1、本科毕业设计（论文）外文翻译原文AMODELFORSUCCESSFULNURSINGHOMEHOSPICEPARTNERSHIPSSUSANCMILLER,PHD,MBAABSTRACTBACKGROUNDWHILEBENEFITSOFHOSPICECAREINNURSINGHOMESHAVEBEENDOCUMENTED,INTERORGANIZATIONALCHALLENGESSUCHASSTAFFCONFLICTSREGARDINGPLANNEDCAREORTHEIRRESPECTIVEROLESHAVEALSOBEENDOCUMENTEDTHROUGHCASESTUDIES,THISRE
2、SEARCHAIMEDTOCHARACTERIZETHEPARTNERSHIPSOFSUCCESSFULNURSINGHOMEHOSPICECOLLABORATORSMETHODSSIXNURSINGHOMESANDHOSPICESWITHSELFIDENTIFIEDSUCCESSFULCOLLABORATIONSWERESTUDIEDINTERVIEWSOFCAREPROVIDERSANDCHIEFEXECUTIVEANDFINANCIALOFFICERSCOLLECTEDINFORMATIONONPRACTICESRELATINGTOSEVENDOMAINSIDENTIFIEDASCRIT
3、ICALTOTHECOLLABORATIONTHEORGANIZATIONALFACTORSANDACTIVITIESRELATINGTOINFRASTRUCTUREDEVELOPMENTANDCARECOLLABORATIONANDPROVISIONMOSTCOMMONACROSSSITESWEREIDENTIFIEDRESULTSNURSINGHOMEHOSPICECOLLABORATORSWEREPHILOSOPHICALLYANDOTHERWISEALIGNEDTHEYHADSIMILARMISSIONS,UNDERSTOODTHEIRDIFFERINGAPPROACHESTOCARE
4、,ANDADMINISTRATORSDEMONSTRATEDANOPENNESSANDSUPPORTFORTHECOLLABORATIONHOSPICESDEVELOPEDINFRASTRUCTURESTOCORRESPONDTOTHEUNIQUENESSANDCOMPLEXITYOFTHENURSINGHOMEENVIRONMENTFOREXAMPLE,THEYHIREDNURSESWITHNURSINGHOMEBACKGROUNDS,CREATEDTEAMSDEDICATEDTONURSINGHOMECARE,ANDTRAINEDHOSPICESTAFFINPROBLEMSOLVINGAN
5、DCONFLICTRESOLUTIONCARECOLLABORATIONPROCESSESFOCUSEDONTHEIMPORTANCEOFTWOWAYCOMMUNICATIONBYACTIVELYSOLICITINGANDSHARINGINFORMATIONWITHNURSINGHOMESTAFFANDRESPONDINGTONURSINGHOMESTAFFANDADMINISTRATORSCONCERNSCONCLUSIONWHILESUCCESSFULCOLLABORATORSWEREORGANIZATIONALALIGNED,HOSPICELEADERSACKNOWLEDGEMENTTH
6、ATPALLIATIVECAREPROVISIONINNURSINGHOMESISCOMPLEXANDUNIQUEWASIMPORTANTTOSUCCESSACCORDINGLY,THEPREVALENTPARTNERSHIPMODELWASAPRODUCTOFSTRATEGICEFFORTSBYLEADERSAIMEDATMATCHINGTHEIRSTAFFINGTOTHENURSINGHOMEENVIRONMENTANDPROMOTINGGOODCOMMUNICATIONANDSKILLSNEEDEDFORPROBLEMSOLVINGINTRODUCTIONOVER25OFAMERICAN
7、SDYINGFROMNOTRAUMATICCAUSESSPENDTHEFINALCHAPTEROFTHEIRLIVESINNURSINGHOMES1INCREASINGLY,NURSINGHOMEENDOFLIFECAREISPROVIDEDTOMOREDIVERSE,FRAIL,ANDCLINICALLYCOMPLEXINDIVIDUALSWHILEPROVIDINGHIGHQUALITYENDOFLIFECARETOTHESEDIVERSEINDIVIDUALSISCHALLENGINGFORNURSINGHOMES,THISCHALLENGEISINTENSIFIEDBYTHEREIMB
