护士参与终末期患者临终决策体验的质性研究

doi:10.16460/j.issn1008-9969.2024.07.006

摘要/Abstract

摘要： 目的了解护士在参与终末期患者临终决策工作的感受及看法,为促进临床护士参与临终决策工作的实施提供参考依据。方法采用目的及滚雪球抽样方法,纳入14名护士,进行半结构深度访谈,运用解释现象学分析法分析访谈资料,提炼主题。结果护士参与终末期患者临终决策体验,可归纳为4个主题15个子主题,包括满足患者需求（信息传递、情感支持）,自身的多重情感体验（职业价值、职业责任、成长与收获、悲伤、矛盾、共情疲劳）,受到复杂的临床环境限制（繁忙的护理工作、承认医生权威、紧张的医护患环境、法律、伦理）,实践能力和素养有待提高（经验与方法薄弱、参加教育和培训的需求强烈）。结论护士在参与终末期患者临终决策实践中承担着信息传递和情感支持的角色和责任分工;其次,护士在参与过程中存在复杂的多重情感体验同时也受到复杂的临床环境限制,也表达出想要通过参加教育培训以及丰富实践经验来提高自己的能力和素养的需求和渴望,希望为完善我国高质量的临终关怀服务体系提供支持。

关键词: 患者, 终末期, 临终决策, 护士, 安宁疗护, 质性研究

Abstract: Objective Understanding the feelings and opinions of nurses in participating in end-of-life decision-making for terminally ill patients, providing a reference basis for promoting the implementation of clinical nurses in end-of-life decision-making work. Methods Purposive and snowball sampling methods were used to recruit 14 nurses for semi-structured in-depth interviews. The data from the interviews were analyzed using interpretative phenomenological analysis to extract themes. Results The experiences of nurses in their involvement in end-of-life decision-making for terminally ill patients can be categorized into 4 themes and 15 sub-themes. Four themes included meeting the needs of patients (information delivery, emotional support), nurses' multiple emotional experiences (professional value, professional responsibility, growth and gains, sadness, conflicts, empathy fatigue), encountering complex clinical environment restrictions (busy nursing work, acknowledging the authority of doctors, tense medical environment, legal and ethical considerations), and the need to improve practical abilities and qualities (weaknesses in experience and methods, strong demand for education and training). Conclusion Nurses play roles and responsibilities in information delivery and emotional support in their involvement in end-of-life decision-making for terminally ill patients. They also experience complex emotional experiences and face restrictions from the complex clinical environment. Furthermore, they express a desire to improve their abilities and qualities through education, training, and rich practical experience, hoping to provide high-quality end-of-life care services in China.

Key words: patient, terminally ill, end-of-life decision-making, nurse, palliative care, qualitative study

中图分类号:

R473

马瑞瑞, 范晓莉, 徐姝娟, 张伟, 陈婷, 谈飞飞. 护士参与终末期患者临终决策体验的质性研究[J]. 护理学报, 2024, 31(7): 6-11.

MA Rui-rui, FAN Xiao-li, XU Shu-juan, ZHANG Wei, CHEN Ting, TAN Fei-fei. Nurses' involvement in end-of-life decision-making for terminally ill patients: a qualitative study[J]. Journal of Nursing, 2024, 31(7): 6-11.

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