安宁疗护模式下老年终末期患者舒适护理干预的临床观察

Clinical Observation of Comfort Care Intervention for Elderly Patients with Terminal Illness under Hospice Care Model

摘要: 目的：探究系统化舒适护理在老年终末期安宁疗护患者中的应用价值，观察其对老人躯体舒适感、疼痛缓解情况、情绪以及生活质量的影响，为优化老年安宁疗护的护理方案提供可靠依据。方法：选取2023年1月~2025年6月浙江老年关怀医院安宁疗护病房收治的80例符合安宁疗护标准的老年终末期患者为研究对象，采用随机数字表法分为对照组与观察组，各40例。对照组按常规安宁疗护要求开展基础护理，观察组在常规护理基础上，实施生理、心理、环境、社会的四维系统化舒适护理，两组均连续干预4周。分别于干预前1 d、干预4周结束后次日，评估Kolcaba舒适状况量表(GCQ)、数字疼痛评分(NRS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)及Karnofsky功能状态量表(KPS)，评估两组患者舒适程度、疼痛水平、心理状态与生活质量。结果：研究过程中对照组脱落2例、观察组脱落1例，最终共77例完成全程数据采集。干预前两组性别、年龄、疾病、病程等一般资料无显著差异(P > 0.05)，组间具备可比性。干预4周后，观察组GCQ生理、心理、环境、社会文化维度评分及总分均显著高于对照组，NRS、SAS、SDS评分均显著低于对照组，KPS功能状态评分显著高于对照组，组间差异均有统计学意义(P < 0.05)；观察组患者满意度为94.87%，显著高于对照组的76.32% (P < 0.05)；观察组并发症发生率为2.56%，显著低于对照组的13.16% (P < 0.05)。结论：在老年终末期患者安宁疗护中实施系统化舒适护理，能从躯体、心理、社交等多维度提升患者舒适感，有效缓解癌性疼痛与负性情绪，降低卧床并发症风险，切实改善终末期生活质量，同时显著提升家属护理满意度，值得在临床安宁疗护工作中推广应用。

Abstract: Objective: To explore the application value of systematic comfort care in elderly patients with end-stage hospice care, and to observe its impact on the physical comfort, pain relief, emotional state, and quality of life of the elderly. This study provides a reliable basis for optimizing the nursing plan of elderly hospice care. Methods: A total of 80 elderly patients with end-stage diseases who met the criteria for hospice care and were admitted to the hospice care ward of a tertiary hospital from January 2023 to June 2025 were selected as the research subjects. They were divided into a control group and an observation group using a random number table method, with 40 patients in each group. The control group received basic nursing care according to the requirements of conventional hospice care, while the observation group received four-dimensional systematic comfort care, including physiological, psychological, environmental, and social dimensions, on the basis of conventional nursing care. Both groups underwent continuous intervention for 4 weeks. The Kolcaba Comfort Questionnaire (GCQ), Numerical Rating Scale (NRS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Karnofsky Performance Scale (KPS) were used to assess the comfort level, pain level, psychological state, and quality of life of the two groups of patients on the day before intervention and the day after the end of 4 weeks of intervention, respectively. Results: During the study, 2 patients in the control group and 1 patient in the observation group dropped out, with a total of 77 patients completing the entire data collection process. There were no significant differences in general information, such as gender, age, disease, and disease duration between the two groups before intervention (P > 0.05), indicating comparability between the groups. After 4 weeks of intervention, the GCQ scores in the physiological, psychological, environmental, and social cultural dimensions and the total score in the observation group were significantly higher than those in the control group. The NRS, SAS, and SDS scores were significantly lower in the observation group than in the control group, and the KPS functional status score was significantly higher in the observation group than in the control group. The differences between the groups were statistically significant (P < 0.05). The satisfaction rate of patients in the observation group was 94.87%, significantly higher than that of the control group (76.32%) (P < 0.05). The incidence of complications in the observation group was 2.56%, significantly lower than that in the control group (13.16%) (P < 0.05). Conclusion: Implementing systematic comfort care in hospice care for elderly patients with end-stage diseases can improve patients’ comfort from multiple dimensions, such as physical, psychological, and social aspects, effectively alleviate cancer pain and negative emotions, reduce the risk of bed complications, and significantly improve end-stage quality of life. At the same time, it significantly enhances the satisfaction of family caregivers, making it worthy of promotion and application in clinical hospice care work.