Care Needs of Patients at the End of Life With a Noncancer Diagnosis Who Live at Home

Jiwon LEE ； Younghye PARK ； Kyounjoo LIM ； Ari LEE ； Hanul LEE ； Jong-Eun LEE

《The Journal of Nursing Research》 27卷2期 (2019/04) Pp. 1-11-002

https://doi.org/10.1097/jnr.0000000000000277

摘要

Background: As the population ages, the prevalence of various chronic diseases increases. Palliative care for patients at the end of life with a noncancer diagnosis is currently limited because of the difficulties of demarcating the boundaries of the end-of-life care period and of determining the various care needs of patients at the end of life. Purpose: This study aimed to investigate the levels of importance and difficulty of the multidimensional care needs for patients with a noncancer diagnosis during various end-of-life stages. Methods: This study is a retrospective survey. Home health-care nurse specialists (HHNS) reviewed medical and nursing records and responded to a structured questionnaire. The caring experiences of HHNS with 115 patients, who were 40 years or older, had received home care nursing throughout the stable (between the onset of the end-of-life stage and 1 week before death) and near-death (1 week before death) stages at Seoul St. Mary's Hospital in Korea, and had died between September 1, 2014, and December 31, 2015, were analyzed. Results: The care needs of ＂coordination among family or relatives＂ and ＂support for fundamental needs＂ were more important in the stable stage than in the near-death stage. The care need of ＂loss, grief care＂ was more important in the near-death stage than in the stable stage. The care need of ＂physical symptoms management＂ was the most difficult to meet in both stages. Lower Palliative Performance Scale score was associated with a higher level of care need, particularly in the ＂management of physical symptoms＂ and ＂psychological support＂ realms in the stable stage and in the ＂coordination among family or relatives＂ realm in both stages. Conclusions: End-of-life stage and initial score on the Palliative Performance Scale were found to have a significant influence on the multidimensional care needs of patients with a noncancer diagnosis. Thus, healthcare professionals should assess patient care needs according to disease trajectory to provide continuous and holistic care.

關鍵字

end-of-life care ； care needs ； chronic illness ； home care nursing

參考文獻

Ang, G. C., Zhang, D., & Lim, K. H. (2016). Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals. Singapore Medical Journal, 57(1), 22-28. https://doi.org/10.11622/smedj.2016008

Ben Natan, M. (2008). Perceptions of nurses, families, and residents in nursing homes concerning residents’ needs. International Journal of Nursing Practice, 14(3), 195-199. https://doi.org/10.1111/j.1440-172X.2008.00687.x

Ben Natan, M., Garfinkel, D., & Shachar, I. (2010). End-of-life needs as perceived by terminally ill older adult patients, family and staff. European Journal of Oncology Nursing, 14(4), 299-303. https://doi.org/10.1016/j.ejon.2010.05.002

Burt, J., Shipman, C., Richardson, A., Ream, E., & Addington-Hall, J. (2010). The experiences of older adults in the community dying from cancer and non-cancer causes: A national survey of bereaved relatives. Age and Ageing, 39(1), 86-91. https://doi.org/10.1093/ageing/afp212

Bužgová, R., & Sikorová, L. (2015). Association between quality of life, demographic characteristics, physical symptoms, and unmet needs in inpatients receiving end-of-life care. Journal of Hospice and Palliative Nursing, 17(4), 325-332. https://doi.org/10.1097/NJH.0000000000000170