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“Magic Happens Here”: Environmental Serenity in Residential Hospice Care “奇迹发生在这里”:安宁安宁的居家临终关怀环境
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505455
D. Waldrop, J. McGinley
Abstract The purpose of this study was to explore the unique interaction between the care that is provided in and the environmental features of hospice residences. Interviews with 40 professionals from eight hospice residences focused on elements of care. Visual content analysis was conducted with 187 photographs of internal and external environments. Three themes illuminated residential care as (a) patient-family-centered, (b) flexible, and (c) comfort-focused. Six environmental features are described as (a) site and context, (b) nature connectivity, (c) arrival spaces, (d) communal spaces, (e) private spaces, and (f) transitional spaces. The interaction between residential care and the environmental features creates environmental serenity.
摘要本研究的目的是探索临终关怀住所提供的护理与环境特征之间的独特互动。对来自八所临终关怀院的40名专业人员的采访集中在护理要素上。对187张内部和外部环境的照片进行了视觉内容分析。三个主题阐明了住院护理:(a)以患者家庭为中心,(b)灵活,(c)以舒适为中心。六个环境特征被描述为(a)场地和环境,(b)自然连通性,(c)到达空间,(d)公共空间,(e)私人空间和(f)过渡空间。住宅护理和环境特征之间的互动创造了环境宁静。
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引用次数: 0
Leon A. Pastalan (1930–2018) 莱昂·帕斯塔兰(1930–2018)
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505457
Benyamin Schwarz
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引用次数: 0
The Last Habitat: Living and Dying in Residential Care Facility 最后的栖息地:居住护理机构的生活和死亡
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505461
Benyamin Schwarz, R. Molnar, J. Benson, R. Tofle
Abstract This article is a part of a larger study regarding the place of dying. Through narrative analysis methods, we strived to obtain rich descriptions and idiosyncratic accounts of the experience of dying in institutional settings, predominately in the nursing home. The quality of the physical environment can impede or greatly enhance the extent to which a disabled older person can remain in his or her own home. Most of long-term care is provided by family members. However, as the condition of the care recipient deteriorates and the stress level of the caregiver increases, the need to supplement the informal care with formal care resources grows. Consequently, frail older adults may be relocated to a residential care facility. In other cases they may be discharged from a hospital to these institutional settings. Nursing homes are considered the last resort for frail, old people. Despite attempts to improve the environment of long-term care settings through “cultural change,” the overriding theme of much of the literature about the nursing home experience is one of rejection, loss, and in some extreme accounts, a “double burial” that equates relocation to a nursing home with a person’s final terminus of life.
摘要这篇文章是关于死亡地点的一项更大研究的一部分。通过叙事分析方法,我们努力获得对机构环境中死亡经历的丰富描述和独特描述,主要是在养老院。物质环境的质量可能会阻碍或大大提高残疾老年人留在自己家中的程度。大部分长期护理由家庭成员提供。然而,随着受护理者的病情恶化和护理者的压力水平增加,用正式护理资源补充非正式护理的需求也在增加。因此,体弱的老年人可能会被转移到寄宿护理机构。在其他情况下,他们可能会从医院出院到这些机构。疗养院被认为是体弱的老年人的最后选择。尽管试图通过“文化变革”来改善长期护理环境,但许多关于疗养院经历的文献的首要主题是拒绝、失落,在一些极端的说法中,“双重埋葬”将搬迁到疗养院等同于一个人生命的最后终点。
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引用次数: 2
Place of Death and Dying: Introduction 死亡地点和临终:介绍
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505459
Benyamin Schwarz, J. Benson
The subject of death is of a considerable interest to all of us, as it has been since the beginning of civilization. However, the place of dying has seldom been studied in the field of environmental gerontology. The concept of aging in place is often explored in the field, but the discussion normally stops short of the last stages as if aging in place is a condition that never ends. Still, dying is part of the inevitability of aging. And even though a number of scientists and statisticians argue whether people die of old age, there is plenty of evidence that life has its natural, inherent limits. Clearly, intrinsic physical developments associated with aging inevitably cause an individual to become more vulnerable to mortality, which “ends in all cases we know of, in death” (Ehrenreich, 2018, p. xv). Even the most successful aging process eventually involves accumulation of disabilities as a result of the ongoing conflict at the cellular level of our bodies. Sadly, “successful” aging is an ideal that hardly accommodates the realities of decline and death (Ehrenreich, 2018). Conforming to the modern demographic pattern, the majority of people in the Western society reach old age, and consequently they are destined to die of one of its ravages. No matter how good our medical care or our exercise and hygienic regimens are, our ability to control the biological continuum between “normal” aging and disease is very limited. We are all susceptible to chronic diseases and death (Cole, 1992), as the paradoxical nature of aging and death discloses.
