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Reflections on the history of occupational stress in hospice/palliative care. 安宁疗护/缓和疗护中职业压力的历史反思。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969X.1999.11882941
M. Vachon
The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century.
临终关怀和姑息治疗的概念是在25年前出现的,因为人们认识到临终者的需求未得到满足,以及20世纪60年代和70年代的社会问题。当时的话题包括性革命;对社会价值的质疑;由于肯尼迪兄弟和马丁·路德·金被谋杀,人们对死亡的意识越来越高,电视上每天都在报道越南战争中的死亡,女权主义,消费主义,在出生过程中重新获得更人性化的角色,因此在死亡过程中也是如此。安宁疗护运动的历史,以及工作人员所承受的压力,可追溯自安宁疗护发展初期至今。最初,有时很难将减轻身体症状的概念与满足患者和家属的社会心理和情感需求结合起来,护理人员被期望为工作牺牲大部分个人生活,情绪强度很高,并开发了支持以减轻护理人员所经历的一些压力。从早期开始,团队压力和倦怠就一直是人们关注的问题。80年代的问题包括建立资金来源,应对新的艾滋病危机,以及解决理想与现实之间的差距。在20世纪90年代,随着财政资源的减少,临终关怀试图将自己定位于主流护理,经济气候使一些一直存在的紧张局势升级。这些都是我们进入下一个世纪时所面临的问题。
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引用次数: 28
Origins: an American perspective. 起源:一个美国人的视角。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969x.1999.11882926
Z Foster, I B Corless

The birth of hospice in the United States was fostered by the work of Florence Wald, former Dean of the Yale School of Nursing. Her activities are emblematic of the dedication of many other hospice volunteers who made hospice a reality in the United States. Nurturer, humanitarian and visionary, we salute Florence Wald and the many others who have contributed to the change in how end-of-life care is rendered in the United States. Congratulations and well done.

美国临终关怀的诞生是在耶鲁大学护理学院前院长弗洛伦斯·沃尔德的工作下促成的。她的活动象征着许多其他临终关怀志愿者的奉献精神,他们使临终关怀在美国成为现实。养育者、人道主义者和有远见的人,我们向弗洛伦斯·沃尔德和其他许多为改变美国临终关怀方式做出贡献的人致敬。恭喜你,干得好。
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引用次数: 7
Symptom control in hospice--state of the art. 临终关怀的症状控制——最先进的技术。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969x.1999.11882928
J C Muir, L M Krammer, J R Cameron, C F von Gunten

There are a myriad of physical symptoms which can complicate the care of patients with advanced disease. Without knowledge of and attention to these distressing symptoms, the rest of the work of the interdisciplinary hospice team is greatly hampered. In this article, we review the management of ten prevalent symptoms in hospice care and to identify areas of clinical investigation underway and point of future areas ripe for investigation.

