Oncology and Geriatrics have hospice wards, and other departments take hospice care for individual dying patients. The dying patient needs a doctor to predict that his life is approaching a critical period according to his condition, and his survival time is no more than 3 months. When the patient knows that his life is close to death, his psychological reaction is very complicated. American Kubler Ross divides psychological reaction into five stages, namely, denial period; Anger period; Bargaining period; Depression period; Acceptance period. These five stages can vary from patient to patient, sequentially, repeatedly or at a certain stage. Medical staff should carry out nursing according to the characteristics of each patient at the end of his life.
2 Nursing characteristics of dying patients in German hospitals
2. 1 The environment of the ward is mainly family. Each ward is equipped with TV, books and newspapers, and each bed is equipped with a telephone, tape recorder, wardrobe, tables and chairs. Flowers and green plants can be seen everywhere. There are no rigid rules and restrictions on the placement of patients' belongings, and patients are allowed to paste their favorite paintings, handicrafts, photos, etc. On the wall, patients can spend a limited time in a comfortable and warm environment.
2.2 Helping dying patients face the reality dying is an important part of the whole life, and it is a reality that no one can escape. The patient is very eager to know his illness. German nurses believe that the methods of concealment and deception will have a negative impact on patients' lives. As executors of hospice care, patients and their families should be helped to face the reality, correctly understand the disease and understand that death is the objective law of life. Through heart-to-heart communication and discussion with patients and their families, patients can understand the current situation, development and treatment of the disease, and at the same time enhance their trust and security in medical staff, so as to improve their disease resistance, improve their quality of life as much as possible and maintain their dignity in a limited time.
2.3 Control the pain of patients with advanced cancer German nurses attach importance to the care of patients' pain in order to improve the quality of life. They think that alleviating pain is the best action to show mercy. According to the symptoms of patients, determine the mode and time of administration. Drugs include heroin and morphine. Usually, the dosage of medicine is carefully balanced on the basis of time, that is, the time is calculated and the medicine is given before the pain appears, so as to keep the balance between the patient's painless and awake to the maximum extent. Although the deterioration of the disease can't be controlled, it can make patients leave this world in a very comfortable and quiet state without pain.
2.4 to meet the physiological needs of patients, patients have the freedom to choose lifestyle. If the patient is willing to go home for one night, he should be satisfied as a hospice care giver. The patient's husband and wife should have the opportunity to enjoy the intimacy between husband and wife, as long as they want, even for the last few hours, because they are human first and then the patient.
2.5 Meet the needs of family members In order to meet the dying people's desire to know their value in the eyes of their relatives, the hospice ward provides a place for relatives to visit, without limiting their companionship, and sets up a visiting entertainment room. There are televisions, comfortable tables and chairs, books and newspapers, chess and cards and handicrafts in the room. Provide tea, milk, coffee and various drinks; Family members can also bring in special foods that patients like. Make patients and their relatives talk and communicate emotionally in a quiet and warm atmosphere, make patients feel the love and care of their relatives and friends, produce a sense of intimacy and satisfaction that is valued and recognized, increase their happy mood and prolong the dying process.
2.6 Meet the needs of patients' hobbies For patients with religious beliefs, it is necessary to remember the past, repent the past and arrange funerals to the priest before they die. Priests or priests can visit patients at any time, allow patients to participate in the whole medical process, and allow patients to go to church; Social workers often accompany patients to do manual work, knitting and painting. , and provide patients with opportunities to show and play their hobbies.
2.7 Establishing a good nurse-patient relationship German nurses pay special attention to establishing a good nurse-patient relationship in hospice care. In their view, nurses should regard the dying person as a whole, a person who is completing an important stage in his life, and give sincere care to patients. Nurses can sit by the bed like friends and relatives and listen to patients recalling their past lives; Taste food with patients; Patients are also allowed to sit in the office and chat with the staff and have coffee. On the patient's birthday, every staff member congratulates him on his happy birthday and shakes hands, or under the leadership of the head nurse, sends him a bunch of flowers and sings birthday songs around the bed. So that they can spend the last stage of their lives comfortably and happily.
3 Nursing care at the end of life
3. 1 Creating a Warm Environment The dying patients are often in a tired sleep state and are no longer interested in anything. People with religious beliefs believe that people who are asleep should not be awakened, because one foot has stepped into another world, and there is no sense of time at this time. Maybe he is meeting his dead friends, and they are welcoming him. Although we don't understand, don't break his fantasy and disturb his peace. Try to accept his world and listen to his soliloquy. Provide the patient with a quiet and comfortable single room with his favorite flowers, favorite paintings, family portraits and his own portraits, and play his favorite music.
3.2 Touching and showing love come from many surveys [1]. Hearing still exists when the patient is unconscious. At this time, you can say whatever he wants to hear, such as "It's a pity that I can't replace you". If the patient has symptoms of irritability, the nurse or relatives will sit quietly by the patient's bed and gently touch him, and he will slowly calm down. But for some people, touching may be a kind of interference, so you should pay attention when breastfeeding.
3.3 Do a good job in basic nursing. The dying patients no longer have the desire to eat. Family members and staff should not force patients to eat, nor should they increase the suffering of patients according to their own wishes. When patients are particularly dry, they should keep moist and keep their mouths clean to increase their comfort. It is necessary to provide patients with a comfortable lying position, turn over regularly, keep sheets, mattresses and clothes dry and comfortable, and safeguard the dignity of patients. Closely observe the changes of vital signs, give symptomatic care, and eliminate the special smell before dying in time.
4 experience
During my two years in Germany, I didn't see 1 patient die in pain. They all died peacefully. Around the dying, there is no endless stream of visitors and inaction, and no mechanical resuscitation is provided. What is given to the patient is a kind of love, a kind of help to alleviate psychological and physical pain; It provides a warm, caring and comfortable environment and measures to make patients feel comfortable and happy. In the last stage of life, the patient still maintained the dignity of being a human being and went to another world with the beautiful love of the world.