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EN
The functioning of hospice institutions may be considered based on three fundamental, functions accomplished by it, i.e. existential, social and economic ones. Holistic evaluation of hospice care requires taking into account actual and potential advantages, possible to achieve both through society represented by all citizens, and through the economy. The article has a survey character – the literature is based on critical analysis within the scope ofthe subject raised. The work was made rich from two-year own experience of volunteer work. For the purpose of realization of the subject raised, empirical examinations were also conducted based on the method of shadow prices and logical matrix. In this paper, the implementation of the function of an existential volunteer hospice is considered on the basis of its ability to alleviate the suffering of patients’ mental and spiritual capacity and give them practical help by volunteers. The usefulness of hospices, which is a part of their social function, was studied by considering the point of existence and functioning of palliative and long-term care centres. In order to define the economic function of a voluntary service, micro and macroeconomic types of analysis were used. One should, however, emphasise that these examinations should have an interdisciplinary character.
EN
Nowadays the good thing is being healthy, young and beautiful. Suffering, disease, old age and death are pushed to the margins of social life, hidden behind the closed doors of hospitals and nursing homes. A man wants do anything to get away from the situation of confrontation with the fragility of human life. However, there are still people who want to support others with professional activity. The purpose of this article is to present reports on the narrative research about working on the pediatric palliative ward and to show what medical staff is thinking about life, death and themselves.
EN
Our long-time experience in palliative care allowed us to notice changes in ethics of palliative medicine. In the handbook of palliative medicine, its authors R.G.Twycross and D.Frampton in 1995 did formulate the following ethical postulate: respect for life, acceptance of death of a patient as an unavoidable event, respect for a patient as a person, beneficence, nonmaleficence, justice. In addition, they stressed prohibition of euthanasia as a rule. Nine years later, however, in the Oxford handbook of palliative care, its authors: M.S.Watson, C.T.Lukas, M.A.Hoy and J.N.Back described their ethical basis, which were slightly different but quite similar to those of T.L.Beauchamp and J.F.Childers: autonomy of a patient, beneficence, nonmaleficence, justice and the trust. Their set of principles may induce controversy because of unlimited patient's autonomy and absence of physician's autonomy. Further, it may permit euthanasia, which is excluded by palliative medicine.
Mäetagused
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2023
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vol. 85
27-42
EN
According to the vision of the World Health Organization, spirituality is an integral part of human existence. Spirituality is even seen as an all-encompassing essence of the human being that requires appreciation and respect. Spirituality is closely linked to the search for meaning, the sense of connection and the feeling and experience of belonging. The article explores the question of whether and how it is possible to teach and learn spiritual care when one is ‘not spiritual’ oneself. The case study, based on the student’s self-reflection, is theoretically inspired by Ricoeur’s theory of narrative meaning-making and a search for explanations of life issues. It is a visual-textual case study, which also explains the appropriateness of the chosen method of self-reflection and analysis for recording and making sense of emotional-social-relational experiences.
EN
This article discusses the need for cultural competencies in hospice and palliative care. The following discussion is based on patient narratives. The interviews (37) were conducted in Munich, Germany, in 2016. Half of the interviewees had a migration history. Thematic analysis revealed that (1) for most of the patients the aims of palliative and hospice care were ambiguous; (2) the end of life was connected with a loss of autonomy and wish for hastened death. Discussions about life, illness, and death were not perceived as burdensome, whereas discussing the end of life seemed challenging. A comparison between two groups revealed that for people with migration history the notion of ‘dying at home’ may cause additional suffering, and thus may need screening and additional attention from professionals. Cultural competence in the hospice and palliative care setting is providing safety by treating each patient as an individual and not as a member of some specific group. The task for medical anthropology in this context is to strive for research free from standpoint epistemology and stereotypes.
EN
The human being is a person from the moment of conception to the natural death and because of that he or she acquires the right to the affirmation of the human dignity at every stage of his or her life. Taking care of the terminally ill people who are in the last stage of their lives has been practised for centuries. This is due to the love of another human being and the desire to provide a widely understood support in the last moments of their life. However, the contact with a person who is about to end his or her life is undoubtedly a very difficult experience which requires extraordinary sensitivity, empathy and, above all, an integral understanding of what the human being is. Any kind of a simplified and reduced approach towards a person hinders or completely prevents the whole affirmation of the human dignity and, as a result, renders a proper care for a person who is totally dependent on other people much more difficult. The integral understanding of the human nature guarantees accurate approach to him or her at every stage of their life, especially during the terminal illness and it should perceive the human being as an entity of the body and the soul as well as an individual in a relationship with other people or the society. However, it seems that it is important, especially in palliative care, to affirm a person in his or her complexity of the natural and the supernatural dimension (mutual complementation of nature and grace) as well as the earthly and the eternal life (from the eschatological point of view). In this way the palliative care is not limited just to the somatic or psychological dimensions but it also deals with other dimensions that are extremely important from the angle of the borderline experience of life and death.
