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.

参考文献

[1] McMillen RE. End of life decisions:nurses perceptions, feelings and experiences[J]. Intensive Crit Care Nurs, 2008,24(4):251-259.DOI: 10.1016/j.iccn.2007.11.002.
[2] Kryworuchko J, Strachan PH, Nouvet E, et al.Factors influencing communication and decision-making about life-sustaining technology during serious illness: a qualitative study[J]. BMJ Open, 2016,6(5):e010451.DOI:10.1136/bmjopen-2015-010451.
[3] Huang J, Yang L, Qi H, et al.Psychometric properties of the Chinese version of the End-of Life Decision-Making and Staff Stress Questionnaire[J].Int J Clin Health Psychol, 2020,20(3):271-281.DOI: 10.1016/j.ijchp.2020.07.001.
[4] 何旭斌, 宦宗素, 杜娜, 等. 青少年非自杀性自伤主要照顾者真实体验质性研究的Meta整合[J]. 护理学报, 2024,31(1):46-51.DOI: 10.16460/j.issn1008-9969.2024.01.046.
[5] Inagaki N, Seto N, Lee K, et al.The role of critical care nurses in shared decision-making for patients with severe heart failure: a qualitative study[J]. PLoS One, 2023,18(7):e0288978.DOI: 10.1371/journal.pone.0288978.
[6] Heradstveit SH, Larsen MH, Solberg MT, et al.Critical care nurses' role in the decision making process of withdrawal of life-sustaining treatment: a qualitative systematic review[J]. J Clin Nurs, 2023,32(17/18):6012-6027.DOI: 10.1111/jocn.16728.
[7] Taylor I, Dihle A, Hofsø K, et al.Intensive care nurses' experiences of withdrawal of life sustaining treatments in intensive care patients: a qualitative study[J]. Intensive Crit Care Nurs,2020,56:102768.DOI:10.1016/j.iccn.2019.102768.
[8] Bloomer MJ, Endacott R, Ranse K, et al.Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand[J]. J Clin Nurs, 2017,26(5/6):690-697.DOI: 10.1111/jocn.13585.
[9] Chang HT, Lin MH, Chen CK, et al.Nurses' experiences and factors related to their attitudes regarding discussions with patients and family members about do-not resuscitate decisions and life-sustaining treatment withdrawal: a hospital-based cross-sectional study[J]. Int J Environ Res Public Health, 2020,17(2).DOI: 10.3390/ijerph17020557.
[10] Huang J, Qi H, Zhu Y, et al.Factors influencing the initiative behavior of intensive care unit nurses toward end-of-life decision making: a cross-sectional study[J]. J Palliat Med,2022,25(12):1802-1809.DOI:10.1089/jpm.2021.0640.
[11] 刘鑫,乔梦圆,王海燕,等.护士参与生命终末期患者临终决策阻碍因素的Meta整合[J]. 中国护理管理, 2023,23(6):904-909.DOI: 10.3969/j.issn.1672-1756.2023.06.020.
[12] 黎东梅, 陈锦丽, 李丽, 等. 300名慢性病患者代理决策者预立医疗照护计划参与现状及影响因素分析[J]. 护理学报, 2023,30(2):67-72. DOI:10.16460/j.issn1008-9969.2023.02.067.
[13] 吴晓芬, 王丽洁, 王宁, 等. 老年人家属临终关怀决策的影响因素分析[J]. 护理学报, 2022,29(18):12-17. DOI: 10.16460/j.issn1008-9969.2022.18.012.
[14] 庞建美, 张青月, 王小媛, 等. 医护人员实施乳腺癌患者决策辅助障碍及促进因素的质性研究[J].中华护理杂志, 2021,56(10):1516-1521.DOI:10.3761/j.issn.0254-1769.2021.10.012.
[15] 李梦婷, 陈朔晖, 陈晓飞, 等. 医护人员对新生儿安宁疗护感受和经验的质性研究[J]. 中华护理杂志, 2022,57(8):908-913. DOI: 10.3761/j.issn.0254-1769.2022.08.002.
[16] Brooks LA, Manias E, Nicholson P.Communication and decision-making about end-of-life care in the intensive care unit[J]. Am J Crit Care, 2017,26(4):336-341.DOI: 10.4037/ajcc2017774.
[17] Sutherland N, Wiersma E, Vangel P.Barriers to staff involvement in end-of-life decision-making for long-term care residents with dementia[J]. Can J Aging, 2019,38(3):255-267. DOI: 10.1017/S0714980818000636.
[18] urkovi M, Brajkovi L, Jozepovi A, et al. End-of-life decisions in Intensive Care Units in Croatia-Pre COVID-19 perspectives and experiences from nurses and physicians[J]. J Bioeth Inq, 2021,18(4):629-643. DOI: 10.1007/s11673-021-10128-w.
[19] Baliza MF, Bousso RS, Poles K, et al.Factors influencing Intensive Care Units nurses in end-of-life decisions[J]. Rev Esc Enferm USP,2015,49(4):572-579.DOI:10.1590/S0080-623420150000400006.
[20] Heradstveit SH, Larsen MH, Solberg MT, et al.Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: a qualitative systematic review[J]. J Clin Nurs, 2023. DOI:10.1111/jocn.16728.
[21] Aperstein Y, Cohen L, Bendavid I, et al.Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters[J]. PLoS One, 2019,14(9):e0222599. DOI:10.1371/journal.pone.0222599.
[22] Yao LY, Xiang ML, Ye ZH, et al.Intervention study of compassion fatigue of oncology nurses in Balint group activities[J]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi, 2017,35(12):910-913. DOI: 10.3760/cma.j.issn.1001-9391.2017.12.007.
[23] Gjessing K, Steindal SA, Kvande ME.Collaboration between nurses and doctors in the decision-making process when considering ending the life-prolonging treatment of intensive care patients[J]. Nurs Open, 2023,10(1):306-315. DOI:10.1002/nop2.1305.

