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临终关怀阶段,医院出院时谁来照顾护理人员?对现行出院计划实践的定性研究以及使用护理人员支持需求评估工具(CSNAT)方法的潜在价值。

Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.

机构信息

1 Centre for Family Research, University of Cambridge, Cambridge, UK.

2 Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.

出版信息

Palliat Med. 2018 May;32(5):939-949. doi: 10.1177/0269216318756259. Epub 2018 Feb 28.

Abstract

BACKGROUND

Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge.

AIM

To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers.

DESIGN

Qualitative.

SETTING/PARTICIPANTS: Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted.

RESULTS

Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition.

CONCLUSION

This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

摘要

背景

照顾者因素阻碍了患者及时获得适当的出院治疗。目前缺乏支持照顾者在患者临终出院时的干预措施研究。

目的

探索在临终患者出院期间,目前是如何以及如何为家庭照顾者提供支持;评估在医院环境中使用照顾者支持需求评估工具(CSNAT)方法来支持照顾者的感知益处、可接受性和可行性。

设计

定性研究。

设置/参与者:英格兰的三个国民保健服务信托基金:对 40 名医院和社区从业者进行焦点小组讨论,对 22 名照顾者进行访谈,了解照顾者在医院出院期间的支持情况,以及对 CSNAT 方法的看法。两次研讨会召集了 14 名从业者和 5 名照顾者,讨论实施问题。进行了框架分析。

结果

目前在医院为照顾者提供支持的障碍是组织关注患者的需求,从业者认为照顾者对在家中临终护理的“不切实际的期望”,以及对患者临终状况缺乏认识。CSNAT 方法被认为能够支持照顾者,并解决在临终时讨论在家中支持某人的现实困难。在医院实施需要考虑从业者工作量和培训的组织因素。为了加强对照顾者的支持,建议使用 CSNAT 作为照顾者的记录,在医院进行评估和支持(社区跟进)的两阶段过程,以管理过渡。

结论

本研究确定了一种新的干预措施,该措施将出院计划的重点扩展到包括评估照顾者在过渡期间的支持需求,这可能防止家庭护理崩溃和患者再次住院。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/968d/5946661/3f355f666abc/10.1177_0269216318756259-fig1.jpg

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