Munley A, Powers C S, Williamson J B
Int J Aging Hum Dev. 1982;15(4):263-84. doi: 10.2190/nkhf-2wlk-vtrd-q3nv.
At the heart of the rapidly growing American hospice movement is a philosophy of care that emphasizes patient individuality and responsiveness to total needs of the dying and their families. To date, the response to this model of terminal care has been favorable. The hospice is viewed as a humanizing mode of health care with a capacity to enhance the quality of life experienced by persons defined as terminal. Data gleaned from participant observation in an American hospice program by one of the authors supports this view. The hospice has the potential to provide a social context for humane, personalized death in which maximum effort can be made to control pain in all its forms: physical, psychological, social, and spiritual. Sociological literature has been much harsher in its assessment of the quality of life in nursing homes. Such discussions frequently include references to nursing home environments as fostering loss of autonomy and social death. This paper suggests that the hospice approach to care of the dying includes several elements that can be utilized to improve the quality of life in nursing homes: a total needs emphasis, increased patient autonomy, open discussion of death, a community ideology, a team orientation that cuts across levels of staff hierarchy, a role blurring of caregivers, focus on patients and families as the unit of care, and mutually beneficial integration of hospice with the outside community. There are, however, crucial differences between a hospice and a nursing home which may hamper direct transference of humanizing hospice principles, e.g., hospice patients are defined as terminal; staff, thus, can be motivated to put forth their best because of perceived time limits. There are also important differences in the characteristics of patient populations, length of stay, economic constraints, ability to attract volunteers, and emphasis on task-orientation. The time has come to apply increased ingenuity to a adapting humanizing hospice principles to the care of elderly in nursing homes.
迅速发展的美国临终关怀运动的核心是一种护理理念，该理念强调患者的个体性以及对临终患者及其家人全部需求的响应。迄今为止，对这种临终护理模式的反响良好。临终关怀被视为一种人性化的医疗保健模式，有能力提高被界定为临终患者的生活质量。其中一位作者在美国临终关怀项目中通过参与观察收集的数据支持了这一观点。临终关怀有潜力提供一个人性化、个性化死亡的社会环境，在这个环境中可以尽最大努力控制各种形式的疼痛：身体上的、心理上的、社会上的和精神上的。社会学文献对养老院生活质量的评估则要严苛得多。此类讨论经常提到养老院环境会导致自主性丧失和社会性死亡。本文认为，临终关怀对临终患者的护理方法包含几个可用于改善养老院生活质量的要素：强调全面需求、增强患者自主性、公开讨论死亡、社区理念、跨越员工层级的团队导向、护理人员角色的模糊化、将患者及其家人作为护理单元、临终关怀与外部社区的互利整合。然而，临终关怀机构和养老院之间存在一些关键差异，这可能会阻碍人性化的临终关怀原则的直接移植，例如，临终关怀患者被界定为临终患者；因此，工作人员可能会因意识到时间有限而被激励全力以赴。患者群体特征、住院时间、经济限制、吸引志愿者的能力以及对任务导向的重视程度也存在重要差异。现在是时候更加巧妙地将人性化的临终关怀原则应用于养老院老年人护理的时候了。
