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首页> 外文OA文献 >'I often worry about the older person being in that system': exploring the key influences on the provision of dignified care for older people in acute hospitals
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'I often worry about the older person being in that system': exploring the key influences on the provision of dignified care for older people in acute hospitals

机译：“我经常担心老年人会进入这个系统”：探讨对急性医院中老年人提供有尊严的护理的关键影响

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Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.
机译：老年人是生活的一个阶段，由于丧失工作能力，身体虚弱和认知能力下降以及缺乏社会和经济资源而造成的脆弱性可能会威胁到尊严。有证据表明，它与尊严受到最大威胁的健康和福利服务机构接触。这项研究探讨了老年人在急性国家卫生服务（NHS）信托中与尊严护理以及影响尊严护理的组织，职业和文化因素有关的经验。这些目标是通过对英格兰和威尔士的四个急性医院信托基金会的人种志进行检查的，其中涉及对最近从医院出院的老年人（65岁以上），其亲戚/护理人员以及信托经理，从业人员和其他员工进行访谈，并辅以非参与观察。出现的情况是在提供有尊严的护理方面缺乏一致性，这似乎是由于系统和组织的优先事项占主导地位以及病房工作人员和临床医生的利益联系在一起的。对临床专科的重视意味着工作人员经常缺乏照料知识和技能的能力，无法照顾年长的患者，这些患者的急性疾病通常会因身体和精神上的合并症而加重病情。急诊病房的物理环境通常设计不当，令人困惑且难以接近，并且可能被视为“不适合目的”以尊严地对待他们的主要使用者（65岁以上）。知情者普遍意识到这一点，但得出的结论是，在“错误地方”的是老年人，并认为“他们”必须有一个更好的地方。因此，急诊医院的现行制度指出了对老年人提供高质量护理的固有歧视。急诊医学的文化需要改变，以便包括患有慢性合并症，精神错乱以及急诊的老年人。

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