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EN
This work deals with present problems of hospice and palliative care. Dying is an inseparable part of everyone´s life. We can point out that hospice care is a big contribution not only for dying person but for his family as well. Hospice and palliative care is a complex care which tries hard to ensure not only patient´s biological needs but also his psychological, social and spiritual needs. It provides health care to an incurably ill person.
EN
Introduction and aim. Palliative care is an approach to improve the quality of life of patients and their families facing problems associated with life-threatening illnesses or old age, to manage their pain, distress, and other symptoms, improving their quality of life, and providing psychological support. This study was designed to identify the care practices planned by nurses for the health issues of palliative surgical patients. Material and methods. This is a retrospective, cross-sectional, descriptive study. The data was collected from digital records of the two state hospitals in the Western Black Sea Region of Turkey between January 2019 and January 2020. The research was completed with a total of 391 data of patients undergoing palliative surgery. Frequency and percentage distributions were used in descriptive statistics. Results. The frequency of symptoms observed in patients were determined as cough and sputum (81.8%), dehydration (73.9%), dyspnea (71.9%), fatigue (49.9%), loss of appetite-weight (49.9%), insomnia (44%), pain (37.6%), nausea (29.2%), and constipation (23.8%). The planned nursing diagnoses for these symptoms were identified as risk for falls, imbalanced nutrition, risk for impaired skin integrity, risk for infection, risk for aspiration, deficient knowledge, risk for impaired respiratory function, constipation, ineffective airway clearance, pain, risk for deficient fluid volume, sleep deprivation, impaired gas exchange respectively. Conclusion. This study highlights the insufficient planning of nursing care for the symptoms of palliative surgical patients receiving palliative care in our country. Therefore, it is recommended that palliative care nurses be supported with in-service training on appropriate care planning topics.
PL
Wstęp: Temat nowotworu w opinii publicznej wciąż jest powodem niepokoju i strachu. W sytuacji, gdy rozwój choroby nowotworowej jest na etapie, w którym wsparcie i opieka bliskich w warunkach domowych są niewystarczające dla chorego, istnieje możliwość zapewnienia opieki i terapii pacjentowi na oddziale medycyny paliatywnej. Badania prowadzone nad jakością życia w opiece paliatywnej wpływają na prawidłowy przebieg leczenia chorego i warunkują prawidłową opiekę medyczną. Cel pracy: Ocena stanu fizycznego, psychicznego i duchowego pacjentów przed przyjęciem na oddział oraz w pierwszym tygodniu pobytu na Oddziale Medycyny Paliatywnej. Materiał i metody: Narzędziem badawczym był kwestionariusz European Organisation for Research and Treatment for Cancer (EORTC) QLQ-C30. Badanie przeprowadzono na Oddziale Medycyny Paliatywnej Ośrodka Medycznego Samarytanin w Opolu, w okresie od listopada 2013 do stycznia 2014 r. W badaniu wzięło udział 35 pacjentów z 62 obecnych na oddziale. Mediana wieku badanych wynosiła 69 lat (min. 31, maks. 93 lata). Wyniki: W dniu przyjęcia na oddział i podczas wypełniania kwestionariusza wszyscy badani respondenci odczuwali dolegliwości bólowe oraz mieli problem ze snem, a 89% (31) odczuwało duszności. 94% (33) badanych wysoko oceniło poziom jakości swojego życia na Oddziale Medycyny Paliatywnej. Wnioski: Pacjenci wysoko ocenili poziom jakości swojego życia na Oddziale Medycyny Paliatywnej. Natomiast doświadczenie dolegliwości bólowych oraz zmęczenia pacjentów w warunkach domowych w tygodniu poprzedzającym przyjęcie na oddział skłania do kontynuowania badań chorych przebywających w tym środowisku, w celu poprawy jakości życia osób z rozpoznaniem nowotworowym pozostających w warunkach domowych.
