Pauls M A, Singer P A, Dubinsky I
Department of Emergency Medicine, Queen Elizabeth II Health Science Centre and Department of Emergency Medicine, Dalhousie University, 1796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7.
J Emerg Med. 2001 Jul;21(1):83-9. doi: 10.1016/s0736-4679(01)00344-4.
Many residents of long-term care (LTC) facilities are transferred to Emergency Departments without advance directives (AD). The goal of this study was to describe an ideal model for the transfer of AD from LTC facilities to Emergency Departments. Health care providers were asked to describe their ideal model for the completion and transfer of the ADs of LTC residents. A grounded theory methodology was used to identify significant themes. The model we present as a result of this analysis acknowledges the importance of simplifying and standardizing ADs, but focuses more attention on the process of completing and transferring the AD. A key feature of this model is an emphasis on the education of LTC residents and their relatives about ADs and advance-care planning. This education should involve a variety of resources used in creative ways; it should begin as soon as LTC placement is being considered, and the emphasis should be on providing information and discussing options rather than pressuring residents to make a decision.
许多长期护理（LTC）机构的居民在没有预先指示（AD）的情况下被转至急诊科。本研究的目的是描述一种将预先指示从长期护理机构转至急诊科的理想模式。医疗服务提供者被要求描述他们对于长期护理机构居民预先指示的完成与转移的理想模式。采用扎根理论方法来确定重要主题。我们通过该分析得出的模式承认简化和标准化预先指示的重要性，但更关注完成和转移预先指示的过程。该模式的一个关键特征是强调对长期护理机构居民及其亲属进行关于预先指示和预先护理计划的教育。这种教育应采用创造性方式利用各种资源；应在考虑安排长期护理时尽早开始，并且重点应是提供信息和讨论选择，而不是迫使居民做出决定。