死亡问题是我们所有人都非常感兴趣的问题,自文明开始以来就是如此。然而,在环境老年病学领域,死亡地点的研究却很少。“就地老化”的概念在该领域经常被探讨,但讨论通常在最后阶段结束,就好像就地老化是一种永远不会结束的条件一样。尽管如此,死亡是衰老不可避免的一部分。尽管许多科学家和统计学家争论人们是否死于老年,但有大量证据表明,生命有其自然的、固有的局限性。显然,与衰老相关的内在身体发育不可避免地会导致个体变得更容易死亡,“在我们所知的所有情况下,死亡都会结束”(Ehrenreich,2018,第xv页)。即使是最成功的衰老过程,由于我们身体细胞层面的持续冲突,最终也会导致残疾的积累。可悲的是,“成功”的老龄化是一种很难适应衰退和死亡现实的理想(Ehrenreich,2018)。根据现代人口结构模式,西方社会的大多数人都到了老年,因此他们注定会死于其中的一场灾难。无论我们的医疗保健、锻炼和卫生方案有多好,我们控制“正常”衰老和疾病之间生物连续性的能力都非常有限。正如衰老和死亡的矛盾本质所揭示的那样,我们都容易患上慢性病和死亡(Cole,1992)。
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引用次数: 3
Care Pathways for the Dying Patients: Physician Perspective 临终病人的护理途径:医师视角
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505463
Benyamin Schwarz, J. Benson
Abstract The overriding care philosophy in medicine is to prevent death, rather than focus on dying. However, increasing longevity in most parts of the world has resulted for many people in prolonged periods of declining health toward the end of life. This has complicated our understanding of when the dying process begins. As a result, there has been a growing movement within society and among health care systems to focus on finding ways to contribute to the quality of life of patients just before they die. The modern hospice and palliative-care movement has gained distinction as an alternative way of looking at health care. These care philosophies perceive dying as a natural part of the life cycle. Staff members prioritize comfort and quality of life over longevity. However, the goals of hospice and palliative care are often misunderstood by the public. This article is based on interviews with two palliative-care physicians that were conducted as part of a larger study about the place of dying. The goal of these interviews was to obtain the physician perspective of dying at a hospital, at home, and in an institutional setting, as well as to provide readers greater clarity on the palliative and hospice care perspectives within these contexts.
摘要医学中最重要的护理哲学是预防死亡,而不是关注死亡。然而,在世界大多数地区,寿命的延长导致许多人在生命的尽头健康状况长期下降。这使我们对死亡过程何时开始的理解变得复杂。因此,在社会内部和医疗保健系统中,越来越多的人开始关注如何在患者去世前提高他们的生活质量。现代临终关怀和姑息治疗运动已经成为看待医疗保健的另一种方式。这些护理哲学将死亡视为生命周期的自然组成部分。工作人员将舒适度和生活质量置于寿命之上。然而,安宁疗护和姑息治疗的目标经常被公众误解。这篇文章是基于对两位姑息治疗医生的采访,这是一项关于死亡地点的大型研究的一部分。这些采访的目的是获得医生对在医院、家中和机构环境中死亡的看法,并让读者更清楚地了解这些背景下的姑息治疗和临终关怀观点。
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引用次数: 3
Environments of Dying, Death, and Caregiving at End-of-Life 临终、死亡和临终关怀的环境
Pub Date : 2018-10-02 DOI: 10.1080/02763893.2018.1505458
J. Benson, Benyamin Schwarz
The process of dying, the provision of care associated with the end of life, and rituals of mourning and memorialization are all profoundly shaped by the physical places and social environments in which death occurs. Matters of dying are not only physical, emotional or spiritual, they are also relational, cultural, and political. Decision making about medical interventions, caregiving, location of death, and burial are complicated by numerous factors. For example, diagnosis and life stage of the dying, patient/caregiver family dynamics, relationships with physicians and nurses, personal beliefs about death and dying, and the ethos of end-of-life care espoused by varying health care systems influence our evaluations of what it means to experience a “good death,” and our