J Hosp Palliat Nurs. 2022 Oct 1;24(5):281-287. doi: 10.1097/NJH.0000000000000885. Epub 2022 May 24.
Chronic obstructive pulmonary disease remains a challenging epidemic across the United States. This serious illness impacts nearly twice as many individuals in the rural area compared with urban counterparts. As the disease progresses, the symptom burden and needs of the patient and caregivers escalate. Access gaps to services, such as hospice and palliative care, and the social determinants of health found in Appalachia may lead to marginalization and social injustice. Defined as the condition of being peripheralized based upon one's social margins of identity, associations, and/or environment, marginalization impacts health outcomes and quality of life. This article explores the triple threat of marginalization for patients with chronic obstructive pulmonary disease living in rural Appalachia. By recognizing marginalization and designing initiatives to reduce the impact, hospice and palliative care nurses serve as advocates and leaders to influence systemic change through partnerships with key policymakers and legislators.
慢性阻塞性肺疾病仍然是美国的一个严峻的流行问题。与城市相比，这种严重疾病在农村地区影响的人数几乎多了一倍。随着疾病的发展，患者和护理人员的症状负担和需求不断增加。在阿巴拉契亚地区，服务（如临终关怀和姑息治疗）的获取差距以及健康的社会决定因素可能导致边缘化和社会不公。边缘化是指基于一个人的社会身份、关联和/或环境的边缘地位而被边缘化的状态，这种状态会影响健康结果和生活质量。本文探讨了生活在阿巴拉契亚农村地区的慢性阻塞性肺疾病患者面临的边缘化的三重威胁。通过认识到边缘化，并设计减少其影响的举措，临终关怀和姑息治疗护士可以通过与主要政策制定者和立法者合作，作为倡导者和领导者，通过伙伴关系来影响系统变革。
