Recognising dying in acute care

The article reports on terminal care services which are offered to patients in Australia and discusses a terminal care program called the Liverpool Care Pathway which was implemented in Great Britain and is being tested in Australia. In the article the author offers her opinions on terminal care in Australia, on the Liverpool Care Pathway and on the education that Australian nurses receive the dying phase of the human life cycle

Saattohoidon toteutus kotihoidossa : opas hoitohenkilökunnalle

Tiivistelmä Tämän opinnäytetyön tarkoituksena oli suunnitella ja tuottaa saattohoito-opas Haukivuoren kotihoidon henkilökunnan käyttöön. Saattohoito-oppaan on tarkoitus soveltua tukemaan kaikkien hoitajien työtä. Saattohoito oppaan tavoitteena on johdonmukaistaa henkilökunnan toimintatapoja ja toimia henkilökunnan ja sijaisten perehdytysvälineenä saattohoidossa. Tässä opinnäytetyössä on keskitytty saattohoidon toteuttamiseen kotihoidossa. Saattohoidossa olevan potilaan elinaika on muutamia viikkoja tai korkeintaan kuukausia. Saattohoito tarkoittaa potilaan hyvää hoitoa ja hänen tukemistaan ennen kuolemaa sekä arvokasta kohtelua kuoleman jälkeen. Keskeisiä asioita saattohoidossa ovat potilaan kipujen lievittäminen ja kärsimyksien helpottaminen sekä fyysisiin, hengellisiin, psyykkisiin ja sosiaalisiin tarpeisiin vastaaminen. Saattohoitoon päätymisen edellytyksenä on, että potilaalla on etenevä parantumaton sairaus, johon ei ole etenemistä hidastavaa hoitoa tai jonka parantavasta hoidosta potilas on kieltäytynyt. Saattohoidon aloittaminen ei ole diagnoosista riippuvainen. Opinnäytetyön prosessi käynnistyi aiheen valinnalla. Saattohoitotyö on aiheena ajankohtainen, sillä vanhusväestön lisääntyessä joudutaan miettimään yhä enemmän saattohoitoa ja sen toteuttamista. Myös kotisaattohoito on lisääntymässä Suomessa, ja siksi aihe on tärkeä sekä itselleni että kotihoidon henkilökunnalle. Opinnäytetyön etenemistä ohjasi tiedonhalu siitä, mitä on saattohoito ja mitä osa-alueita kuuluu hyvään saattohoitoon. Sairaanhoitajan yksi keskeinen tehtävä on tarjota hyvää hoitoa myös potilaille, jotka ovat saattohoitovaiheessa. Tietoa aiheesta hain useista kansallisista ja kansainvälisistä tietokannoista ja arvioin sen soveltuvuutta tarkoitukseen yhteistyössä Haukivuoren kotihoidon henkilöstön kanssa. Henkilöstö osallistui saattohoito-oppaan suunnitteluun ja toteuttamiseen suunnittelupalaverissa ja kommentoimalla oppaan sisältöä ja ulkoasua kaksi kertaa prosessin aikana. Saattohoito-oppaaseen olen koonnut tiiviinä kokonaisuutena tietoa saattohoidosta, saattohoitopotilaan yleisimmistä oireis-ta ja niiden hoidosta sekä potilaan ja omaisen kohtaamisesta. Myös henkilökunnan resurssien vaikutus saattohoitotyön toteuttamiseen on otettu huomioon.Abstract The purpose of this thesis was to design and produce a terminal care guide for the personnel of Haukivuori home care. The guide is designed to be compatible in order to support all the work of the whole nursing personnel by offering consistent practices for terminal care. In addition, the guide can be used as an orientation tool for the personnel, substitutes and new employers. The thesis is focused on the implementation of terminal care at home. Patients receiving terminal care have a life expectancy of a few weeks or months at most. Terminal care means that patients are receiving good care and support before death as well as are treated with respect after death. The main aspects of terminal care are alleviation of patients´pain and suffering as well as facilitation of their physical, spiritual, psychological and social needs. Terminal care is meant for patients with progressive incurable disease when retarding therapy is not available or patients who refuse to receive curative treatment. Starting terminal care is not dependent on the diagnosis. The process on the thesis started by topic selection. Terminal care is a current subject, and as the elderly population increases it is necessary to think more and more about terminal care and its implementation. Terminal care at home is increasing in Finland, and therefore I considered it as an important topic for myself as well as home care personnel. One of the most important tasks of a nurse is to provide good care for patients who are in terminal care. The thesis was directed by the interest of what terminal care is. I searched for information concerning the topic from several national and international databases and evaluated compatibility of the data for the purpose of the thesis together with the personnel of Haukivuori home care. The personnel participated in designing and producing the guide in a planning meeting and by commenting the contents and appearance of the guide two times during the process. The terminal care guide contains information about terminal care, the most common symptoms of dying patients and their care as well as how to face patients and their relatives. In addition, the resources of personnel have been taken in the consideration

The Value of Life Near its End and Terminal Care

Medical care at the end of life, which is often is estimated to contribute up to a quarter of US health care spending, often encounters skepticism from payers and policy makers who question its high cost and often minimal health benefits. It seems generally agreed upon that medical resources are being wasted on excessive care for end-of-life treatments that often only prolong minimally an already frail life. However, though many observers have claimed that such spending is often irrational and wasteful, little explicit and systematic analysis exists on the incentives that determine end of life health care spending. There exists no positive theory that attempts to explain the high degree of end-of life spending and why differences across individuals, populations, or time occur in such spending. This paper attempts to provide the first rational and systematic analysis of the incentives behind end of life care. The main argument we make is that existing estimates of the value of a life year do not apply to the valuation of life at the end of life. We stress the low opportunity cost of medical spending near ones death, the importance of keeping hope alive in a terminal care setting, the larger social value of a life than estimated in private demand settings, as well as the insignificance in quality of life in lowering its value. We derive how an ex-ante perspective in terms of insurance and R&D alters some of these conclusions.