bereavement. This special issue of the Journal of Housing for the Elderly includes six empirical articles focused on the environments of dying, death, and caregiving at end-of-life for older adults. The first four articles constitute a collection of papers by researchers at the University of Missouri that are derived from a larger, narrative project addressing older patients’, family caregivers’, and physicians’ perspectives about the process of dying in three different environments: home, nursing home, and hospital. A broad introduction entitled “Place of Death and Dying: Introduction” precedes the four empirical articles that developed from this project. The fifth and sixth articles in this issue constitute original research from others that address dying in residential hospice facilities, and places of burial and memorialization practices, respectively. In the first empirical article, “The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives,” the authors present a rich understanding about the meaning of home in the context of dying. Relational aspects of death and dying, especially relating to family and the co-conspiratorship between family, home, and experiencing a “good death,” are major themes derived from this study. The authors challenge the notion that dying at home is synonymous with dying well, and recommend that practitioners and caregiving families focus less on controlling the physical location of death and instead focus on evoking the “essence of home” regardless of location. The second article, “The Last Habitat: Living and Dying in a Residential Care Facility,” addresses patient and family caregiver perspectives about the phenomenon of dying in a residential care facility or nursing home. Based on the findings, the authors suggest that dying in a nursing home is arguably less dignified and more isolating than dying at home or in a hospital due to the chronic health conditions that typify nursing home residents and the ways nursing homes are physically, financially, and operationally structured. In the next article, “The ‘Medicalized Death’: Dying in the Hospital,” the authors present four cases of caregiver perspectives on dying in the hos
死亡的过程、与生命终结相关的护理以及哀悼和纪念仪式都受到死亡发生的物理场所和社会环境的深刻影响。死亡不仅是身体上的、情感上的或精神上的,也是关系上的、文化上的和政治上的。关于医疗干预、护理、死亡地点和埋葬的决策因多种因素而变得复杂。例如,死亡的诊断和生命阶段、患者/护理者的家庭动态、与医生和护士的关系、个人对死亡和死亡的信念,以及不同医疗保健系统所支持的临终关怀精神,都会影响我们对经历“美好死亡”和丧亲之痛意味着什么的评估。这期《老年人住房杂志》特刊包括六篇实证文章,重点关注老年人的死亡、死亡和临终关怀环境。前四篇文章是密苏里大学研究人员的论文集,这些论文来源于一个更大的叙事项目,涉及老年患者、家庭护理人员和医生对三种不同环境中死亡过程的看法:家庭、疗养院和医院。在该项目的四篇实证文章之前,有一篇题为“死亡之地:引言”的广泛介绍。本期的第五篇和第六篇文章构成了其他人的原创研究,分别涉及在寄宿临终关怀设施、埋葬和纪念场所死亡的问题。在第一篇实证文章《在家中死亡的动机和后果:家庭护理者视角》中,作者对死亡背景下家的意义有了丰富的理解。死亡和死亡的关系方面,特别是与家庭以及家庭、家庭和经历“美好死亡”之间的共谋有关,是本研究的主要主题。作者们对在家中死去等同于死得好的观点提出了质疑,并建议从业者和护理家庭不要太关注控制死亡的物理位置,而是专注于唤起“家的本质”,而不管位置如何。第二篇文章《最后的栖息地:在养老院生活和死亡》阐述了患者和家庭护理者对在养老院或疗养院死亡现象的看法。根据研究结果,作者认为,由于养老院居民的慢性健康状况以及养老院的身体、财务和运营结构,在养老院死亡可以说比在家或医院死亡更有尊严,更孤立。在下一篇文章“‘药物化死亡’:在医院中死亡”中,作者介绍了四个护理人员对在医院环境中死亡的看法。在这项研究中,“好的死亡”与“坏的死亡”的争论是照顾者故事的核心。与流行的观点不一致,作者发现医院
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引用次数: 0
Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change 从政策驱动的文化变革看疗养院的物理环境
Pub Date : 2018-03-07 DOI: 10.1080/02763893.2018.1431586
Emily Roberts, Alana Pulay
ABSTRACT A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.
