Mills M, Davies H T, Macrae W A
Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School.
BMJ. 1994 Sep 3;309(6954):583-6. doi: 10.1136/bmj.309.6954.583.
To study the process of care of dying patients in general hospitals.
Non-participant observer (MM) carried out regular periods of continuous comprehensive observation in wards where there were dying patients, recording the quantity and quality of care given. Observations were made in 1983.
13 wards (six surgical, six medical, and one specialist unit) in four large teaching hospitals (bed capacity 504-796) in west of Scotland.
50 dying patients (29 female, 21 male) with mean age of 66 (range 40-89); 29 were dying from cancer and 21 from non-malignant disease.
Final period of hospitalisation ranged from 6 hours to 24 weeks. More than half of all patients retained consciousness until shortly before death. Basic interventions to maintain patients' comfort were often not provided: oral hygiene was often poor, thirst remained unquenched, and little assistance was given to encourage eating. Contact between nurses and the dying patients was minimal; distancing and isolation of patients by most medical and nursing staff were evident; this isolation increased as death approached.
Care of many of the dying patients observed in these hospitals was poor. We need to identify and implement practical steps to facilitate high quality care of the dying. Much can be learned from the hospice movement, but such knowledge and skills must be replicated in all settings.
研究综合医院中临终患者的护理过程。
非参与观察者（MM）在有临终患者的病房进行定期的持续全面观察，记录所提供护理的数量和质量。观察于1983年进行。
苏格兰西部四家大型教学医院（床位504 - 796张）的13个病房（6个外科病房、6个内科病房和1个专科病房）。
50名临终患者（29名女性，21名男性），平均年龄66岁（范围40 - 89岁）；29名死于癌症，21名死于非恶性疾病。
住院的最后阶段从6小时到24周不等。超过半数的患者直到临近死亡前不久仍保持意识。维持患者舒适度的基本护理措施常常未得到落实：口腔卫生通常较差，口渴得不到缓解，鼓励进食方面提供的帮助很少。护士与临终患者之间的接触极少；大多数医护人员明显与患者保持距离并使其处于隔离状态；随着死亡临近，这种隔离加剧。
在这些医院观察到的许多临终患者的护理情况很差。我们需要确定并采取切实可行的措施，以促进对临终患者的高质量护理。临终关怀运动中有很多值得借鉴之处，但此类知识和技能必须在所有环境中得到推广。