EN
Background: The subject of cancer is still the cause of fear and anxiety in the public opinion. The order of daily life of the patient and their family is disturbed by numerous medical consultations, treatment and the side effects of the therapy. In the situation, when the development of cancer goes beyond the possibilities of the support and care from the loved ones in household conditions and this care is no longer sufficient, there is an opportunity to provide care and therapy for the patient in the palliative medicine departments. In the studies of the life quality we take into account not only the clinical state of the patient, but also their subjective feelings. The quality of life is assessed in the dimension of the current health status. Aim of the study: The paper aims to show the physical, mental and spiritual state of the patients before admission to the department, and in the first week of the stay in the palliative medicine department. Material and Methods: The research was performed with the use of a questionnaire (EORTC) QLQ-C30. The study was conducted among the patients of the Palliative Medicine Department of the Medical Centre ‘Samaritan’ in Opole, in the period from November 2013 to January 2014. 35 patients participated in the study. The average age was 69±31. Results: On the day of admission to the department and while filling in the questionnaire, all the respondents felt pain ailments and had some sleeping problems. 89% (31) experienced shortness of breath. 94% (33) of the respondents assessed their level of life in the palliative medicine department as high. Conclusions: The patients have assessed their level of life in the palliative medicine department as high. The low assessment of the quality of life in household conditions during the week preceding the admittance to the palliative medicine department encourages the continuation of the research in household conditions, in order to improve the life quality of people with the diagnosed cancer remaining in home environment.
EN
A children’s hospice is regarded not only as a specific place but as a multi-faceted program of care for terminally ill children and their families. Hospices take care of people in need, taking into consideration their physical, emotional, social, and also spiritual needs. Hospice workers deal with treating the painful symptoms of the disease, bringing relief and respite to families as well as support during both the time of dying and the period of mourning. The main aim of these institutions is to improve the quality of the last days of patients’ lives by providing not only professional and attentive medical care but also psychological, pastoral, spiritual, and social support. The article presents the premises of hospice work and compares the situation in this respect in Poland and Ukraine.
EN
Introduction: Malignant cancers of the central nervous system with the consequences of strong symptoms and urgent progression of the disease put the palliative teams of the palliative wards in the feeling of helplessness. Difficulties in undertaking the treatment and lack of experience with such patients cause their higher mortality rate. The main aim of the case: The aim of the study is to present the clinical treatment and the palliative care of the patient with Astrocytoma GII/GIII (ICD 10 C -71). Data and Methods: Analyses of the medical documentation, observation and nursing interview with the patient’s family were taken into account. Case study: A 39 year old woman, who had never been cured for cancer before, was transferred from the neurosurgery to the palliative care ward with brain cancer astrocytoma GII/GIII without any contact and lack of improvement of her condition. After a symptomatic treatment, a combined therapy was applied which consisted of oral chemotherapy (Lomustine) and radiotherapy. The patient’s condition was systematically improving. The patient and her family received care and support from the therapeutic team, which made it possible for the patient to return back home after eight months on the ward. It made the patient function alone and lead active social life despite of the limitations caused by cancer. Conclusions: It is not advisable to make quick decisions of ceasing the treatment only because of the diagnosis of inoperable brain malignant cancers. The therapeutic team play a significant role in the process of restoring the vital functions of the patient and in the entire therapy. Especially the family, who are the active members of the team, become very important. Education and the family support is essential and helps to tackle such a difficult chronic disease with bad prognosis. It also helps to understand specific symptoms and behaviours of the patients with brain cancer much better. Furthermore, it helps to lower the level of the family’s anxiety and frustration. Active cooperation of the family and the therapeutic team allows the patient to get back home AFVSS.
