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Development of a Home-Based Family Caregiver Cancer Education Program 以家庭为基础的家庭照顾者癌症教育计划的发展
Pub Date : 2000-12-01 DOI: 10.1080/0742-969X.2000.11882960
M. Pickett, F. Barg, M. P. Lynch
ABSTRACT Introduction: This article describes a home-based educational program developed specifically for family caregivers of cancer patients who receive hospice and home care. The overall aim of this educational program is to specifically address family caregivers’ needs for acquisition of necessary knowledge and skills to meet the physical and psychosocial demands associated with caring for a patient with advanced cancer. Program Development: Originally, components of this program were offered in a small group discussion format within hospital and community settings. The educational program was transformed to accommodate the unique needs and constraints of homebound family caregivers who have very limited time and/or opportunities for support and education outside of the home. The program is comprised of educational modules that provide hospice and home care professionals with written and audiovisual materials designed to facilitate brief, structured, educational encounters with family caregivers in the home setting. Discussion: Two hundred thirty-seven educational module kits were distributed to professionals affiliated with twenty-four home care and hospice agencies in the Greater Philadelphia area. Results of a telephone survey designed to elicit evaluation data from professional staff members who had used the educational modules are presented. Limitations, plans for future program evaluation, cost implications, and implementation recommendations related to this educational program are described. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ©2001 by the Haworth Press, Inc. All rights reserved.]
摘要简介:这篇文章描述了一个专门为接受临终关怀和家庭护理的癌症患者的家庭护理人员开发的基于家庭的教育计划。这个教育项目的总体目标是专门解决家庭照顾者对获得必要知识和技能的需求,以满足与照顾晚期癌症患者相关的身体和心理需求。项目开发:最初,这个项目的组成部分是在医院和社区环境中以小组讨论的形式提供的。教育项目经过改造,以适应家庭照顾者的独特需求和限制,这些家庭照顾者在家庭之外获得支持和教育的时间和/或机会非常有限。该计划由教育模块组成,为临终关怀和家庭护理专业人员提供书面和视听材料,旨在促进与家庭护理人员在家庭环境中的简短,结构化,教育接触。讨论:237个教育模块包分发给大费城地区24个家庭护理和临终关怀机构的专业人员。本文介绍了一项电话调查的结果,该调查旨在从使用教育模块的专业工作人员那里获得评价数据。描述了与该教育计划相关的限制、未来计划评估、成本影响和实施建议。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。网站:©2001 by the Haworth Press, Inc.。版权所有。]
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引用次数: 15
When Someone You Love is Dying: Making Wise Decisions at the End of Life. David Clark and Peter Emmett 当你爱的人即将死去:在生命的尽头做出明智的决定。大卫·克拉克和彼得·埃米特
Pub Date : 2000-12-01 DOI: 10.1080/0742-969X.2000.11882964
J. Sweers
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引用次数: 0
Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Therese A. Rando, Ed. 预见性哀悼的临床维度:与临终者,他们的亲人和他们的照顾者一起工作的理论和实践。特蕾莎·a·兰多,埃德。
Pub Date : 2000-12-01 DOI: 10.1080/0742-969X.2000.11882962
A. Hecht
(2000). Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Therese A. Rando, Ed. The Hospice Journal: Vol. 15, No. 4, pp. 53-55.