摘要:由于严格的组织因素和类似医院的文化,迫切需要挑战养老院护理的方法。有人认为,住院护理需要通过解决养老院设施中的组织、社会和物理环境,朝着以人为本的方向发展,这一过程通常被称为文化变革。为了满足这一需求,医疗保险和医疗补助服务中心(CMS)为绩效付费(P4P)养老院激励计划提供了资金,允许养老院提供者获得CMS对设施文化变化的补偿。通过护理人员访谈、现场观察和文件审查,这项定性研究评估了中西部州P4P激励计划对三家参与养老院的影响。本研究采用环境与行为(E-B)政策导向框架,通过关注研究环境中的政策、物理环境、场所依恋以及社会和心理过程来考察文化变化。
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引用次数: 9
Experiences of a Mass Interinstitutional Relocation for Long-Term Care Staff 长期护理人员大规模机构间搬迁的经验
Pub Date : 2018-03-01 DOI: 10.1080/02763893.2018.1431582
S. Canham, M. Wada, L. Battersby, M. Fang, A. Sixsmith
ABSTRACT This research explored long-term care (LTC) staff perceptions and experiences of working in LTC and providing care to residents following a mass interinstitutional relocation. In-depth, semistructured interviews were conducted with 63 LTC workers. Thematic analyses revealed three overarching themes related to how staff members perceived their relationships with other staff members following relocation. The first theme, post-relocation relationships between staff members, included the subthemes “Staff are segregated from each other” (physical distance) and “We were a family” to “barely say hi” (psychological distance). The second theme, post-relocation stress, has two subthemes: “Staffing is our big issue” and consequences of stress: absenteeism and leave. The third theme is recommendations for improving and managing staff relationships post-relocation. Relationships among staff members are integral to working in LTC and providing care to residents following a mass interinstitutional relocation. Recommendations for improving staff relationships and morale are suggested.
摘要本研究探讨了长期护理(LTC)工作人员在大规模机构间搬迁后在LTC工作并为居民提供护理的看法和经验。对63名长期护理工作者进行了深入的半结构访谈。专题分析揭示了三个总体主题,涉及工作人员如何看待搬迁后与其他工作人员的关系。第一个主题是工作人员搬迁后的关系,包括“工作人员彼此隔离”(身体距离)和“我们是一家人”到“几乎不打招呼”(心理距离)的副标题。第二个主题是搬迁后的压力,有两个子主题:“人员配备是我们的大问题”和压力的后果:缺勤和休假。第三个主题是关于搬迁后改善和管理工作人员关系的建议。工作人员之间的关系对于在LTC工作和在大规模机构间搬迁后为居民提供护理是不可或缺的。提出了改善工作人员关系和士气的建议。
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引用次数: 2
Vulnerable African American Seniors: The Challenges of Aging in Place 弱势非裔美国老年人:老龄化的挑战
Pub Date : 2018-03-01 DOI: 10.1080/02763893.2018.1431581
James H. Johnson, Jr., Huan Lian
ABSTRACT American Community Survey data are used to develop typologies of the generational dynamics and living arrangements of the estimated 1.6 million African American older adult households who will likely encounter the most difficulty aging in place. Policy recommendations and strategies are offered to address the specific barriers and challenges that must be overcome in order for these older adults to successfully live out their lives in their homes and community.
摘要:美国社区调查数据用于对估计160万非洲裔美国老年家庭的代际动态和生活安排进行分类,这些家庭可能会在当地遭遇最困难的老龄化。提供了政策建议和战略,以解决必须克服的具体障碍和挑战,使这些老年人能够在自己的家庭和社区中成功地生活。
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引用次数: 6
Perceptions about Compliant Flooring from Senior Managers in Long-Term Care 高级管理人员对长期护理中合规地板的看法
Pub Date : 2018-03-01 DOI: 10.1080/02763893.2018.1431584
C. Lachance, V. Zaborska, P. Leung, F. Feldman, S. Robinovitch, D. Mackey
ABSTRACT This study explored barriers and facilitators to adoption of compliant flooring as a fall injury prevention strategy within long-term care from the perspective of 18 long-term care senior managers. In-depth interviews were recorded, transcribed, and analyzed using the Framework Method. The most important organizational facilitators to adoption were potential for injury prevention and long-term care staff's openness to change. The most important organizational barriers to adoption were negative effects to long-term care staff and financial considerations (i.e., cost and lack of funding). The most important general organizational considerations were uncertainties about clinical effectiveness, effects on long-term care staff, and flooring performance. Overall, compliant flooring was viewed positively for long-term care. The findings also suggest an opportunity for knowledge translation to inform long-term care senior managers about the existing evidence on compliant flooring.
本研究从18名长期护理高级管理人员的角度探讨了在长期护理中采用柔性地板作为跌倒伤害预防策略的障碍和促进因素。使用框架方法记录、转录和分析深度访谈。组织采用的最重要的促进因素是伤害预防的潜力和长期护理人员对变化的开放性。采用的最重要的组织障碍是对长期护理人员的负面影响和财务考虑(即成本和缺乏资金)。最重要的一般组织考虑因素是临床有效性的不确定性,对长期护理人员的影响,以及地板性能。总的来说,依从性地板对于长期护理是积极的。研究结果还提出了一个知识转化的机会,告知长期护理高级管理人员关于合规地板的现有证据。
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引用次数: 6
期刊
Journal of Housing for the Elderly
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