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This entry was reviewed by the "Popular Science China" Encyclopedia of Science Entry Writing and Application Project.
Hospice care is not a cure, but a type of medical care that focuses on alleviating the symptoms and slowing the progression of a disease in the weeks or even months before a patient's death.
Chinese name
Hospice care
Foreign name
hospice care
Category
Marginal interdisciplinary
Contents
1 Overview
2 Introduction to the meaning of end-of-life care
3 Care content
4 Care Objects of care
5 Goals of care
6 Notes on care
7 History of development
Overview
The fundamental core of hospice care is to help the departing person to confess their sins and repent of them, and ultimately to have their souls saved, and so all other forms of care, except for religious beliefs, stop at the level of physical and psychological care. This stage refers to medical care that provides spiritual care to patients who have a limited time to live (6 months or less) and is supplemented by appropriate hospital or home-based medical and nursing care to alleviate the symptoms of their illness and slow its progression.
Hospice care
Hospice care does not pursue drastic, potentially painful, or pointless treatments for the patient, but requires skillful practice and good service on the part of the medical staff to control the patient's symptoms. Because hospice care necessarily involves palliative care for a variety of symptoms, it and palliative care are often synonymous in the field of oncology.
Hospice care is an emerging marginal cross-discipline in the field of modern medicine, which is a sign of the needs of society and the development of human civilization. As far as the world is concerned, its emergence is only two or three decades old.
Hospice care makes life "go" warmly
Introduction of the significance of hospice care
Hospice care is a noble cause in line with the interests of mankind, and is of great significance to the advancement of human society:
1. RequirementsWith the progress of human society and civilization, people put forward higher requirements for the quality of life and death quality of life, to meet the new life, turn the first page of the life course; send off, close the last page of the life course, draw a perfect conclusion. So that the patient can get peace, calmness and comfort at the time of death, and the family is not left with any regrets and shadows after the patient's death.
2. Hospice care is a sign of social civilization everyone wants to live smoothly and die peacefully. Hospice care is precisely for the dignity of the patient, comfortable to reach the other side of life and carry out a social public **** cause, it is a sign of social civilization.
3. End-of-life care reflects the noble health care ethics, the core content of health care ethics is to respect the value of the patient, including the value of life and human dignity; end-of-life care through the implementation of holistic care of the patient, with the scientific method of psychological care, superb clinical care means, as well as palliative, supportive therapy to maximize the help of the patient to reduce the pain of the body and spirit, improve the quality of life, and calmly go through life. quality of life, and calmly go through the last stage of life. Healthcare professionals, as the specific implementers, fully embodies the noble healthcare ethics to improve the value of life and quality of life as the purpose of service. [1]
Contents of care
(1) Physical care: Relief of pain and suffering through the care of healthcare workers and family members, and enhancement of physical energy through the use of natural and healthy diets.
(2) Heart Care: Through the establishment of concepts to alleviate the fear, anxiety, anxiety, blame, worry and other psychological, so as to make them feel at ease, relaxed, and full of hope and confidence in the future world (refers to the aftermath of death).
(3) Spiritual Care (considered by Buddhists to be Taoist Care): Looking back on life to seek the meaning of life, or mostly through religious studies and ways to establish the value of life, such as immortality, ascension to heaven, and going to the Western world of bliss. The perfect end-of-life care[2]
"End-of-life care": an issue that needs the attention of the whole society
I. End-of-life care is an inevitable product of the development of social civilization to a certain stage, which is usually referred to the team of doctors, nurses, psychologists, social workers and volunteers who have no hope of saving the patient, and whose survival period is not more than 3 to 6 months, and who have no hope of being saved. It usually refers to a team of doctors, nurses, psychologists, social workers and volunteers who provide special palliative care to terminally ill patients who have no hope of salvation and a survival period of no more than three to six months, as well as physical and psychological comfort and support to the families of the dying. Instead of relying on medical technology and large amounts of financial resources to passively extend their lives, patients who are unable to return to their original state of health can live out the rest of their lives according to their own wishes, using basic treatment to alleviate their physical discomfort as a guarantee.
