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首页> 外文期刊>International journal of older people nursing >Awareness of impending death for residents of long-term care facilities
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Awareness of impending death for residents of long-term care facilities

机译：意识到长期护理机构居民即将死亡的意识

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Aim: To explore awareness of impending death for very old persons in long-term care facilities. Background: The trajectories of decline that are associated with chronic progressive diseases in advanced old age have few prognostic markers. Consequently, it is difficult to determine when to start palliative or end-of-life care. Design: Mixed methods. Methods: Data were collected in three long-term care facilities in Canada. Statistical data were subjected to basic descriptive analysis. Qualitative data were collected using methods commonly associated with ethnography including interviews, focus groups, observations and artefact review. Constant-comparative analysis of qualitative data occurred as data were collected. Results: A 2-stage layered awareness of impending death was identified: first generalised and then clinical awareness. Generalised awareness was characterised by an understanding of human mortality and an understanding of the person's nearness to the end of an expected lifespan. Care routines and use of resources were not influenced by this early awareness. Clinical awareness of impending death was later acknowledged when health status changes suggested that death was likely within a few hours or days. The care then changed substantially to palliative in nature. Conclusions: Despite an awareness that death occurs naturally at the end of a long life and/or long illness, a serious decline towards death was not noticed or acknowledged until the last few hours or days of life, thus limiting palliative care to late-stage pain and symptom management. Implications for practice: Although this late-stage awareness of impending death is arguably the first necessary step for a change in nursing homes to a palliative-oriented approach to care for people who are nearing death in late life, timely acknowledgement of the potential for death is needed to facilitate improvements in care for residents of long-term facilities.
机译：目的：探索对长期护理机构中非常老的人即将死亡的认识。背景：与老年晚期慢性进行性疾病相关的下降轨迹几乎没有预后指标。因此，很难确定何时开始姑息治疗或临终治疗。设计：混合方法。方法：在加拿大的三个长期护理机构中收集数据。对统计数据进行基本描述性分析。使用与人种志相关的常用方法收集定性数据，包括访谈，焦点小组，观察和文物审查。在收集数据时进行定性数据的恒定比较分析。结果：确定了即将死亡的两阶段分层意识：首先是广义的，然后是临床意识。普遍意识的特征是对人类死亡率的理解以及对人们接近预期寿命终点的认识。早期的意识并没有影响护理程序和资源的使用。当健康状况改变表明可能在几小时或几天之内死亡时，人们就意识到即将死亡的临床意识。然后，照护实质上从本质上变为姑息治疗。结论：尽管意识到死亡是在长寿和/或长病长寿后自然发生的，但直到生命的最后几个小时或几天才注意到或未认识到严重的死亡下降，因此将姑息治疗限制在后期疼痛和症状管理。对实践的影响：尽管可以将这种对即将死亡的后期认识，可以说是将疗养院转变为以姑息治疗为导向的方法来护理晚年接近死亡的人的第一步，但要及时认识到死亡的可能性需要改进长期护理设施居民的护理。

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