Lucas Beverley, Small Neil, Greasley Peter, Daley Andrew
School of Life Sciences, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
BMC Palliat Care. 2008 Aug 1;7:9. doi: 10.1186/1472-684X-7-9.
Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home.A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners.
Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques.
The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care.
Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care.
在英国，基层医疗服务在癌症和姑息治疗方面的作用不断发展，导致姑息家庭护理团队有所增加。在家庭环境中提供专业护理旨在为那些希望在家中离世的患者提供必要服务并增加选择。本研究所在的布拉德福德地区发现，患者对在家中死亡的偏好与实际在家中死亡的人数之间存在不匹配。针对这种不匹配，并鉴于希望加强社区服务提供的政策环境，该市的四个初级保健信托基金（PCTs）试图为那些希望在绝症末期仍留在自己家中的患者提供支持。为了提供这种支持，他们成立了一个专门的临终关怀居家团队。该团队将为患者提供服务和支持，以实现有尊严、无痛苦且安宁的死亡，让家人能够最大限度地共度时光。本研究的目的是从护理人员、护士和全科医生的角度评估布拉德福德临终关怀居家服务。
向使用布拉德福德临终关怀居家服务的护理人员（n = 289）、社区护士（n = 508）和全科医生（n = 444）发送邮政调查问卷。使用社会科学统计软件包（SPSS）对所得的定量数据进行分析，使用扎根理论技术对定性数据进行分析。
护理人员、社区护士和全科医生的数据为布拉德福德临终关怀居家服务提供了总体支持。护理人员高度重视有机会对希望在家中接受护理的个人“兑现承诺”。社区护士和全科医生提到了获得专科专业知识的积极影响。这对基层医疗团队来说是一种“令人安心的存在”，通过提供及时、便捷且贴心的护理“减轻了护理人员的焦虑”。
护理人员和健康专业人员欢迎增加患者在家中接受护理的可能性。该研究确定需要专注于提高工作人员的技能水平并确保护理的连续性。