Hospice care is a product of modern Western society's rethinking of instrumental rationality and modernity, and it breaks with the doctor-driven model of treatment by putting the patient's wishes first. Hospice challenges two major habitual perceptions, the first is the Western medical concept: to continue life as the highest goal and ignore the quality of life; the second is the traditional filial piety: to give up the traumatic treatment is the same as giving up the life of loved ones. Hospice returns to the natural attributes inherent in death, emphasizing that life is a unified whole of mind and body, and that the spiritual dimension of the patient is valued, reversing modern medicine's perception of life based on Cartesian mind-body dichotomy, liberating the dying from hopeless mechanical salvation, and granting them the freedom to dominate their lives.
Hospice care in practice presents a high degree of three-dimensionality and socialization, concentrating on social and humanistic care, and since its birth in the United Kingdom in 1967, it has soon spread to more than 70 countries and regions on five continents, benefiting countless patients and families.
Two, hospice care will directly bring "five wins" situation. The first winner is the country. According to the Ministry of Health data: a person's lifetime health investment of 80% for the last month of life, meaning that the end of life care occupies the largest share of China's medical expenditure. In the U.S., every dollar spent on hospice care saves $1.52 in health insurance costs, and the source of savings is the patient's treatment, medication, hospitalization and nursing care; in the last year of life, those who practice hospice care spend $2,737 less than those who don't, and $3,192 less than those who spend in the last month of life. It can be deduced that if our country promotes hospice care, it will be able to save huge medical expenses and reduce medical waste. In addition, hospice care has public welfare, can absorb social charitable funds, constituting an effective supplement to social health care funding.
The rest of the "four wins" are: hospitals. The development of hospice care can help limited medical resources to give full play to their effectiveness and alleviate the gap between medical resources and social needs. Medical personnel. It is expected to reduce a large number of hopeless cases, which is conducive to establishing and maintaining the professional confidence of doctors and reducing doctor-patient conflicts. Terminally ill patients. Possessing the right to die is having the complete right to life, and terminally ill patients can arrange their last days independently, avoiding destructive life-prolonging treatment. Family members. The intervention of hospice agencies and teams not only compensates for the shortage and unprofessionalism of modern family caregivers, but also provides sufficient human security. Hospice care usually does not require costly equipment, effectively relieving the financial pressure on the patient's family and avoiding the situation of "the dead dragging the living down". With professional help throughout the process, bereaved parents can effectively reduce their grief reaction and resume normal work and life as soon as possible, greatly reducing the hidden loss to society.
Thirdly, the problems that have arisen in the process of modernization in China have also been experienced by developed countries. Modernization has brought great changes to society, such as the expanding population and urbanization and concentration, the increasing nuclearization of the family model, and the high degree of aging of the population, which has led to the family's traditional caregiving function to become weaker and weaker, and the decline in the ability to withstand the death of a relative, which has had an incipient negative impact on the society and the family, and the situation will be even more serious in the future. According to the data released by the National Tumor Registry, there are about 3.12 million cases of new tumors and 2.7 million deaths due to cancer in China every year. At present, the number of people in need of "end-of-life care" is getting larger and larger, and the socialized end-of-life care service is increasingly highlighting the great necessity and urgency.
Targets of care
(1) Priority targets:
1. Seriously ill people and their families
Hospice care
2. Elderly people
3. Animals, etc.
(2) Positive level targets:
1. School education
2. Adult education
Care Objectives
The objective of end-of-life care is to improve the quality of life of patients by eliminating or alleviating pain and other physical symptoms, relieving psychological problems and mental anguish, and enabling patients to face death with inner peace. At the same time, hospice care can also help the patient's family to take some of the labor and stress.
Hospice care differs from euthanasia in that it does not promote or delay death. Its main tasks include symptomatic treatment, home care, symptomatic relief, pain control, reduce or eliminate the patient's psychological burden and negative emotions. Therefore, hospice care often consists of physicians, nurses, social workers, family members, volunteers, as well as nutrition and psychology workers and other aspects of personnel **** with the participation.