PL
Wstęp: Złośliwe nowotwory centralnego układu nerwowego w konsekwencji ostrych objawów i nagłej progresji choroby stawiają w poczuciu bezradności zespoły terapeutyczne oddziałów medycyny paliatywnej. Trudności w podjęciu leczenia oraz braku doświadczenia w opiece nad pacjentami z tego typu nowotworami, są powodem podwyższonego wskaźnika umieralności pacjentów. Cel badania: Przedstawienie leczenia klinicznego oraz opieki nad pacjentką z rozpoznaniem astrocytoma GII/GIII (ICD 10 C-71). Materiał i Metody: Analizy dokumentacji medycznej, obserwacja i wywiad pielęgniarski z rodziną pacjentki. Opis przypadku: 39-letnia kobieta nigdy wcześniej nieleczona onkologicznie została przekazana z oddziału neurochirurgii do oddziału medycyny paliatywnej z rozpoznaniem guza mózgu astrocytoma GII/GIII bez kontaktu i brakiem rokowań na poprawę stanu. Po podjęciu leczenia objawowego, zastosowaniu terapię skojarzoną: chemioterapią doustną (Lemustyna) oraz radioterapię. Stan pacjentki ulegał systematycznej poprawie. Opieka i wsparcie zespołu terapeutycznego udzielone chorej oraz jej rodzinie pozwoliły nie tylko na powrót pacjentki do domu po ośmiu miesiącach pobytu na oddziale, ale również na jej samodzielne funkcjonowanie i aktywny udział w życiu społecznym pomimo ograniczeń, jakie niesie choroba nowotworowa. Wnioski: Pomimo nieoperacyjnych nowotworów złośliwych mózgu nie należy zbyt szybko podejmować decyzji o zaprzestaniu leczenia pacjenta. W procesie terapii i powrotu najważniejszych funkcji życiowych pacjenta dużą rolę odgrywa zespół terapeutyczny, szczególnie rodzina, która staje się aktywnym członkiem tego zespołu. Edukacja i system wsparcia dla rodziny pozwalają na zmierzenie się z trudną sytuacją choroby przewlekłej o złym rokowaniu, oraz zrozumienie specyficznych objawów i zachowań pacjenta towarzyszących tego typu nowotworom. Pozwala to na zmniejszenie poziomu lęku i frustracji członków rodziny. Aktywna współpraca rodziny z personelem medycznym umożliwia powrót pacjenta do domu w stanie stabilnym.
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Content available remote

Rola pomocy społecznej w opiece paliatywnej w Polsce

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PL
Opieka paliatywna polega na sprawowaniu całościowej opieki nad pacjentem w terminalnym okresie życia. Dotyczy sfery medycznej, duchowej, psychicznej oraz socjalnej. Podstawową formą wsparcia jest działalność zespołu interdyscyplinarnego, w którym jednym z członków jest pracownik socjalny. Gwarantuje on pomoc, np. w bezpłatnym zaopatrzeniu w sprzęt, uzyskaniu informacji na temat otrzymania renty, oraz wsparcie psychiczne dla chorych i ich rodzin. Inną formę wspierania stanowią stowarzyszenia samopomocy, które oferują pomoc psychologiczną chorym i ich rodzinom. Opieka paliatywna korzysta także z działalności medialnej, czego przykładem jest Warszawskie Hospicjum dla Dzieci. W opiece paliatywnej pomoc społeczna odgrywa ważną rolę, jednak w Polsce nie jest ona doceniana. Wzorem są tu Stany Zjednoczone, w których funkcjonuje organizacja pracowników socjalnych – Social Work Hospice-Palliative Care Network (SWHPN). W Polsce należy podnieść poziom współpracy pomiędzy służbą zdrowia a pomocą społeczną. Zespoły opieki zobowiązane są do wspólnej troski o chorych oraz ich rodziny.
EN
Palliative care includes all forms of necessary care in terminally ill patients. It concerns medical, mental and social aspects The primary form of the assistance is based on the action of the interdisciplinary team which, among others, includes a social worker. They provide help in organising free necessary equipment, obtaining information about the Disability Living Alovance (DLA) and ensuring psychological support for the patients and their families. Another form of help might be achieved from self-help associations which also offer psychological support. Palliative care uses a media work, too. The Warsaw Hospice for Children is one of the examples. However, social assistance in palliative care plays a fundamental role, although, it is not valued significantly in Poland. The formula from the USA with a special organization of social workers called Social Work Hospice-Palliative Care Network (SWHPN) should be the model to follow. In Poland the level of cooperation between the Health Service and Social Assistance should be improved as both institutions are obliged to ensure proper care of patients and their families.
EN
The aim of this article is a presentation of the problem of terminal sedation as a special medical procedure, an alternative to euthanasia and physician assisted death. Terminal sedation is consist in narcotizing the patient in the last stage of terminal disease, sometimes with discontinued nutrition and hydration until death. The goal of this procedure is to eliminate pain and suffering without causing death of the patient. The opponents of this method claim that terminal sedation is a form of euthanasia. The supporters see the difference because the intention of physician must relieve unbearable suffering when the other procedures are useless. The terminal sedation has to be last resort in palliative care and the decision making process must be very careful. In case of applying this radical method the basis should be always the informed consent of the patient and the respect for the dying person.