特別養護老人ホームにおける終末期ケアの現状と課題 : A県下の施設職員への調査から

Research purpose: The necessary condition for end term care fullness is clarified from investigation of the personnel who work in special elderly nursing home. Method of research: The reply of question paper was totaled and arranged for every question. The question about the basic attribute set up 11 items, such as "sex", "age", "years of experience", and an "occupational description." The question about the terminal care set up 122 items, such as a "sense of values", "practice", "knowledge", "technology", and "conditions." Research findings: The high concern about the terminal care was shown. But The uneasiness and shortage to knowledge and technology were shown. Furthermore, shortage of equipment and a staff was shown. As measures, It must be substantial in training of the terminal care. In order to examine the state of the terminal care, it is most important to clarify one's view of life and death

End of Life Care: The Importance of Culture and Ethnicity

Despite Australia's cultural diversity, there is little doubt that ethnic minority groups continue to have less access to health care systems, let alone culturally appropriate care, including palliative and end of life care. Such disparity of access for all individuals requiring such care ignores a basic human right to live and die in comfort. This article will discuss some barriers that may limit people of different cultural backgrounds receiving appropriate palliative and end of life care, and provides some generic approaches that may assist general practitioners when considering care needs of people from different cultural backgrounds. It also highlights care issues that GPs may need to consider when providing terminal care for someone from a different cultural background

終末期医療に関する一考察(2) : 看護職員の終末期医療に対する意識と年齢および臨床経験との関係

前号(市立名寄短期大学紀要第39巻)では,終末期医療に対する看護職員の意識調査結果の概要から,道北地域における終末期医療の課題について報告した。今回は,同調査結果から終末期医療に対する意識と年齢や臨床経験等との関係について明らかにし,道北地域における終末期医療,特に看護の課題を解決していくための具体的方法を検討しようとするものである。In our previous report (BULLETIN OF NAYORO CITY COLLEGE, NO. 39), we discussed issues regarding terminal care in the North Hokkaido region based on a summary of the results of a survey on the awareness of terminal care among nursing staff. Based on the results of that same survey, we herein elucidate the relationships between awareness of terminal care and factors such as age and clinical experience. This study investigates specific methods for resolving issues of terminal care in the North Hokkaido region, particularly with respect to nursing

Vapaaehtoinen tukihenkilötoiminta palliatiivisessa- ja saattohoidossa Pohjois-Karjalassa

Suomessa saattohoitoa tarvitsee vuosittain 15 000 henkilöä, joista puolet hoidetaan kotona kotisairaalan sekä kotisairaanhoitajan turvin. Muut hoitoa tarvitsevat saattohoi-topotilaat hoidetaan saattohoitokodeissa tai sairaalassa. Jokaisen potilaan kohdalla siirtyminen saattohoitoon ratkaistaan yksilöllisesti. Opinnäytetyö selvittää millainen vapaaehtoisen tukihenkilön toimenkuva on, sekä millaisena vapaaehtoinen tukihenkilö kokee oman työnsä ja merkityksensä palliatiivisessa hoidossa ja saattohoidossa. Tutkimus tehtiin laadullisella tutkimusmenetelmällä haastattelemalla toiminnassa mukana olevia vapaaehtoisia tukihenkilöitä. Haastattelu toteutettiin teemahaastatteluna ja tulokset analysoitiin teemoittelulla. Vapaaehtoiseksi tukihenkilöksi hakeutumisen syyksi haastateltavat kertoivat halun auttaa. Useimmat tunsivat, että heillä on jotain annettavaa tuettavalle sekä hänen läheisilleen. Tehtävänkuvaa osastolla ja kotona pidetään osaltaan hyvin samanlaisena, mutta eroavaisuuksiakin löytyi. Kuukaudessa vapaaehtoiseen tukitoimintaan käytetty aika vaihteli viidestä tunnista kahteenkymmeneen tuntiin. Tutkimuksen keskeisistä tuloksista laadittiin opaslehtinen. Jatkotutkimusaiheena opinnäytetyölle olisi tutkimus aiheesta monikulttuurisuus palliatiivisessa ja saattohoidossa vapaaehtoisen tukihenkilön näkökulmasta katsottuna.There are 15 000 people who need terminal care in Finland every year. Half of them are taken care of at home assisted by home care unit or a district nurse. Other patients who need help are nursed in hospice homes or at hospitals. Every patient’s transition to terminal care is solved individually. This thesis studies voluntary supporter’s job description and how he/she sees these activities and his/her significance in palliative and terminal care. The research was carried out using the qualitative study method by interviewing volunteer supporters. The interview was conducted as a theme interview and the results were analyzed by themes. The volunteer supporters told that the main reason to join was that they want to help other people. The most of them felt that they have something to give the patient and his/her close ones. The job description is partly the same in the wards and at home, but there are, however, some differences. Volunteer supporters worked five to twenty hours per month. Guide leaflet was drawn up about the main results. A further research subject could be to study multiculturalism in palliative and terminal care from the volunteer supporter’s point of view