Carpenter Joan G, Berry Patricia H, Ersek Mary
Post-doctoral Nurse Research Fellow, Patient Care Services/Department of Nursing, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia.
Director, Hartford Center of Gerontological Nursing Excellence at OHSU, Professor, Oregon Health and Science University School of Nursing.
J Hosp Palliat Nurs. 2018 Apr;20(2):153-159. doi: 10.1097/NJH.0000000000000420.
Despite hospital palliative care consultations during which goals of care are discussed in the context of poor prognoses, older adults are admitted to nursing homes for post-acute care where the focus is on rehabilitation. The purpose of this qualitative descriptive study was to describe factors that influence discontinuity between a palliative care consult and nursing home care and explore the potential consequences of this discontinuity. Twelve adults (mean age of 80 years) were enrolled from one community hospital and nursing home in the mid-Atlantic United States. Semi-structured interviews and medical record reviews were used to elicit information about clinical course, care processes, and patient/family preferences at hospital discharge and up to four times after nursing home admission. Data were analyzed using inductive content analysis techniques. Analysis revealed two themes: characterized by the lack of information about the palliative care consult after hospital discharge and evidenced by data demonstrating a discrepancy between hospital prognosis and nursing home care. Ongoing communication between settings to re-address goals of care, prognosis, and symptoms-the central tenets of palliative care-is lacking. Efforts to improve access to comprehensive palliative care delivery after hospitalization and during nursing home transitions are greatly needed.
尽管在医院进行了姑息治疗咨询，期间在预后不良的背景下讨论了护理目标，但老年人仍被送往疗养院接受急性后期护理，其重点是康复。这项定性描述性研究的目的是描述影响姑息治疗咨询与疗养院护理之间脱节的因素，并探讨这种脱节的潜在后果。在美国大西洋中部地区的一家社区医院和疗养院招募了12名成年人（平均年龄80岁）。采用半结构化访谈和病历审查来获取有关临床病程、护理过程以及出院时和疗养院入院后最多四次的患者/家庭偏好的信息。使用归纳性内容分析技术对数据进行分析。分析揭示了两个主题：一是出院后缺乏有关姑息治疗咨询的信息，二是数据表明医院预后与疗养院护理之间存在差异。各机构之间缺乏持续沟通以重新确定护理目标、预后和症状——姑息治疗的核心原则。非常需要努力改善住院后和疗养院过渡期间获得全面姑息治疗的机会。
