Dying in hospital: Medical failure or natural outcome?
Dying in hospital: Medical failure or natural outcome?
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DOI：
10.1016/s0885-3924(01)00362-1
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发表时间：
2001-12-01
影响因子：
4.7
通讯作者：
Gardner, A
中科院分区：
文献类型：
--
作者：
Middlewood, S;Gardner, G;Gardner, A
本研究的目的是描述模式的医疗和护理实践中的病人死于肿瘤和血液恶性肿瘤的护理，在澳大利亚的急性护理环境。在一项类似的美国研究中验证的工具用于研究1999年8月之前在澳大利亚首都直辖区的堪培拉医院死于肿瘤或血液恶性肿瘤的100名连续患者的病历。临终关怀模式的三个主要指标是Do AW复苏（DNR）命令的文件，病人被认为是死亡的证据，以及姑息治疗的意图。结果是，88名患者记录了DNA，63名患者的记录表明患者正在死亡，74名患者有姑息治疗计划的证据。46例患者在死亡前2天或更短时间内记录了DNR，其中12例在死亡当天记录。在考虑死亡和死亡之间，以及姑息治疗目标和死亡之间，出现了类似的模式。60例患者在死亡时正在接受积极治疗。临终管理计划执行较晚，而且这些计划之间缺乏一致性，这表明病人在死亡前一直在接受医疗干预和调查。姑息治疗团队的影响，包括需要教育医护人员和规划和实施政策，在急性护理环境中的垂死患者的管理。虽然澳大利亚的医疗保健系统与美国的情况相比存在文化差异，但这项研究表明，延长生命的治疗方法与美国的研究结果相似。(C)美国癌症疼痛缓解委员会，2001年。
The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in, the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do AW Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNA 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American based studies. (C) U.S. Cancer Pain Relief Committee, 2001.