(2000)。预期性哀悼的临床维度:与垂死者、他们的亲人和他们的照顾者合作的理论和实践。Therese A.Rando,《临终关怀杂志》编辑:第15卷,第4期,第53-55页。
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引用次数: 0
Effects of Massage on Pain Intensity, Analgesics and Quality of Life in Patients with Cancer Pain: A Pilot Study of a Randomized Clinical Trial Conducted Within Hospice Care Delivery 按摩对癌症疼痛患者疼痛强度、镇痛药和生活质量的影响:一项在安宁疗护内进行的随机临床试验的初步研究
Pub Date : 2000-09-01 DOI: 10.1080/0742-969X.2000.11882956
D. Wilkie, Janice Kampbell, S. Cutshall, Heather Halabisky, Hilda Harmon, Linda P. Johnson, Lynn Weinacht, Mark Rake-Marona
ABSTRACT Aims: In a randomized controlled clinical trial (RCCT), we examined the effects of four massages on pain intensity, prescribed IM morphine equivalent doses (IMMSEQ), hospital admissions, and quality of life (QoL). Methods: Of 173 referred patients, 29 (14 control, 15 massage) completed this pilot study. Subjects were 69% male and aged 63 years on average. Licensed therapists administered four, twice-weekly massages. Baseline and outcome measurements were obtained by other team members before the first and after the fourth massages. Results: Pain intensity, pulse rate, and respiratory rate were significantly reduced immediately after the massages. At study entry, the massage group reported higher pain intensity (2.4 ± 2.8 vs. 1.6 ± 2.1) which decreased by 42% (1.4 ± 1.5) compared to a 25% reduction in the control group (1.2 ± 1.3) (p > .05). IMMSEQ doses were stable or decreased for eight patients in each group and increased for seven massage and six control group patients. One massage group and two control group patients were hospitalized. All initial QoL scores were higher in the massage group than in the control group, but only current QoL was statistically significant. Both groups reported improved global QoL. The control group reported slight improvement in current QoL and satisfaction with QoL whereas these two aspects of QoL declined in the massage group even though their average QoL scores were higher than the control group at the end of the study. Conclusions: We demonstrated feasibility of conducting an RCCT in which we systematically implemented massage as a nonpharmacologic comfort therapy along with our usual hospice care. The massage intervention produced immediate relaxation and pain relief effects. A power analysis based on trends in the longer-term effects indicate that a study with 80 subjects per group is likely to detect statistically significant effects of usual hospice care with twice-weekly massage therapy sessions on pain intensity, analgesic dosages, and quality of life. Lessons we learned from conducting this pilot study are being used to improve documentation of our hospice program outcomes and to plan a definitive study. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
摘要目的:在一项随机对照临床试验(RCCT)中,我们研究了四种按摩对疼痛强度、处方吗啡当量剂量(IMMSEQ)、住院率和生活质量(QoL)的影响。方法:173例转诊患者中,29例(对照组14例,按摩组15例)完成本初步研究。受试者69%为男性,平均年龄63岁。有执照的治疗师每周进行两次按摩。基线和结果测量由其他团队成员在第一次按摩前和第四次按摩后获得。结果:按摩后疼痛强度、脉搏率、呼吸率均明显降低。在研究开始时,按摩组报告了更高的疼痛强度(2.4±2.8 vs. 1.6±2.1),与对照组(1.2±1.3)减少25% (p < 0.05)相比,疼痛强度降低了42%(1.4±1.5)。每组8例患者的IMMSEQ剂量稳定或减少,按摩组7例患者和对照组6例患者的IMMSEQ剂量增加。推拿组1例,对照组2例。按摩组的所有初始生活质量评分均高于对照组,但只有当前生活质量有统计学意义。两组都报告了总体生活质量的改善。对照组在目前的生活质量和对生活质量的满意度方面略有改善,而按摩组在生活质量的这两个方面有所下降,尽管他们的平均生活质量评分在研究结束时高于对照组。结论:我们证明了进行RCCT的可行性,在RCCT中,我们系统地将按摩作为一种非药物舒适疗法与我们通常的临终关怀一起实施。按摩干预产生了立即放松和缓解疼痛的效果。一项基于长期效果趋势的功效分析表明,一项每组80名受试者的研究可能会发现,每周两次的常规临终关怀按摩治疗对疼痛强度、止痛剂剂量和生活质量的影响具有统计学意义。我们从这项初步研究中学到的经验,正被用来改善我们安宁疗护计划结果的文件,并计划一项明确的研究。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 132