8、URSEMENTANDREGULATORYENVIRONMENTSINWHICHUSNURSINGHOMESOPERATEFURTHERMORE,THESECURINGOFPALLIATIVECAREEXPERTISEANDSUPPORTTHROUGHPARTNERSHIPSWITHHOSPICEPROVIDERSCANADDTOEXISTINGCOMPLEXITY,GIVENTHECHALLENGESKNOWNTOBEINHERENTWITHINTERORGANIZATIONALCOLLABORATIONSPERHAPSBECAUSEOFTHIS,22OFUSNURSINGHOMESIN20
9、04DIDNOTPARTNERWITHHOSPICES,ANDFORTHOSETHATDID,THEMAGNITUDEOFHOSPICEUSEVARIEDWIDELYACROSSANDWITHINUSSTATESIN1982THEUSCONGRESSPASSEDLEGISLATIONALLOWINGPAYMENTFORHOSPICECARETOTERMINALLYILLMEDICAREBENEFICIARIES，ANDIN1986THEBENEFITWASEXTENDEDTOTERMINALLYILLMEDICAREBENEFICIARIESRESIDINGINNURSINGHOMESNURS
10、INGHOMESCANOFFERMEDICAREHOSPICECAREBYDEVELOPINGWORKINGRELATIONSHIPSINCLUDINGFORMALCONTRACTSWITHCERTIFIEDMEDICAREHOSPICEPROVIDERSRESEARCHATTESTSTOHOSPICESPOSITIVEIMPACTONTHECAREANDOUTCOMESOFNURSINGHOMERESIDENTSENROLLEDINHOSPICEANDSUGGESTSHOSPICEPRESENCEINNURSINGHOMESRESULTSINDIFFUSIONOFHOSPICEPHILOSO
11、PHYANDPRACTICESTOTHECAREOFRESIDENTSDYINGWITHOUTHOSPICEWHILEHOSPICEBENEFITSHAVEBEENDOCUMENTED,INTERORGANIZATIONALCOLLABORATIONSPRESENTCHALLENGESTHATCANADDTONURSINGHOMEOPERATINGCOSTSFOREXAMPLE,BYINCREASINGMANAGEMENTTIMENEEDEDTOADDRESSCONFLICTSANDARISEFROMFACTORSSUCHASPOORLYCOORDINATEDCAREANDORSTAFFCON
12、FLICTSREGARDINGPLANNEDCAREEG,THEUSEOFMORPHINE,OTHERANDTHEIRROLESINCAREPROVISIONADDITIONALLY,REGULATORYOVERSIGHTPRESENTSCHALLENGESSINCESURVEYORSMAYCITENURSINGHOMESFORDEFICIENCIESRELATEDTOHOSPICEAPPROACHESTOCARETHATAREDIFFERENTFROMWHATNURSINGHOMEREGULATIONSENCOURAGEIE,PALLIATIVEAPPROACHESTOCAREVERSUSR
13、ESTORATIONORREHABILITATIONFURTHERMORE,SELECTEDSTATEMEDICAIDNURSINGHOMEREIMBURSEMENTPOLICIESANDPRACTICESAPPEARTOPRESENTNURSINGHOMESWITHFINANCIALINCENTIVESTONOTPARTNERWITHHOSPICESFOREXAMPLE,SOMESTATESMANUALLYVERSUSELECTRONICALLYREVIEWNURSINGHOMEMEDICAIDCLAIMSFORRESIDENTSENROLLEDINHOSPICEANDTHISRESULTS
14、INSLOWERPAYMENTSSINCESUCCESSFULNURSINGHOMEHOSPICECOLLABORATIONSHAVETHEPOTENTIALTOLEADTOPARTNERSHIPSYNERGYWHEREPROVIDERSANDDYINGRESIDENTSANDTHEIRFAMILIESBENEFITFROMTHEDIFFERINGCAREEXPERTISEANDCULTURESOFNURSINGHOMEANDHOSPICEPROVIDERS,EFFORTSTOFACILITATESUCCESSFULCOLLABORATIONSAREIMPORTANTWITHTHISINMIN
