospice service, while patients aged between 40 and 60 years, longer survivors and those born in the United Kingdom and Europe were more likely to receive hospice care. Hospice involvement increased significantly between 1990 and 1993 for patients who died at home (59 to 73 per cent), in nursing homes (20 to 45 per cent), private hospitals (33 to 52 per cent) and public hospitals (48 to 55 per cent), but the proportion of patients with hospice involvement who died in country hospitals remained at 45 per cent. The increase in hospice coverage of terminal cancer patients reflects the continued integration of hospice care into the mainstream of health care delivery. The types of patients who miss out on hospice services should be given special consideration in the future planning of terminal care services. ( Aust N Z J Public Health 1998; 22: 45-8)     

Anesthesia practitioner involvement, invasive treatments, and need in hospice pain management: a survey of patient care coordinators.

Pain management is one of the major concerns for the terminal patient. The hospice care team is a highly trained group of health care providers in the area of symptom control, including pain management, for the dying patient. Anesthesia providers also specialize in pain control. The purposes of this study were to survey hospice patient care coordinators to gain an understanding of anesthesia practitioners' involvement with hospice patients, hospice patients' access to anesthesia pain management services, and hospice patient care coordinators' attitudes toward the necessity of anesthesia pain management services for the hospice community. A questionnaire was developed to assess these issues. In general, the findings reflected minimal anesthesia practitioner involvement in the hospice community. Fifty-two percent reported that patients could benefit from invasive treatments offered by anesthesia practitioners. Forty percent responded that more patients could be considered as candidates for invasive pain management techniques if procedures were performed in the patient's home or hospice. Access to anesthesia pain management services was limited by distance to pain clinics and anesthesia practitioners, and more anesthesia pain management services were needed for hospice patients in smaller communities. Cost of anesthesia pain management was frequently proposed as a prohibitive factor.     

A comparison of hospice and conventional care

Interviews with relatives and others who knew a group of people dying of cancer in England are reported. The bulk of the paper compares 45 such patients who received hospice care with 126 who received conventional care. The sampling procedure showed that 2.9% of people aged 15 or over at death died in a hospice, and 6.9% received some form of hospice service. The hospice patients differed in several ways from other cancer patients. They had fewer conditions other than cancer recorded on the death certificate, were believed to be more religious and were more likely to suffer from a variety of symptoms and restrictions, including pain. Hospice patients were reported more likely to know that they were dying and respondents' levels of satisfaction with hospice home nursing and in-patient hospice care were significantly higher than for other forms of care. Hospice home nurses were found to have adopted a more advisory approach to nursing care than other home nurses who focussed more on practical care. When final admissions were considered, in-patient hospice care involved fewer medical interventions and, in the last year of life, those receiving hospice services were less likely to have an operation. There were few differences between the two groups in what happened at the time of death, although for in-patient deaths, respondents judged the staff of hospices to be more understanding. The relatives of hospice patients were more likely to be visited by a nurse at home after the death. Few differences in bereavement reaction were found, but those that were suggested that respondents for the hospice group were adjusting better.(ABSTRACT TRUNCATED AT 250 WORDS)     

艾滋病患者临终关怀工作模式和机制研究

摘要：目的　探索红十字会系统如何落实国务院艾滋病防治工作委员部门职责规定,深入开展艾滋病患者
临终关怀工作。方法　中国红十字会总会组建专家组,制定了调研计划,统一开发指导手册,在广西壮族
自治区南宁市、宁夏回族自治区银川市、四川省德昌县和资中县,四个点开展临终关怀试点和调研工作。
结果　共有１３６２人接受了调查,对７５ 例艾滋病患者接受临终关怀和照护。患者在接受过临终关怀服务
后,精神状态有了明显的改善,对死亡的恐惧感有所下降,心态也变得轻松舒缓。患者及家属通过本次临
终关怀服务,对临终关怀及其理念有了更深的了解,对为其提供临终关怀服务的医务人员及志愿者们深表
感激。结论　我国开展艾滋病患者临终关怀工作十分必要;红十字会系统开展艾滋病患者临终关怀工作可
行;红十字会系统开展艾滋病患者临终关怀工作具有独特优势,并已经积累了初步经验。建议在艾滋病防
治领域专项开展艾滋病患者临终关怀项目;红十字会系统全面参与,并协调多部门、社会组织、志愿者开
展艾滋病患者临终关怀工作;采取先试点,再推广的原则,在我国逐步推广艾滋病患者临终关怀服务。通
过宣传向大众普及死亡教育,同时告知社会,红十字会专项开展对艾滋病患者的临终关怀工作,待时机成
熟,建立专项基金,为爱心人士搭建捐助平台,为该项工作可持续发展奠定基础。
关键词：艾滋病;患者;临终关怀;模式和机制
中图分类号：Ｒ５１２．９１　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０５ ０４２３ ０３     