Hospice Family Caregivers: An Experience in Coping 安宁疗护家庭照护者:应对的经验
Pub Date : 2000-09-01 DOI: 10.1080/0742-969X.2000.11882954
Stephenie V. Brinson, Q. Brunk
ABSTRACT The purpose of this phenomenological study was to identify coping strategies of rural family caregivers who were caring for an elderly relative in a home hospice situation. Each of the six participants were interviewed on two occasions exploring their caregiving experience with a focus on coping strategies. Colaizzi’s six step phenomenological method was employed for data analysis. Participant caregivers specifically identified coping strategies of support, adaptive activities, spiritual means, and avoidance. The collected data were analyzed and the findings compared to related caregiving literature. Implications for nursing practice and future research opportunities are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
摘要本研究旨在探讨农村家庭照护者在居家安宁疗护情境下照顾长者的因应策略。六名参与者中的每一位都接受了两次采访,探讨了他们的护理经历,重点是应对策略。采用Colaizzi的六步现象学方法进行数据分析。参与者照顾者特别确定了支持、适应性活动、精神手段和回避的应对策略。对收集的数据进行分析,并与相关护理文献进行比较。对护理实践的启示和未来的研究机会进行了讨论。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 15
Using the Solution Focused Brief Therapy Model with Bereavement Groups in Rural Communities: Resiliency at Its Best 使用解决方案为重点的简短治疗模式与丧亲团体在农村社区:弹性最佳
Pub Date : 2000-09-01 DOI: 10.1080/0742-969X.2000.11882955
Susan W. Gray, Marilyn R. Zide, H. Wilker
ABSTRACT The major goals of bereavement groups are to help resolve the conflicts of separation, facilitate the completion of grief tasks, provide a social support system, and give permission to mourn. This article describes how the Solution Focused Brief Therapy (SFBT) model can be applied to bereavement groups. In addition, the authors’ provide examples of techniques useful for setting the beginning foundation for bereavement group work in the rural community. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
丧亲小组的主要目标是帮助解决分离的冲突,促进悲伤任务的完成,提供社会支持系统,并允许哀悼。这篇文章描述了如何解决集中简短治疗(SFBT)模式可以应用于丧亲团体。此外,作者还提供了有助于为农村社区丧亲小组工作奠定基础的技术实例。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 10
Association Between Administrative and Ownership Characteristics of Hospices and Their Proportion of Inpatient Deaths 安宁疗护院行政与所有权特征与住院病人死亡比例之关系
Pub Date : 2000-09-01 DOI: 10.1080/0742-969X.2000.11882958
C. Ryan
ABSTRACT Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policymakers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
安宁疗护病人比接受传统医疗照护的病人更可能在家中死亡,但不同疗护方案的家庭死亡比例不同。本文研究安宁疗护行政特质对住院病人死亡率的影响。1993年至1995年间在纽约州开展的临终关怀项目的数据来自州卫生部和国家临终关怀组织的出版物。住院病人死亡率在不同的运营结构之间差异很大:作为家庭保健机构分支的临终关怀院为11%;医院公司下属的临终关怀医院占34%;20%是独立的临终关怀公司。这种差异可以用专门的住院安宁疗护单位的存在来解释:有这种单位的计划比没有的计划显示出更高的住院死亡率(42%比11%;p < .00001)。虽然不一定是因果关系,但这些关联应该引起患者、医生、家属和决策者的兴趣。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 3
Association between administrative and ownership characteristics of hospices and their proportion of inpatient deaths. 安宁疗护的行政与所有权特征与住院病人死亡比例之关系。
Pub Date : 2000-06-29 DOI: 10.1300/J011V15N03_05
C. Ryan
Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policy-makers.