In the terminal stage, cancer patients, in addition to physical pain, more importantly, the fear of death. A hospice expert in the United States believes that "the mental pain of people before death is greater than the physical pain", therefore, we must control and alleviate the patient's physical pain at the same time, do a good job of psychological care of terminal patients.
Patients enter the dying stage, the beginning of the psychological denial period, when the patient often do not recognize the seriousness of their own condition, denying that they are terminally ill, and always hope that there is a miracle of treatment to save the death. When the patient learns that there is no hope of saving the patient's condition, and the patient feels that he or she is already facing death, he or she enters the period of fear of death, which is characterized by fear, irritability and anger. When the patient is convinced that death is inevitable, and instantly come, then the patient instead of calmly waiting for death to come, also entered the acceptance period. Generally speaking, the needs of dying people can be divided into three levels: ① preserving life; ② relieving pain; ③ dying without pain. Therefore, when death is inevitable, the patient's greatest needs are peace and quiet, avoidance of harassment, easy company of relatives, spiritual comfort and support, the need for beauty (e.g., flowers, music, etc.), or certain special needs, such as writing a will, meeting the most wanted person, etc. The patient's relatives should try to give these people the best possible care. The patient's relatives should try to give the patient these spiritual comfort and care, so that they can spend the last moments of their lives painlessly. [3]
Notes on care
1. Care-centered
For terminal patients, the hope of a cure has become very slim, and what is most needed is physical comfort, pain control, life care and psychological support, so the goal is to change from treatment-oriented to symptomatic treatment and care-centered care.
2. Maintaining human dignity
Despite being in the terminal stage, patients' personal dignity should not diminish as a result of reduced vitality, and their personal rights should not be deprived of due to physical exhaustion; as long as they are not in the coma stage, they still have thoughts and feelings, and healthcare professionals should maintain and support their personal rights; for example, retaining personal privacy and their own lifestyle, participating in the development of medical care programs, and choosing the mode of death. development, choosing the manner of death, etc.
3. Improve the quality of life at the end of life
Some people one-sidedly think that the end of life is to wait for death, life has no value, the patient has become depressed, lost interest in everything around them, and even, some health care workers also think so, and show indifference to the face, the attitude, the language, the operation of the rude, I do not know how to face the patient. Hospice care, on the other hand, believes that: the end of life is also life, a special type of life, so correctly recognize and respect the value of the patient's last life, improve its quality of life is the most effective service for terminal patients.
4.***The same face to death
There is life, there is death, death and birth, as the natural law of the objective world, can not be violated, is the fact that everyone has to go through, and it is the death to make the life seem meaningful. The terminal patients are just people who face death earlier than we do. Death gives meaning to life, and death is a person's final decision. Therefore, we should cherish life and time, and we should meet the challenges and face them bravely.
History of Development
The Hospice movement began at St. Christopher's Hospital in the U.K. In the 1950's, CicellSaunders, a British nurse, was determined to change the situation after witnessing the suffering of dying patients in her longtime job as a hospital for advanced oncology.In 1967, she founded the world-famous hospice ( ST. Christophers' Hospice) in 1967, enabling dying patients to have their needs met and comfortably cared for during the last part of their life's journey, "lighting a beacon for the hospice movement." Finally, hospice service practice and theoretical research were carried out in many countries and regions of the world, and hospice care was introduced to the United States in the late 1970s and to China in the late 1980s.
The formal application of the term "hospice care" began with the establishment of the Hospice Research Center of Tianjin Medical College in 1988.
Hospice care
Previously, many scholars' translations of Hospice and HospiceCare often failed to express the connotation and extension of the term. "HospiceCare has been translated as "hospice care" or "end-of-life care". Scholars in Hong Kong call it "hospice" and in Taiwan it is called "hospice care.