15、D,THERESEARCHREPORTEDHEREAIMEDTOUNDERSTANDTHEORGANIZATIONALFACTORSRESOURCESANDACTIVITIESCOMMONTOSUCCESSFULNURSINGHOMEHOSPICECOLLABORATORSTOGAINTHISUNDERSTANDING,GIVENTHECOMPLEXITYOFPALLIATIVEANDNURSINGHOMECAREANDOFINTERORGANIZATIONALPARTNERSHIPS,CASESTUDIESWERECONDUCTEDTHEGOALOFTHISRESEARCHWASTODOCU
16、MENTANDDISSEMINATETHEPRACTICESOFSUCCESSFULROLEMODELSIE,POSITIVEDEVIATES,WHICHPROVIDERSCOULDTHENEMULATETOACHIEVESIMILARSUCCESSESORGANIZATIONFACTORSANDACTIVITIESPRESENTATSTUDYSITESORGANIZATIONALFACTORS/RESOURCESBOTHNURSINGHOMEANDHOSPICECHIEFEXECUTIVEOFFICERSCEOSREPORTEDTHEIRORGANIZATIONSHADCOMMUNITYFO
17、CUSEDMISSIONSANDTHEYVERBALIZEDSHAREDPHILOSOPHIESANDGOALSOFCAREINPARTICULAR,NURSINGHOMECEOSCITEDTHEIRNURSINGHOMESRECOGNITIONOFTHENEEDTOSUPPORTTHESPECIALNEEDSOFDYINGNURSINGHOMERESIDENTSANDFAMILIES,ANDATBOTHSETTINGS,STAFFSPOKEABOUTTHENURSINGHOMEANDHOSPICEHAVINGACOMMONGOALTHATOFPROVIDINGQUALITYENDOFLIFE
18、EXPERIENCESTORESIDENTSFAMILIESMOSTHOSPICECEOSHADMUCHFAMILIARITYWITHNURSINGHOMECAREANDTHECHALLENGINGREGULATORYANDREIMBURSEMENTENVIRONMENTSINWHICHUSNURSINGHOMESOPERATE,ANDSEVERALWEREACTIVELYINVOLVEDWITHNURSINGHOMEMEMBERSHIPORGANIZATIONSWHILECOMMITMENTTOTHEPARTNERSHIPWASVOICEDBYBOTHCEOS,THEHOSPICECEOAP
19、PEAREDTOBETHEDRIVINGFORCEBEHINDSUCCESSINFACT,TWONURSINGHOMESREPORTEDTHEIRCOLLABORATIONSIMPROVEDSUBSTANTIALLYWITHACHANGEINHOSPICELEADERSHIPTHEACTIVITIESESTABLISHINGTHEINFRASTRUCTUREHOSPICESPLANNEDORGANIZATIONALANDSTAFFINGINFRASTRUCTURESCAPABLEOFSUPPORTINGTHEUNIQUENESSOFNURSINGHOMESETTINGS,SUCHASTHEHI
20、GHPREVALENCEOFDEMENTIA,THEINTENSEREGULATORYOVERSIGHT,ANDTHEGENERALLYSTRESSFULENVIRONMENTSCONTRIBUTINGTOTHISPLANNINGANDTHUSHELPINGTOMOLDTHEPARTNERSHIP,NURSINGHOMECEOSSHAREDTHEIREXPECTATIONSWITHHOSPICESFOREXAMPLE,ONECEOSTATEDSHEMADEITCLEARSHEWANTEDHOSPICETOBEAVAILABLE24/7ANDEDUCATIONPROVIDEDTOALLSHIFT
21、STHEFOURLARGERSTUDYHOSPICESHADDEDICATEDNURSINGHOMECARETEAMSWHOWERECONSISTENTLYASSIGNEDTOTHESAMENURSINGHOMES,PROMOTINGTHEFORMATIONOFSTRONGRELATIONSHIPSTHETWOSMALLERHOSPICESINCALIFORNIAANDNEWJERSEYWITHOUTDEDICATEDTEAMSREPORTEDNOSIGNIFICANTNURSINGHOMEHOSPICESTAFFISSUESBUTALSOHADLONGSTANDINGNURSINGHOMER
