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首页> 外文期刊>International journal of older people nursing >Diagnosis, prognosis and awareness of dying in nursing homes: Towards the Gold Standard?
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Diagnosis, prognosis and awareness of dying in nursing homes: Towards the Gold Standard?

机译：养老院的诊断，预后和死亡意识：迈向金本位制？

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Background: In Western society and increasingly elsewhere, death has become medicalised and 'hospitalised' even when people are enduring deteriorating terminal conditions such as dementia and heart failure. In an attempt to rationalise and dignify the place and manner of death, evidence is emerging that the adoption of end-of-life care pathways and models can improve the experience of the end-of-life care across a range of care settings. Each of these demands skills and knowledge in the assessment and prediction of the dying trajectory. Aim: In this study, we report complexities facing relatives, residents and nursing home staff in the awareness, diagnosis and prediction of the dying trajectory. Methods: Data were collected and analysed within a broadly qualitative methodology. The contexts were two nursing homes in the Greater Manchester area, each at different stages of implementing 'Gold Standards Framework' approaches to planning end-of-life care with residents and their relatives. From 2008 to 2011 and with appropriate consent, data were collected by a mixture of interviews and participant observation with residents, relatives and staff. Appropriate ethics approvals were sought and given. Results: Key emerging themes were diagnosis and awareness of dying in which there is no substitute for experience. Significant resource is needed to engage staff, residents and relatives/carers with the idea of advance care planning. Conclusions: Talking to residents and relatives about their feelings and wishes for care at the end of life remains especially difficult, but education and training in key skills and knowledge can engender confidence. Challenges include diagnosing and predicting dying trajectories. Implications for practice: Advance care planning can reduce the distress from and number of inappropriate hospital admissions, but requires determination and consistent application of the approach. This can be very challenging in the face of staff rotation and the unpredictability both of the dying trajectory and the decision-making of some out of hours medical staff.
机译：背景：在西方社会以及越来越多的其他地方，即使人们忍受着诸如痴呆和心力衰竭之类的日益恶化的绝症，死亡也已被医学化和“住院治疗”。为了使死亡的地点和方式合理化和端庄化，越来越多的证据表明，采用生命终止护理途径和模型可以改善一系列护理环境中的生命终止护理体验。这些中的每一个都需要对垂死的轨迹进行评估和预测的技能和知识。目的：在这项研究中，我们报告了亲属，居民和疗养院工作人员在垂死轨迹的认识，诊断和预测方面面临的复杂性。方法：采用广泛的定性方法收集和分析数据。背景是大曼彻斯特地区的两个疗养院，每个疗养院处于实施“金标准框架”方法以规划与居民及其亲属的临终护理的不同阶段。从2008年到2011年，在适当的同意下，通过与居民，亲戚和工作人员的访谈和参与者观察相结合的方式收集了数据。寻求并给予了适当的道德批准。结果：新兴的关键主题是对死亡的诊断和意识，这些经验是无法替代的。需要大量资源来使工作人员，居民和亲戚/看护人参与事先护理计划的想法。结论：与居民和亲戚谈谈他们生命终了的感觉和希望仍然特别困难，但是对关键技能和知识的教育和培训可以增强信心。挑战包括诊断和预测垂死的轨迹。对实践的影响：预先护理计划可以减少因不适当住院而造成的困扰和数量，但需要确定并一致地采用该方法。面对人员轮换以及垂死的轨迹和一些非工作时间医务人员的决策的不确定性，这可能是非常具有挑战性的。

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