EN
The aim of this paper is to review the situation in communist and post-revolutionary Czechoslovakia in the area of palliative care. It will familiarize readers with the enormous efforts of two big personalities in the history of Czech health care: Marie Opatrná and Marie Svatošová, who tried to change the old and inconvenient Soviet health care system and make the care of terminal and dying people more human. At the end, it will present some challenges which the current Czech hospice care is confronted with.
EN
Opioid analgetics (the most potent painkillers) are widely used in palliative care of patients with terminal malignant neoplasms. They often cause such gastrointestinal adverse effects as nausea, vomiting, flatulence, abdominal pain and constipation, referred to as opioid-induced bowel dysfunction (OIBD ). While some of them, like nausea and vomiting, disappear or at least tend to diminish with continued use, patients do not develop tolerance to opioid-induced constipation. Constipation is an adverse effect of all opioid analgetics and its severity increases with the dose of an opioid, as well as with the progression of the neoplastic disease, markedly decreasing the patient’s quality of life. The incidence of opioid-induced constipation is significantly reduced by the administration of controlled-release tablets containing an opioid receptor agonist and antagonist (oxycodone + naloxone) which acts as a painkiller and reduces the frequency and/or severity of OIBD symptoms. Nowadays, apart from laxatives (initially usually osmotic and/or stimulant agents), new medications such as methylnaltrexone (a peripheral opioid receptor antagonist), administered in subcutaneous injections, are successfully used in the treatment of opioid-induced constipation. The aim of this review is to present the incidence, etiology, prophylaxis and treatment of opioid-induced constipation in the population of patients with malignant neoplasms in palliative care.
XX
Opioidowe leki przeciwbólowe (najsilniej działające analgetyki) stosuje się powszechnie w leczeniu paliatywnym terminalnej choroby nowotworowej. Do ich częstych działań niepożądanych ze strony układu pokarmowego należą między innymi nudności, wymioty, wzdęcia, bóle brzucha i zaparcia, określane jako zaburzenia jelitowe wywołane przez opioidy (ZJW O). O ile niektóre z nich ustępują lub przynajmniej stają się z czasem mniej nasilone, zaparcie nie podlega zjawisku tolerancji. Zaparcie pojawia się po wszystkich analgetykach opioidowych, a jego nasilenie rośnie wraz z dawką leku i progresją choroby nowotworowej, obniżając jakość życia pacjenta. Prawdopodobieństwo pojawienia się zaparć zmniejsza zastosowanie tabletek o kontrolowanym uwalnianiu zwierających agonistę i antagonistę receptora opioidowego (oksykodon + nalokson), co zapewnia działanie przeciwbólowe i mniejszą częstość/nasilenie objawów ZJW O. W leczeniu zaparć poopioidowych, poza środkami przeczyszczczającymi (początkowo najczęściej osmotycznymi i/lub pobudzającymi zwoje nerwowe jelit), stosuje się obecnie z powodzeniem nowe preparaty, jak metylonaltrekson (antagonista receptorów opioidowych o działaniu obwodowym) w postaci iniekcji podskórnych. Artykuł stanowi podsumowanie danych dotyczących częstości, etiologii, profilaktyki i leczenia zaparć indukowanych przez analgetyki opioidowe w populacji pacjentów z rozpoznanym nowotworem złośliwym w opiece paliatywnej.