22、ELATIONSHIPS20AND14YEARS,RESPECTIVELYCRITICALTOHOSPICESINFRASTRUCTUREWASTHERIGHTHOSPICERECRUITMENTAND/ORASSIGNMENTALSO,ALMOSTALLNURSESONTHEDEDICATEDNURSINGHOMETEAMSHADNURSINGHOMEWORKEXPERIENCESEVERALNURSESCOMMENTEDHOWTHEIRNURSINGHOMEBACKGROUNDSHELPEDTHEMTOEMPATHIZEWITHNURSINGHOMESTAFFANDTOGAGETHELEV
23、ELOFENVIRONMENTALSTRESSORSONANYPARTICULARDAY,ANDTHUSTOMODIFYTHEIRBEHAVIORACCORDINGLYFOREXAMPLE,ONEHOSPICENURSEEXPLAINEDHOWONHIGHSTRESSDAYSSHEMODIFIEDWHENANDHOWSHEAPPROACHEDNURSINGHOMESTAFFTHEPRESENCEOFLIAISONSALSOAPPEAREDCRITICALTOSUCCESSFORHOSPICES,THENURSINGHOMELIAISONPOSITIONWASFORMALIZEDWITHITBE
24、INGFULLTIMEATTHELARGERHOSPICESINNURSINGHOMES,HOWEVER,NURSESUPERVISORSORDIRECTORSOFNURSINGOFTENASSUMEDTHELIAISONDUTIESHOSPICELIAISONSINTERACTEDWITHTHEIRNURSINGHOMECOUNTERPARTSANDRAISEDANDRESPONDEDTOCONCERNS,ADDRESSINGPROBLEMSNOTRESOLVEDATTHESTAFFLEVELHOSPICELIAISONSREPORTEDTHENEEDATTIMESTOREASSIGNANU
25、RSEORAIDEWHOWASNOTAGOODFITATAPARTICULARNURSINGHOMETHEACTIVITIESPROCESSESRELATINGTOIMPORTANTCOLLABORATIVEDOMAINSSTAFFVIEWEDHIGHQUALITYCOMMUNICATIONASCRITICALTOBOTHMANAGINGTHECOLLABORATIONANDTOPROVIDINGWELLCOORDINATEDCAREINFACT,STAFFMOSTFREQUENTLYCITEDCOMMUNICATIONATALLLEVELSASTHEMOSTIMPORTANTFACTORFO
26、RPARTNERSHIPSUCCESSANEXAMPLEOFACOMMONCONSISTENTCOMMUNICATIONPRACTICEWASHOSPICESTAFFSAPPROACHTOTHENURSINGHOMEVISITSTAFFCHECKEDINWITHDISCIPLINECOUNTERPARTSUPONARRIVAL,ASKEDFORINPUTONTHERESIDENT/FAMILYSCONDITIONANDNEEDS,ANDTOUCHEDBASEAFTERTHEVISITTOREPORTFINDINGS/OTHERIMPORTANTLY,PROCESSESWEREINPLACETO
27、ACKNOWLEDGENURSINGHOMESTAFFANDTOENSURERESPECTWASCONVEYEDNURSINGHOMESTAFFREPORTEDONEONONEINFORMALEDUCATIONPROVIDEDBYHOSPICESTAFFWASMOSTIMPORTANTINADVANCINGTHEIRPALLIATIVECAREKNOWLEDGE,BUTALSOVALUEDTHEFORMALEDUCATIONPROVIDEDBYHOSPICESONAVERAGE,TWOTOFOURPROGRAMSPERYEARMOSTHOSPICESPROVIDEDTHEIRSTAFFWITH
28、EDUCATIONONRELATIONSHIPBUILDINGANDONNURSINGHOMESANDTHEIRREGULATORYENVIRONMENTHOSPICEMEDICALDIRECTORSATTWOHOSPICESWEREPARTICULARLYINVOLVEDINSTAFFEDUCATIONALEFFORTSONEPERFORMEDROUNDSATNURSINGHOMESWITHNURSINGHOMESTAFFINATTENDANCEANDANOTHERREPORTEDEMPOWERINGHOSPICESTAFFBYHELPINGTHEMROLEPLAYCONFLICTRESOL