AIDS and hospice

Which AIDS patients should be admitted to hospice programs? Many health care professionals feel that any anti-viral drug or treatment directed against the opportunistic infections characteristic of AIDS to be incompatible with hospice philosophy. Others argue that inclusion of AIDS patients blurs the distinction between hospice and community service programs. We argue that achieving consensus on this issue is best served by focusing on the defining characteristic of hospice programs--the care of the dying. Consensus is not served by dwelling on the specific palliative or supportive measures used to achieve the hospice goal. We suggest a framework by which AIDS patients may be accommodated in existing hospice programs while maintaining hospice program integrity. It is further suggested that these may be used for the consideration of any patient for hospice care.     

‘I am closer to this place’—Space,place and notions of home in lived experiences of hospice day care

In the United Kingdom hospice day care services are the fastest growing yet least researched of the palliative care services. Using photo-elicitation interviews with 11 day care patients attending a specialist hospice day care setting we explored their experiences of the hospice as a place and how these changed over time.Informed by concepts from existential and humanistic geography we propose three existential modes of being – Drifting, Sheltering and Venturing – which characterize the patients’ lived experiences of the hospice. Our phenomenological analysis shows that the hospice is (re)constructed purposefully to achieve a sense of ‘home’ and ‘homelikeness’, creating an important therapeutic landscape for patients.     

Bereaved Hospice Caregivers' Views of the Transition to Hospice

This study was conducted to explore the communication process between patients, caregivers, and health care professionals, including social workers, through which the decision to choose hospice occurred. Ten bereaved hospice caregivers of patients over age 60 receiving home hospice services participated in this qualitative (phenomenological) study. They represented a range of patient and caregiver characteristics such as age, ethnicity, diagnoses, length of hospice service use, and caregiver relationship to patient. A semi-structured interview guide was used to capture key components in the end-of-life communication process, including discussions caregivers had with health care professionals regarding patients' diagnoses, prognoses, end-of-life care treatment options, and eventual referral to hospice. Themes that emerged included: involvement of health care professionals, relationship with physicians, involvement of patients in decisions, content of discussion, understanding of hospice, and suggestions for improvement. Physicians and social workers were noted to be most involved in the communication, decision making, and transition to hospice; however, a need exists for a more coordinated approach to discussing end-of-life care options with seriously ill patients and their families.     

What does hospice cost?

This paper presents the preliminary results of the economic analyses of the National Hospice Study (NHS), mandated by the United States Congress to investigate the implications of including hospice services in Medicare. Data were collected over an 18-month period from approximately 4,000 patients receiving hospice and conventional terminal care in 25 hospices and 12 conventional care sites. Subsequent analysis may lead to changes in the specific results, and some of the differences may be due to confounding variables that cannot be adjusted for. According to these data, hospital based (HB) hospice costs per day are 44 per cent higher than home care (HC) hospice costs per day ($95 versus $66, respectively). In addition, per patient hospice costs are 24 per cent more for patients enrolled in HB than in HC hospices ($5,890 versus $4,758, respectively). The proportional difference between HB and HC in cost per patient is smaller than the cost per day difference due to the shorter average HB length of stay, 62.3 days compared to 72.5 days for HC. Regarding the cost savings of hospice compared to conventional care, HC hospice costs are lower than conventional care costs regardless of length of stay. However, HB costs seem lower than conventional care costs only for patients with lengths of stay less than two months. Hospice and conventional care patients appear to differ with respect to predisposition toward intensive health care utilization. When this difference is explored more thoroughly in subsequent analyses, the estimated cost differential between hospice and conventional care may change.