Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease
Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease
复制标题
DOI：
10.1111/jocn.13170
复制
发表时间：
2016-08-01
影响因子：
4.2
通讯作者：
Munday, Daniel
中科院分区：
文献类型：
--
作者：
Bailey, Cara;Hewison, Alistair;Munday, Daniel
目的和目标。探讨晚期慢性阻塞性肺疾病（COPD）合并肺癌患者、其护理人员和医护人员在急诊入院后的经验。肺癌和慢性阻塞性肺病患者的急诊入院人数有所增加，全球对死于医院的患者人数感到担忧。晚期肺癌和慢性阻塞性肺疾病患者在接近生命终点时作为急诊入院的经验以前尚未调查。关键事件定性案例研究。对39名患者（15名COPD患者和24名肺癌患者）、20名非正式护理人员和50名医疗保健专业人员进行了半结构化访谈，探讨患者急诊入院的经历。在入院后和出院后进行了访谈。参与者提名亲属和医疗保健专业人员进行面试。对数据进行主题分析。患者对他们的“紧急”护理感到满意，但对他们在最初症状稳定后接受的护理不满意。他们所经历的护理质量较差，其特点是缺乏对其基本需求的关注，缺乏家庭的参与，护理计划沟通不畅，初级和二级护理之间缺乏连续性。一个概念模型的“壮观”和“subtacular”的轨迹的照顾是用来与调查结果的更广泛的背景下，医疗保健提供。晚期呼吸道疾病患者病情的复杂性使得急诊入院成为可能。虽然患者（慢性阻塞性肺病和肺癌）在急性“壮观”的阶段，他们的入院护理感到满意，需要给予更多的关注，以持续的护理需求的患者在“subtacular”phase.Relevance临床实践。这是第一项研究，探讨病人的经验，急性护理后，紧急入院，并确定有潜力的照顾，以改善。
Aims and objectives. To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital.Background. Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated.Design. Qualitative critical incident case study.Methods. Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients' experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically.Results. Patients were satisfied with their 'emergency' care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of 'spectacular' and 'subtacular' trajectories of care was used to relate the findings to the wider context of health care provision.Conclusion. The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute 'spectacular' phase of their admission, more attention needs to be given to the continuing care needs of patients in the 'subtacular' phase.Relevance to Clinical Practice. This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.