29、UTIONNURSINGHOMESCONTRIBUTEDTOCOLLABORATIVESUCCESSBYACTIVELYASSESSINGTHEIRRESIDENTSPALLIATIVE/HOSPICECARENEEDSFOREXAMPLE,ONENURSINGHOMEHADASTANDUPMEETINGEVERYMORNINGWHERERESIDENTSTAKINGADECLINEORWITHPAINOUTOFCONTROLWEREIDENTIFIEDFORPOTENTIALHOSPICEREFERRALDOCUMENTATIONSYSTEMSPERSEDIDNOTAPPEARTODRIVE
30、COORDINATEDCAREPROVISION,BUTINSTEAD,FREQUENTHIGHQUALITYCOMMUNICATIONBETWEENHOSPICEANDNURSINGHOMEDISCIPLINESTOGETHERWITHAHIGHPRESENCEOFHOSPICESTAFFATSOMESITESBECAUSEOFHIGHERHOSPICEENROLLMENTSAPPEAREDTOBECRITICALTOWELLCOORDINATEDCAREONLYONESTUDYSITEHADATOTALLYINTEGRATEDNURSINGHOME/HOSPICECAREPLANFORMW
31、HILEOTHERSITESINTEGRATEDHOSPICECAREINTOTHENURSINGHOMESCAREPLANINTERVIEWERSCONSISTENTLYHEARDTHATHOSPICESTAFFWEREAVAILABLE24/7,ANDNURSINGHOMESTAFFANDDIRECTORSOFNURSINGCITEDTHISAVAILABILITYASCRUCIALTOPROVIDINGHIGHQUALITYCAREINFACT,BOTHHOSPICEANDNURSINGHOMESTAFFTALKEDABOUTOTHERHOSPICESTHATWERENOTASAVAIL
32、ABLEASTHESTUDYHOSPICESSTUDYHOSPICESALSOPROVIDEDAFULLRANGEOFHOSPICESERVICES,INCLUDINGBEREAVEMENTANDEMOTIONALSUPPORTTORESIDENTSFAMILIESANDNURSINGHOMESTAFFADDITIONALLY,HOSPICESPROVIDEDOTHERSUPPORTTONURSINGHOMESFOREXAMPLE,HOSPICELEADERSINTERACTEDASNEEDEDWITHMEDICARE/MEDICAIDSURVEYORSDURINGCERTIFICATIONV
33、ISITSTOPROVIDECLARIFICATIONRELATINGTOPALLIATIVE/HOSPICECAREDISCUSSIONRATHERTHANIDENTIFYINGPROCEDURESORFORMSESSENTIALTOCOLLABORATIVESUCCESS,ASWASEXPECTED,THISRESEARCHFOUNDTHESUCCESSOFTHENURSINGHOMEHOSPICEPARTNERSHIPSSTUDIEDRESULTEDFROMWELLPLANNEDEFFORTSBYKNOWLEDGEABLEHOSPICELEADERSANDINFORMEDBYTHESHA
34、REDEXPECTATIONSOFNURSINGHOMECEOSTHESTUDYSITESHADMANYATTRIBUTESTHATHAVEBEENATTRIBUTEDTOSUCCESSFULCOLLABORATORSTHENURSINGHOMESANDHOSPICESHADSHAREDVALUES,VIEWEDTHECOLLABORATIONASMUTUALLYBENEFICIAL,ENCOURAGEDPARTICIPATIONATALLLEVELS,HADSKILLEDLEADERSHIP,OPENANDFREQUENTCOMMUNICATION,ANDHADSUFFICIENTRESOU
35、RCESTOSUPPORTTHECOLLABORATIONHOSPICECEOSUNDERSTOODPROVISIONOFCAREINNURSINGHOMESTOBEUNIQUEANDACCORDINGLYDEVELOPEDINFRASTRUCTURESCAPABLEOFSUPPORTINGTHISUNIQUENESSTHEPARTNERSHIPSWEREDYNAMICWITHREGULARDIALOGUESANDPROBLEMSOLVINGATALLLEVELS,AIDEDBYTHEPRESENCEOFADEDICATEDHOSPICELIAISONCARECOLLABORATIONPROC
36、ESSESFOCUSEDONTHEIMPORTANCEOFTWOWAYCOMMUNICATIONBYACTIVELYSOLICITINGANDSHARINGINFORMATIONWITHNURSINGHOMESTAFFANDRESPONDINGTONURSINGHOMESTAFFANDADMINISTRATORSCONCERNSUSNURSINGHOMESARECONSIDEREDTOBECOMPLEXADAPTIVESYSTEMS,DUETOOPERATINGINDYNAMICENVIRONMENTSWHEREFEEDBACKFROMREGULATORSAND/ORPAYERSROUTINE