安宁疗护的病人比接受传统医疗照护的病人更可能在家中死亡,但在家死亡的比例因疗护计划而异。本文研究安宁疗护行政特质对住院病人死亡率的影响。1993年至1995年间在纽约州开展的临终关怀项目的数据来自州卫生部和国家临终关怀组织的出版物。住院病人死亡率在不同的运营结构之间差异很大:作为家庭保健机构分支的临终关怀院为11%;医院公司下属的临终关怀医院占34%;20%是独立的临终关怀公司。这种差异可以用专门的住院安宁疗护单位的存在来解释:有这种单位的计划比没有的计划显示出更高的住院死亡率(42%比11%;P < 0.001)。虽然不一定是因果关系,但这些关联应该引起患者、医生、家属和决策者的兴趣。
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引用次数: 1
Participatory Action Research and Hospice: A Good Fit 参与式行动研究与安宁疗护:一个很好的契合
Pub Date : 2000-06-29 DOI: 10.1080/0742-969X.2000.11882957
P. Kovacs
ABSTRACT While research has always been an important component of the hospice movement in this country, increasingly hospices are involved in research as a result of demands for outcome measures and greater accountability. In addition to the more traditional research strategies, hospice researchers are encouraged to use participatory action research (PAR) in their efforts to better understand, document, and evaluate services. This article describes PAR and provides an example of a modified usage of PAR with a hospice program serving persons with AIDS. Whether used primarily in the planning phase of research or in conducting and reporting results as well, PAR maximizes input from those who know hospice best-staff, volunteers, patients, and caregivers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
虽然研究一直是这个国家临终关怀运动的重要组成部分,但由于对结果测量和更大责任的要求,越来越多的临终关怀医院参与研究。除了比较传统的研究策略外,我们鼓励安宁疗护研究人员使用参与性行动研究(PAR)来更好地了解、记录和评估服务。本文描述了PAR,并提供了一个在为艾滋病患者服务的临终关怀项目中修改PAR用法的示例。无论是主要用于研究的计划阶段,还是用于执行和报告结果,PAR都可以最大限度地利用最了解临终关怀的人员、志愿者、患者和护理人员的意见。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 12
Intermittent Subcutaneous Injections for Symptom Control in Hospice Care: A Retrospective Investigation 间歇性皮下注射在安宁疗护中的症状控制:一项回顾性调查
Pub Date : 2000-06-01 DOI: 10.1080/0742-969X.2000.11882949
M. Letizia, J. Shenk, T. D. Jones
ABSTRACT An alternative route to oral medications used by some hospice programs is intermittent injections of medications using an indwelling subcutaneous butterfly needle. The nurse places the infusion sets and instructs caregivers on medication administration. Although this method has become more common in hospice care, it has not received much attention in part because of a lack of data to support its efficacy. This study describes the use of intermittent subcutaneous medications for symptom relief in a home hospice program. A chart review was conducted of the 191 patients who received medications by this route during three calendar years; 77% had cancer. The average duration of hospice care was 25 days; on average, intermittent subcutaneous medications were instituted 4 days prior to the patient’s death. The main indications for this route were inability to swallow/somnolence (65%), and pain unresponsive to oral medication (19%). Symptoms to be controlled by this method were pain (88%), anxiety (72%), and dyspnea (4%). Morphine was used most frequently for pain, and Ativan was used most frequently for anxiety. Side effects from the medications and problems with this route of administration were rarely reported, thereby supporting the practicality of this method in hospice care. These results form the foundation for a prospective study that is documenting staff, patient, and caregiver variables that impact on the effectiveness and manageability of this method of symptom management in hospice care. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
一些安宁疗护计划使用的替代口服药物的途径是使用皮下蝴蝶针间歇注射药物。护士放置输液器并指导护理人员给药。虽然这种方法在临终关怀中越来越普遍,但由于缺乏数据支持其有效性,它并没有受到太多关注。本研究描述在家庭安宁疗护计画中使用间歇性皮下药物来缓解症状。对在三个日历年内通过这种途径接受药物治疗的191名患者进行了图表审查;77%的人患有癌症。临终关怀的平均持续时间为25天;平均而言,在患者死亡前4天开始间歇性皮下药物治疗。这一途径的主要适应症是无法吞咽/嗜睡(65%),以及口服药物对疼痛无反应(19%)。用这种方法控制的症状是疼痛(88%)、焦虑(72%)和呼吸困难(4%)。吗啡最常用于治疗疼痛,阿拉西泮最常用于治疗焦虑。药物的副作用和这种给药途径的问题很少被报道,因此支持这种方法在临终关怀中的实用性。这些结果构成了一项前瞻性研究的基础,该研究记录了影响临终关怀中这种症状管理方法的有效性和可管理性的员工、患者和护理人员变量。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
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引用次数: 6
期刊
The Hospice journal
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