University of Saskatchewan, College of Nursing, Room 423 Ellis Hall, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 5E5.
Soc Sci Med. 2010 Apr;70(8):1166-70. doi: 10.1016/j.socscimed.2009.12.019. Epub 2010 Feb 12.
Although institutional policies related to care at the end of life (EOL) are a common feature of hospitals, there has been little examination of the ways in which these policies shape the focus and provision of care. The question asked in this study was "What effect do institutional policies relating to care at the EOL have on practice?" Data were drawn from health record reviews of 310 adults who had died in 3 acute care facilities in a major urban centre of a Western Canadian health region. Medical orders relating to care at the end of life were written for the majority of decedents, highlighting the value providers placed on care planning during this time. Relatively few providers, however, followed policy directives regarding use of care plans, terminology or documentation of discussions with patients and families about treatment plans. The findings of this study demonstrate a significant gap between institutional EOL care policies and practice in this health region, challenging institutional decision makers and front-line providers to collaborate more effectively to devise clinically relevant policies that enhance patient care at a particularly vulnerable time of life.
尽管与终末关怀相关的机构政策是医院的一个常见特征，但很少有人研究这些政策如何影响关怀的重点和提供方式。本研究提出的问题是“与终末关怀相关的机构政策对实践有什么影响？”数据来自于对在加拿大西部一个主要城市地区的 3 家急症护理机构去世的 310 名成年人的健康记录审查。为大多数死者书写了终末关怀医疗医嘱，这突显了提供者在此期间对护理计划的重视。然而，相对较少的提供者遵循关于使用护理计划、术语或记录与患者和家属讨论治疗计划的政策指令。这项研究的结果表明，在该卫生区域，机构的终末关怀政策与实践之间存在显著差距，这对机构决策者和一线提供者提出了挑战，需要他们更有效地合作，制定更具临床相关性的政策，在生命特别脆弱的时刻提高患者护理水平。