有无数的身体症状会使晚期疾病患者的护理复杂化。如果不了解和关注这些令人痛苦的症状,跨学科安宁疗护团队的其他工作将受到极大的阻碍。在这篇文章中,我们回顾了临终关怀中十种常见症状的管理,并确定了正在进行的临床调查领域和未来成熟的调查领域。
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引用次数: 0
End of life care and decision making: how far we have come, how far we have to go. 临终关怀和决策:我们已经走了多远,还要走多远。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969X.1999.11882931
C. Zuckerman, D. Wollner
While enormous progress has been made in improving the quality of care and the decision-making process for patients at the end of life, as a society we still have far to go to ensure that dying patients and their families have a comfortable and dignified death. In particular, reexamination and reconfiguration of our current decision framework is essential as our elderly population with chronic disease and slowly fatal conditions expands. With less certain disease paths and more complex and ambiguous choices, the growth of this geriatric population challenges us to develop a broader conceptualization of end of life care planning, so that end of life considerations are integrated into a larger anticipatory framework addressing options and needs as patients gradually decline. Within this framework hospice becomes a natural, integrated option along a continuum of care planning, rather than an abrupt alternative at a late stage of illness. End of life care planning must positively anticipate a robust array of needs and concerns well beyond the dramatic decisions to withhold or withdraw life-prolonging technologies usually found in advance directives. To embrace this broader framework it is critical that primary care physicians as well as disease specialists receive training in fundamental aspects of both geriatric and palliative care. Professionals from both of these disciplines must share expertise with each other, and should collaborate in advocacy efforts to effectuate changes in the clinical, policy and legislative arenas.
虽然在改善临终病人的护理质量和决策过程方面取得了巨大进展,但作为一个社会,我们仍有很长的路要走,以确保临终病人及其家属有一个舒适和有尊严的死亡。特别是,随着患有慢性病和慢性致命疾病的老年人口的扩大,对我们目前的决策框架进行重新审查和重新配置是至关重要的。由于不太确定的疾病路径和更复杂和模糊的选择,老年人口的增长挑战我们发展更广泛的临终关怀计划概念,因此,随着患者逐渐衰退,临终关怀考虑被纳入更大的预期框架,解决选择和需求。在这个框架内,临终关怀成为一个自然的、综合的选择,沿着连续的护理计划,而不是在疾病晚期的突然选择。临终关怀计划必须积极地预测一系列强有力的需求和关注,远远超出了预先指示中通常发现的保留或撤回延长生命技术的戏剧性决定。为了接受这一更广泛的框架,初级保健医生和疾病专家接受老年和姑息治疗基本方面的培训至关重要。这两个学科的专业人员必须相互分享专业知识,并应在宣传工作中合作,以实现临床、政策和立法领域的变革。
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引用次数: 29
End-of-life care: challenges and opportunities for health care professionals. 临终关怀:卫生保健专业人员的挑战和机遇。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969X.1999.11882932
D. Sherman
The failings of the American Health Care System in meeting the comprehensive needs of the seriously and terminally ill have led to both professional and public efforts to improve end-of-life care. Following a discussion of the shortcomings of end-of-life in America, this article describes the goals and philosophy of palliative care, while highlighting current innovative programs in end-of-life needs and insure quality of life for patients and families experiencing incurable, progressive illness. Health care professionals are called to respond to the challenges and opportunities of end-of-life care as individual health care providers, as members of professions, and as members of interdisciplinary teams committed to improving the care of the dying in America.
美国医疗保健系统在满足重病和绝症患者的全面需求方面的失败,导致专业人士和公众都在努力改善临终关怀。在讨论了美国临终关怀的缺点之后,本文描述了临终关怀的目标和理念,同时强调了当前临终关怀需求的创新项目,并确保患有无法治愈的渐进性疾病的患者和家庭的生活质量。卫生保健专业人员被要求作为个人卫生保健提供者,作为专业人员,作为致力于改善美国临终者护理的跨学科团队的成员,来应对生命末期护理的挑战和机遇。
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引用次数: 12
Documenting the impact of hospice. 记录临终关怀的影响。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969X.1999.11882937
M. Merriman
Hospice care has had an impact at many levels--on individual patients and families, on the health care industry, and on society. However, no comprehensive body of evidence has been generated that documents the impact of hospice care in terms that are meaningful to competitors, referral sources, and consumers. In part, this is because of the many challenges for evaluating hospice care. This paper describes recent efforts in the documentation of the value of hospice which have focused on outcomes measurement by individual providers rather than on large scale studies. Several groups are working to develop reliable measurement tools, to support standardized measurement in large numbers of hospices, and to collect information for benchmarking and comparison. Measurement of the impact of hospice care will set standards for other providers of end-of-life care and will document the expertise and knowledge of hospice professionals. Once established as centers of excellence in care of the dying, hospices will be well positioned for whatever delivery models may evolve for end-of-life care.
临终关怀在许多层面上产生了影响——对病人个人和家庭,对医疗保健行业,对社会。然而,目前还没有完整的证据来证明临终关怀对竞争者、转诊来源和消费者有意义的影响。在某种程度上,这是因为评估临终关怀面临许多挑战。本文描述了最近的努力,在文件的价值的安宁疗护已集中在结果测量由个人提供者,而不是大规模的研究。一些团体正在努力开发可靠的测量工具,以支持大量临终关怀的标准化测量,并为基准和比较收集信息。对安宁疗护影响的测量,将为其他生命末期疗护提供者设定标准,并将记录安宁疗护专业人员的专长与知识。一旦确立了临终关怀的卓越中心地位,临终关怀院将处于有利地位,无论临终关怀的交付模式如何发展。
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引用次数: 5
Personal reflections. 个人反思。
Pub Date : 1999-01-01
C B Tehan