37、LYINFLUENCESPRACTICEANDWHERESEVERALPARTIESEG,ADMINISTRATORS,DOCTORS,NURSES,NURSINGASSISTANTS,VOLUNTEERS,FAMILIES,ETCROUTINELYINTERACTTOPROVIDECARETODIVERSERESIDENTSINSUCHSYSTEMSTRADITIONALHIERARCHICALPOLICYDRIVENMANAGEMENTSYSTEMSARELESSLIKELYTOBESUCCESSFULATENSURINGORIMPROVINGQUALITYINSTEAD,FLEXIBLE
38、MANAGEMENTAPPROACHESTHATCONSIDERTHELIVINGDYNAMICSYSTEMARENEEDEDTHEREFORE,THEPREVALENTPARTNERSHIPMODELWASAPRODUCTOFSTRATEGICEFFORTSBYHOSPICELEADERSAIMEDATMATCHINGTHEIRSTAFFINGTOTHENURSINGHOMEENVIRONMENTANDPROMOTINGGOODTWOWAYCOMMUNICATIONANDSKILLSNEEDEDFORONGOINGPROBLEMSOLVINGALIMITATIONOFTHISSTUDYIST
39、HATALLPROVIDERSHADNONPROFITOWNERSHIPANDWEREFREESTANDINGALSO,ONLYONESITEHADHIGHNURSINGHOMESTAFFTURNOVERANDONLYONEEXPERIENCEDSLOWMEDICAIDNURSINGHOMEPAYMENTSFORHOSPICEENROLLEESHOWEVER,THESEFACTORSDIDNOTAPPEARTOAFFECTPARTNERSHIPSUCCESSATTHESESITESSTILL,FUTURERESEARCHAIMEDATUNDERSTANDINGHOWHOSPICEOWNERSH
40、IP,PAYMENTBARRIERSANDHIGHTURNOVERMAYINFLUENCETHESUCCESSOFTHEIDENTIFIED，PARTNERSHIPMODELISRECOMMENDEDINTHISSTUDYALLBUTONENURSINGHOMECOLLABORATEDWITHONLYONEHOSPICEANDTHISFACTORPROBABLYCONTRIBUTEDTOTHEREPORTEDSUCCESSWHILECOLLABORATINGWITHTWOORMOREHOSPICESMAYINTENSIFYTHECHALLENGESINHERENTINTHEPROVISIONO
41、FINTERORGANIZATIONALCARE,ANDTHEREFOREMIGHTNOTBEARATIONALNURSINGHOMEMANAGEMENTDECISION,NURSINGHOMESMAYFEELCOMPELLEDTOHAVEMULTIPLECONTRACTSTOALLAYSUSPICIONSTHATAHOSPICEPROVIDERCHOICEMAYBEDRIVENBYILLEGALINDUCEMENTSRATHERTHANBYSUPERIORCAREAND/ORMANAGEMENTSTYLESSUSPICIONSOFILLEGALINDUCEMENTWERERAISEDBYAN
42、OFFICEOFINSPECTORGENERALOIG1998FRAUDALERTSUGGESTINGNURSINGHOMESCHOOSINGTOCONTRACTWITHONLYONEORTWOHOSPICEPROVIDERSCOULDBEFINANCIALLYMOTIVATED,CHOOSINGTHEHOSPICESOFFERINGTHEGREATESTFINANCIALREMUNERATIONHOWEVER,FROMTHISSTUDYITAPPEAREDTHEMOSTLYEXCLUSIVECOLLABORATIONSSTUDIEDWEREDRIVENBYTHENURSINGHOMESSAT
43、ISFACTIONWITHTHEHOSPICESABILITYTOMEETTHEIRRESIDENTSANDFACILITIESNEEDSWITHOUTADDINGUNDUECOMPLEXITYTOTHEIROPERATIONSTHEUSCENTERFORMEDICAREANDMEDICAIDSERVICESRECENTLYPUBLISHEDREGULATIONSRELATEDTOTHENURSINGHOMEHOSPICECOLLABORATIONTOMEETANDEXCEEDTHESEREGULATIONSANDTOACHIEVEPARTNERSHIPSUCCESSTHISRESEARCHI
