Eisenberger, Andrew, MD; Zeleznik, Jomarie, MD. Palliative & Supportive Care; Cambridge Том 2, Изд. 3, (Sep 2004): 283-9.
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Pressure ulcers are not uncommon (Hanson et al., 1994; Bale et al., 1995; Leff et al., 2000) in dying patients because of acquired risk factors of immobility, functional incontinence, and compromised nutrition (Hanson et al., 1991, 1994; Bale et al., 1995; Walding & Andrews, 1995; Chaplin, 2000). However, their management, especially the unpleasant aspects of care (Dallam et al., 1995; Szor & Bourguignon, 1999; Kayser-Jones et al., 2003), has received little attention from palliative care researchers. Consistent with the traditional standards of pressure ulcer care, most of the relevant studies are studies of the effectiveness of nursing prevention programs in single hospices (Hanson et al., 1991, 1994; Bale et al., 1995; Walding & Andrews, 1995; Chaplin, 2000) or factors affecting the incidence of pressure ulcers at the end of life in long-term care (Kayser-Jones et al., 2003).
In all settings, the management of a patient with a pressure ulcer requires an interdisciplinary approach (Baranoski et al., 1998; van Rijswijk & Braden, 1999), and in the home environment, care is highly reliant on family caregivers. The burdens in general experienced by families caring for patients with terminal illness at home have been explored (Covinsky et al., 1994; Emanuel et al., 2000). Similarly, both the burdens (Baharestani, 1994) and positive contributions (Clarke & Kadhom, 1988) of families providing pressure ulcer care at home for chronically ill patients have been described. We report a qualitative description of the factors contributing to pressure ulcer care planning for hospice patients, which was collected as part of a broad explorative study of pressure ulcers in hospice (Eisenberger & Zeleznik, 2003).
We developed a telephone survey instrument consisting of questions based on a Medline and bibliographic review of the medical and nursing literature using combinations of the search terms "hospice," "palliative care," "pressure ulcer," and "decubitus ulcer." The instrument was reviewed for face validity and pilot-tested on two physicians and five nurses with experience in wound care and end-of-life care, and a family member of a patient who died with a pressure ulcer. The format and language were revised in consultation with an educational researcher. Three versions were produced for interviews with directors of clinical services, direct-care nurses, and family members. The versions had approximately three-quarters overlap in.