A hospice pioneer and veteran of 23 years reflects on the early days of the hospice movement in the United States. The political, social and economic forces, which shaped the industry, are addressed from a local state and national perspective. Current challenges are briefly referenced with a call for hospice leaders to recognize the need for and identify where hospice fits into the broad end of life discussions.

一位从事了23年的临终关怀先驱和老兵,回顾了美国临终关怀运动的早期。政治、社会和经济力量塑造了这个行业,从地方和国家的角度来解决。目前的挑战被简要地提及,并呼吁安宁疗护领导者认识到安宁疗护的需要,并确定安宁疗护适合于广泛的生命终结讨论。
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引用次数: 0
Hospice reminiscences and reflections--an 18 year personal and professional love affair. 临终关怀的回忆和反思——18年的个人和职业爱情。
Pub Date : 1999-01-01
A MacGregor
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引用次数: 0
Access to care. 获得医疗服务。
Pub Date : 1999-01-01
C M Dahlin

In the twenty years since the National Hospice Organization began, hospice has grown tremendously. However, it still only serves a small percentage of terminally ill patients. This is because access to hospice services is limited by various restrictions to care. These barriers to care include societal attitudes towards death, diversity issues, socioeconomic issues, and eligibility issues. In order to develop and serve more of the population, hospice agencies must be flexible, creative, and use ingenuity to bridge the gaps that occur for some terminally ill patients.

自国家临终关怀组织成立以来的二十年里,临终关怀得到了极大的发展。然而,它仍然只服务于一小部分绝症患者。这是因为获得临终关怀服务受到各种护理限制的限制。这些护理障碍包括对死亡的社会态度、多样性问题、社会经济问题和资格问题。为了发展和服务更多的人口,安宁疗护机构必须灵活、有创意,并运用聪明才智来填补一些临终病人的空缺。
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引用次数: 0
"What should I say?": qualitative findings on dilemmas in palliative care nursing. “我该说什么呢?”对姑息治疗护理困境的定性研究。
Pub Date : 1999-01-01 DOI: 10.1080/0742-969x.1999.11882918
P McGrath, P Yates, M Clinton, G Hart

The nursing literature suggests that talking and listening to patients about issues associated with death and dying, is both important and difficult, and may be improved with training. This discussion presents the results of recent nursing research to confirm, and elaborate on, this theme. In this research participants touched on many central issues in communicating with patients that included articulating a sense of discomfort and inadequacy about the whole process, detailing the innumerable blocks to open communication [e.g., interference, denial, unrealistic optimism, resistance, collusion and anger] and sharing their sense of success and failure. The insights of nurses who participated in this research testify to the ongoing need to prioritize the development of nursing skills and support in this challenging but important area.

护理文献表明,与病人谈论和倾听与死亡和临终有关的问题既重要又困难,可以通过培训得到改善。本文介绍了近期护理研究的结果,以证实和阐述这一主题。在这项研究中,参与者触及了与患者沟通的许多核心问题,包括阐明整个过程中的不适和不足感,详细说明开放沟通的无数障碍[例如,干涉,否认,不切实际的乐观,抵抗,勾结和愤怒]以及分享他们的成功感和失败感。参与这项研究的护士的见解证明,在这个具有挑战性但重要的领域,护理技能和支持的优先发展需要持续不断。
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引用次数: 40
期刊
The Hospice journal
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