44、DENTIFIESAMODELDRIVENBYINFRASTRUCTURESANDPROCESSESADDRESSINGTHECOMPLEXITYOFPROVIDINGPALLIATIVECAREINUSNURSINGHOMES,ANDFOCUSINGONTHEINTERACTIONSBETWEENNURSINGHOMEHOSPICESTAFFASPORTRAYEDBYONEHOSPICESVALUESTATEMENT,ITSABOUTTHERELATIONSHIPSOURCEBYMILLERSC,JOURNALOFPALLIATIVEMEDICINEJPALLIATMED,ISSN15577
45、740,2010MAYVOL135,PP52533PMID20377497译文一个关于养老院和临终关怀医院的成功建立合作伙伴关系的案例哲学博士，工商管理硕士SUSANCMILLER摘要背景选择在养老院养老是有备案的,是各种组织间的合作挑战，如关于照料计划的人员冲突，或其各自的角色也被记录。通过个案研究,本研究的主要目的在于描述一个关于养老院和临终关怀医院的成功建立合作伙伴关系。研究方法六个养老院和临终关怀医院自己确定的成功合作伙伴关系被作为研究对象。在对医务人员、行政长官和财务人员实地访谈中收集信息，关于对这七个领域发展的判别,来确定合作。组织因素及其他相关活动的基础设施建设，和关怀合作最常见
46、的规定通过协作平台被判别。结果养老院和临终关怀医院友好一直地相互合作；他们有相似的任务,他们懂得不同的方法去关心,管理员证明这是一个开放的和很受支持的合作。临终关怀医院开发各种基础设施来满足养老院环境的复杂性和特殊性。例如,他们雇用了养老院的护士,创造了团队致力于养老院的服务,和训练临终关怀医院的员工解决难题和解决冲突。关怀合作的过程集中在双向沟通的重要性和养老院的工作人员，通过积极地招揽客户和分享信息，响应养老院的员工和管理人员所关切的问题。结论然而成功的合作者是组织统一的,临终关怀医院的领导人承认，在养老院缓和医疗规定对于成功而言，复杂及独特是很重要的。因此,普遍的伙伴关系模式是一种战略上
47、努力的结果，目的在于合理安置他们的员工到养老院的环境中去,为了解决问题的需要，促进良好的沟通技能。简介超过25的美国人死于没有外伤引起，他们生命最后的时光是在第一养老院度过的。越来越多的养老院提供的临终关怀服务，更多是针对那些不同的,虚弱的,临床诊断状况复杂的个别老人。然而给这些不同的个别老人提供优质的临终关怀服务，对于养老院来说是一个挑战,在美国的一些养老院管理中发现，这个挑战的难度由于赔偿和监管环境而被增强。此外，固定的缓和医疗的专门技术和支援，是通过合作伙伴，与临终关怀医院的提供者一起，因此增加了存在的复杂性和挑战性。也许正因为这样,22的2004年美国养老院没有与临终关怀医院建立合作伙
48、伴关系,对那些临终关怀医院，它们用处的大小也随之广泛地改变在美国各个州。1982年,美国国会通过了立法，对于需要临终关怀的老人提供医疗保险的支付，到1986年这项利益扩展到居住在养老院的临终老人。养老院可以提供医疗保险临终关怀，通过发展工作关系与被证明的临终关怀和医疗保险提供者（包括正式的合同）。研究表明临终关怀医院在关怀上积极的影响,和在临终关怀医院注册的养老院居住者的效果，还有建议临终关怀医院进入养老院，这样会导致临终关怀医院的理念和实际，在对没有进入到临终关怀医院的养老院居住者的关怀服务的向内扩散。而临终关怀医院的利益已经在案,组织合作现在的挑战是，希望能增加养老院的运营成本例如,通过提
49、高管理时间需要做的是处理好冲突由各种因素引起,如不协调的关怀照顾，或者员工间对于计划的关怀照顾的冲突例如使用吗啡，等和他们的角色,在护理的规定上。此外，监督管理机制所出现的挑战，因为调查员可能引用养老院对于与临终关怀医院有关的缺点,接近于关怀照顾，这种关怀照顾与养老院规章制度鼓励的事项不同。就是，对于恢复、康复，他们更趋向于缓和医疗。此外,选定的州医疗补助计划的养老院的偿还政策和措施，似乎现在的养老院通过金钱刺激不合作的伙伴临终关怀医院。例如,一些州手动地非电子化地审查养老院医疗补助计划，要求养老院的居住者登记到临终关怀医院，这样可以拖延一下资金的支付时间。因为成功的养老院和临终关怀医院合作有可能导致“合作协同”，供应商、临终老人和他们的家人受益于不同的护理专业知识，和养老院的文化，和临终关怀医院的供应商，为促进双方之间的成功合作而做出的努力是很重要的。考虑到这一点,研究报告旨在了解养老院和临终关怀医院共同为建立成功的合作关系，他们的组织因素、资源和活动。获得这一认识,缓和的复杂性,养老院的关怀照顾和角色间的合作伙伴关系,将要进行个案研究。此研究的目的是记录和传播实践成功的榜样例如,积极性的偏离,让其他养老机构的服务提供者可
