Ivany Elena, While Alison
Newly qualified staff nurse at Barts Health NHS Trust.
Br J Community Nurs. 2013 Sep;18(9):441-5. doi: 10.12968/bjcn.2013.18.9.441.
It is increasingly recognised that end-of-life care is suboptimal, especially for those with advanced non-malignant diseases. This study shows that individuals living with heart failure have a number of palliative care needs, including education, communication, symptom management and psychosocial needs. Clinicians struggled to discuss palliation with heart failure patients due to the unclear disease trajectory and cardiac-specific barriers to identifying palliation needs. Carers reported a need for greater social support and better guidance on best practice care. Furthermore, patients struggled to cope physically and psychologically with their reduced physical capabilities and were fearful of being a burden to their carers. Both patients and clinicians recognised a discontinuity between secondary and primary care, which has particular resonance in the context of the intention to relocate care nearer home.
人们越来越认识到临终关怀并不理想，尤其是对于那些患有晚期非恶性疾病的患者。这项研究表明，心力衰竭患者有许多姑息治疗需求，包括教育、沟通、症状管理和心理社会需求。由于疾病轨迹不明确以及识别姑息治疗需求存在心脏方面的障碍，临床医生难以与心力衰竭患者讨论姑息治疗。护理人员表示需要更多的社会支持以及关于最佳实践护理的更好指导。此外，患者在身体和心理上难以应对身体机能下降的状况，并且担心成为护理人员的负担。患者和临床医生都认识到二级护理和初级护理之间存在脱节，这在打算将护理地点迁至离家更近的情况下尤为明显。
