J Hosp Palliat Nurs. 2021 Apr 1;23(2):120-127. doi: 10.1097/NJH.0000000000000735.
Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.
美国的养老院、辅助生活设施和其他长期护理设施中爆发的 COVID-19 疫情对居民造成了毁灭性的影响。为了减缓病毒的传播，已经实施了限制访客、隔离居民和检测医护人员等措施。然而，这些措施的后果包括居民的身心健康状况下降、病情恶化和感到绝望。我们提出并探讨了一个辅助生活设施的案例研究，以解决在平衡社区管理与居民的自主和自决权利方面的伦理问题。一组姑息治疗专家被引入辅助生活设施，以管理患者、照顾健康居民，并在预先护理计划和症状管理方面提供意见。我们探讨了自主和自决、管理和分配公正的原则。护理技能在分诊和评估中的应用、公共卫生原则以及姑息治疗的 8 个领域为构建应急行动提供了一个全面的框架。姑息治疗干预措施和姑息治疗护士的作用是解决病毒控制和老年人社会隔离的有害影响方面的伦理挑战的重要组成部分。