On July 15, 1988, Dr. Huang Tianzhong, a Chinese-American, and Professor Wu Xianzhong, the dean of the Tianjin Medical College, and Vice Dean Cui Yitai cooperated to create China's first end-of-life care research institution, the Hospice Research Center of the Tianjin Medical College. Dr. Huang successively funded RMB 100,000, Tianjin Medical College also took out the corresponding funds, Wang Guiying, the chairman of Tianjin Nursing Association, personally funded RMB 1,000, and Gan Lanjun, a nursing expert, was appointed as the deputy director of the institution (changed to be the consultant in May 1991) to ****together carry out the end-of-life care research work. The establishment of the Hospice Research Center of Tianjin Medical College marked China's place among the world's hospice research and practice. As it was the first hospice research institution in China, the news media were quite interested in it and publicized it through various newspapers and magazines, causing a strong social reaction. Hospice hospitals, wards or nursing homes have also been established in Shanghai, Beijing, Anhui, Xi'an, Ningxia, Chengdu, Zhejiang, Guangzhou and other cities. While actively carrying out academic research, the Hospice Research Center of Tianjin Medical College started to prepare for the establishment of a hospice ward, and in October 1990, the ward began to admit patients. The major newspapers reported on it, and the Beijing Science and Education Film Studio invested more than 100,000 yuan to produce a scientific and educational film entitled "Hospice Care", the premiere of which was held at the Great Hall of the People in Beijing. Hundreds of terminally ill patients have so far arrived at the end of their lives with dignity, comfort and peace. Since its establishment, the ward has received thousands of visitors and learners from all provinces, cities and autonomous regions of China, as well as experts and scholars from the U.S., Britain, Japan, Ireland, Canada, Australia and other countries, and has been universally praised and recognized. So far, the development of end-of-life care in China has made remarkable progress, although it has only been a short course of nine years. Since the establishment of the Hospice Research Center of Tianjin Medical College in 1988, the development of China's hospice career has gone through three stages. That is, the theory of the introduction of the research stage, publicity and popularization and professional training stage and academic research and clinical practice of the overall development stage.
In March 1991, the Hospice Research Center held the "First National Academic Symposium and Workshop on End-of-Life Care". On this basis, five hospice workshops have been held. These included two "China-US Psychological End-of-Life Care Workshops" and "China-Britain End-of-Life Care Workshops", "93 Beijing Hospice International Workshops", etc., and were held in Tianjin, Beijing, Xi'an, Wuhan, Tangshan, Qingdao, Xi'an, Wuhan, Tangshan, Qingdao, and Beijing, Xi'an, Wuhan, Tangshan, Qingdao, Yantai, Lushan and other places to organize end-of-life care symposium or end-of-life care series of lectures, has nearly 2,000 people engaged in medical, nursing, psychological and other aspects of the work of the participants, thus contributing to the formation and development of end-of-life care team in China. 1992 May, with the approval of the State Science and Technology Commission, Tianjin Medical College and the U.S. East-West Institute for the Study and Research of Dying Education jointly organized the "first Oriental death care program" in Tianjin. In May 1992, with the approval of the State Science and Technology Commission, Tianjin Medical College and the East-West Death Education and Research Society jointly held the "First International Symposium on Hospice Care in the East" in Tianjin, and the Minister of Health, Mr. Chen Minzhang, and other leaders attended the meeting and delivered speeches, in which he fully affirmed the cause of hospice care and believed that this meeting should be recorded in the history of China's health development. The Ministry of Health decided to incorporate it into the national medical and health care development plan. After the international symposium, hospice organizations were established in many provinces and cities across the country, and China's hospice career began to enter a period of comprehensive development.
In May 1993, the "China Mental Health Association Hospice Professional Committee Founding Conference and the Second National Hospice Academic Symposium" was held in Yantai City, Shandong Province; in May 1995, the "Third National Hospice Academic Symposium" was held in Guilin City, Guangxi Province; in March 1996, the "Third National Hospice Academic Symposium" was held in Guilin City, Guangxi Province. In May 1995, the Third National Symposium on Hospice Care was held in Guilin, Guangxi Province, and in March 1996, the National Symposium on Death Education and Hospice Care was held in Kunming. After years of preparation, the Journal of Hospice Care was founded and published to promote the further development of hospice care. [3]