Hospice emphasizes "four whole care" (whole person, whole family, whole process, whole team care), so it is a complete care of body, mind and soul; not only cares for the patient, but also cares for the care of the family; not only cares for the patient to the end of his life, but also helps the family to get through the grief; and combines the physician, nurse practitioner, social workers, volunteers, religious teachers and other related personnel*** to care for the patient and his family.
Basic introduction Chinese name: hospice ward Function: care, consultation, education Target: patients and their families Treatment mode: passport club group, ward, home care Treatment ward function, home care function, continuous care, hospice mode, all-around care, patient's heart, continuous learning, treatment ward function should include: 1. care service center, 2. education demonstration center, 3. Information and Consultation Center. In short, it is a promotion center, or what I call a "base". It can serve patients and their families, provide hospice training to medical staff and students, and educate the general public about life and death. It can be used as a base for liaison, education, counseling and service. Frankly speaking, the hospice units in major hospitals have become "tourist areas" after they are established (if they charge admission, they can make up for their losses). For the hospice team, it is a place to serve patients and their families; for hospital administrators, it is a place to promote the concept of "respect for life. Functions of home care Hospice emphasizes "four-whole care" (whole person, whole family, whole process, whole team care), so it is a complete care for body, mind and soul; not only caring for the patient, but also caring for the family; not only caring for the patient to the end of the life, but also helping the family to get through the sadness; and combining the physician, nurse practitioner, social workers, volunteers, religious teachers and other related personnel*** to take care of the patient and the family together. Therefore, hospice home care, first, to respect the patient's autonomy: the patient is the master in his own home, health care workers as visitors to visit the patient; and then to meet the needs of human nature: because the most comfortable and most accustomed place to live is still his own home, hospice home care is more important, so as to achieve the continuity of care. The basic goal of hospice care is to maximize the lifestyle desired by the patient being cared for, so when the patient wants to spend the rest of his or her life at home, we must provide hospice home care services. Continuity of Care There are two types of hospital discharges: MBD (stable or recovered enough to be discharged) and AAD (Against Advice Discharge). However, terminal cancer patients may be discharged in another way: DDT (Discharge Due to Terminal), which is also known as "going home with one breath". Based on the concept of "Respect for Life" and the practice of "Respect for Patient Autonomy", there should be no such thing as "Discharge Due to Terminal" for terminal cancer patients. When the patient's condition is stable, he/she can go home with MBD and continue to receive hospice home care services. When the patient's condition deteriorates and the patient wishes to die at home, he or she can go home on DDT and receive hospice care at home. If the patient and family are comfortable with dying in the hospital, the patient will remain in the hospital room for end-of-life care. For the latter two, near-death education and dying preparation are important. We have produced a leaflet on end-of-life symptoms and assisted family members to prepare for death and make funeral arrangements in a timely manner, so as to prevent patients from being subjected to unnecessary and painful measures such as cardiopulmonary resuscitation (CPR) before death. Grief counseling for family members continues after the patient dies. The hospice home care team will follow up with family members who are overly grieving on a regular basis, including sending greeting cards, telephone interviews, and home visits, until the family member returns to normal life. Although Universal Health Care does not yet cover "grief counseling," we still provide this service in order to achieve whole family care and holistic care. Hospice Care Models At this stage, there are only three types of hospice care in China: hospice passport groups, hospice wards (acute wards) and hospice home care. A complete hospice model should also include: hospice centers or nursing home, day care centers, chronic care, and care consultation centers. Domestic hospice wards originally belonged to acute wards, Tzu Chi Hospital Xinlian Ward applied for reclassification as a special ward in early 1987, and was approved by the Department of Health, which should be able to meet the objective needs of hospice care in the future. The establishment of a province-wide hospice referral network and regional hospice centers is a goal that requires continued efforts. Hospice care requires the integration of multiple technologies (e.g., Chinese and Western medicine) with the goal of symptom control and improved quality of life, so no single specialist can solve all of a patient's problems, and if there is a question or non-specialty issue, other specialists should be consulted. We call it "doing whatever it takes" for the patient. As long as it is beneficial to the patient and agreed upon by the patient, we should find a way to do it and respect the patient's decision. Patient's Journey Most terminal cancer patients and their families have gone through a complicated process of seeking medical treatment and therapy, and they also have a lot of psychological disturbances, which require time to care for and understand. We only need to listen to them, not to criticize or make judgment, and all we can do is to accompany them to go through this difficult time. We should not criticize Chinese medicine, herbal medicine, traditional Chinese medicine or western medicine, and we should not blame the patient and his/her family for their previous wrong decisions and behaviors, because they are already fait accompli, and it is useless to talk about them. What we should do is to face the reality, and to make good use of and cherish the few remaining moments of time together. Continuous learning Hospice team members should recognize their own limits and pursue new knowledge on all fronts, as long as it is beneficial to the patient. Without self-limitation, physicians can study nursing, sociology, religion, etc., while others can study medicine, oncology, communication, etc., so that we can function to the limit and do the best for our patients and families. We are all just mortals and have moments of weakness, so we should support each other and **** grow together. (The author of this article is a physician in the Department of Family Medicine at Tzu Chi Hospital in Hualien)