PL
Wstęp. Mimo postępu medycyny wciąż wielu chorych pozostaje z niepomyślną prognozą własnego stanu zdrowia. Z analiz ekspertów Światowej Organizacji Zdrowia wynika, że do 2020 r. średnia długość życia wzrośnie do 71,6 lat. Prognozowany wzrost liczby osób w starszym wieku zwiększa ryzyko zachorowań na choroby nowotworowe i inne choroby somatyczne. Nowoczesna opieka paliatywna różni się zasadniczo od opieki, która sprawowana była w szpitalach dawniej. Obecnie wprowadzono szereg programów postępowania medycznego opartych na wynikach badań naukowych, a dotyczących między innymi poprawy jakości życia, sprawności funkcjonalnej i sprawności psychofiycznej tej grupy chorych. celem pracy była ocena stopnia ograniczenia sprawności funkcjonalnej osób przyjmowanych do hospicjum. Materiał i metoda. Grupę badaną stanowiło 41 osób objętych opieką hospicyjną i 41 osób z grupy kontrolnej. Do oceny badanych czynników wykorzystano skalę Katza, skalę złożonych czynności życia codziennego Lawtona oraz skalę Tinetti. Badanie przeprowadzono w czasie przyjmowania pacjentów do opieki hospicyjnej. Wyniki. Na podstawie analizy statystycznej prostych i złożonych czynności życia codziennego zaobserwowano zróżnicowanie poziomu sprawności badanych osób obu grup, na niekorzyść grupy badanej. Grupa badana uzyskała gorsze wyniki w zakresie czynności lokomocyjnych, jak zmiana pozycji i chód. U 56% osób badanej grupy wystąpi- ło duże i średnie ryzyko upadków, w grupie kontrolnej duże i średnie ryzyko upadków stwierdzono u 24% badanych osób. Wnioski. 1. Większość osób przyjmowanych do hospicjum charakteryzuje ciężka i umiarkowana zależność w zakresie prostych i złożonych czynności życia codziennego oraz ograniczona sprawność lokomocyjna. 2. Najczulszą skalą oceny utraty sprawności funkcjonalnej jest skala Lawtona. 3. Wyniki w skali Lawtona są porównywalne do wyników uzyskanych w skali Katza i skali Tinetti, co pozwala stosować skale zamiennie dla oceny stanu funkcjonalnego osób przyjmowanych do hospicjum.
EN
background. Despite advances in medicine, many patients still experience an unfavorable prognosis as to their health. The analysis conducted by the experts of the World Health Organization shows that by 2020, the average life expectancy will increase to 71.6 years. The projected increase in the number of elderly people increases the risk of developing cancer and other somatic disorders. Modern palliative care is fundamentally diffrent from the care that was common in hospitals in the past. A range of treatment procedures has been introduced, based on the results of medical research relating to, among other things, improving the quality of life, functional capacity and psychophysical capacity in this group of patients. Objective. The aim of this study was to assess the functional capacity impairment of persons admitted to hospice care. Material and method. The test group consisted of 41 patients receiving hospice care and 41 persons in the control group. To evaluate the factors tested, Katz Scale (Index of Independence in Activities of Daily Living, ADL), Lawton Scale (Instrumental Activities of Daily Living, IADL) and Tinetti Scale have been used. The examination was performed at the time of admission of patients to hospice care. results. Based on statistical analysis of basic and complex activities of daily living a diffrence in the capacity level was observed, with the test group subjects receiving poorer results. The test group achieved worse results in terms of locomotor activity such as change of the position and gait. In 56% of the subjects from the test group there was a high and medium risk of falls; in the control group large and medium risk of falls was found in 24% of subjects. conclusions. 1. The majority of patients admitted to hospice care are characterized by severe and moderate dependence in terms of basic and complex activities of daily living and have limited locomotor capacity. 2. Lawton IADL Scale is the most sensitive one in the assessment of the loss of functional capacity. 3. Lawton scale results are comparable to the results obtained using Katz Scale and Tinetti Scale, which allows for the use of the scales interchangeably.
EN
The article presents current conditions for activities of institutions providing palliative and hospice care in Poland, taking under special consideration urban agglomeration of Szczecin. The results of presented research are based on an analysis of legal regulations of palliative and hospice care in Poland, an analysis of factual and financial reports of the institutions, and interviews focusing on the subject conducted with managers of such institutions. The article shows legal, financial and social aspects of provided care. It also indicates difficulties that come from current systemic solutions, which are inadequate to actual needs of patients.
XX
Artykuł jest prezentacją stanu rzeczywistego działania podmiotów organizujących opiekę paliatywną i hospicyjną w Polsce, ze szczególnym uwzględnieniem aglomeracji miejskiej Szczecina. Wyniki prezentowanych badań zostały oparte na analizie uwarunkowań prawnych opieki paliatywnej hospicyjnej w Polsce, analizę sprawozdań merytorycznych i finansowych podmiotów oraz na wywiadach skoncentrowanych na temacie przeprowadzonych z dyrektorami placówek. Artykuł pokazuje zarówno aspekty prawne, finansowe, jak i społeczne realizowanej opieki. Wskazuje również trudności wynikające z przyjętych rozwiązań systemowych nieadekwatnych do rzeczywistych potrzeb pacjentów.
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