相关文章 15

[1]	田美雨, 王翠玲, 高若男, 田佳, 刘怡. 妇科肿瘤科护士性健康照护培训方案的构建[J]. 护理学报, 2025, 32(4): 18-23.
[2]	彭琦, 吴婉英, 谢玲女. 造口伤口失禁专科护士培训中基于ADDIE模型案例教学的实践及效果评价[J]. 护理学报, 2025, 32(4): 24-27.
[3]	吴超瑜, 刘尚昆. 麻醉恢复室护士危机管理能力的质性研究[J]. 护理学报, 2025, 32(3): 17-21.
[4]	郝瑞霞, 王秀梅, 蔚玲, 郭越, 张学. 磁性医院管理理念对手术室护士出勤主义行为的影响[J]. 护理学报, 2025, 32(3): 27-31.
[5]	李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[6]	谭雯渲, 张容, 张立力, 王玮, 邵艳红, 方庆虹, 朱瑾. 心脏移植患者手术决策困境的现象学研究[J]. 护理学报, 2025, 32(3): 69-73.
[7]	曹敏, 张培莉, 侯晓雅, 高超越, 郭林芳, 李滢. ABC-X模型下结直肠癌化疗患者照顾者营养照护体验的质性研究[J]. 护理学报, 2025, 32(2): 13-18.
[8]	刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[9]	李雪, 廖常菊, 张健, 丁娟, 陈晓丽, 胡玉庭. 三级甲等医院ICU护士睡眠障碍的风险预测模型构建及验证[J]. 护理学报, 2025, 32(2): 63-69.
[10]	闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[11]	李静依, 梁冠冕, 缪群芳, 赵月琰, 王晓宁, 钱萍萍. 临床护士死亡工作自我应对能力潜在剖面及影响因素研究[J]. 护理学报, 2025, 32(1): 13-18.
[12]	孙娟, 李亚莉, 马安娜, 王华, 张会敏. 护理研究生对社区护理实践思政教学体验的质性研究[J]. 护理学报, 2025, 32(1): 19-23.
[13]	王子萱, 原振青, 赵一鋆, 王惠平, 洪菲菲, 邹敏. 体面劳动感在三级甲等医院手术室护士反思能力与创新行为的中介效应[J]. 护理学报, 2025, 32(1): 62-67.
[14]	王语, 赵慧杰, 肖梦伟, 范硕宁, 孙佳丽, 王珂心, 苏炫, 杨滢瑞. 糖尿病视网膜病变患者硅油填充期间疾病体验与应对的质性研究[J]. 护理学报, 2025, 32(1): 68-72.
[15]	冯春玲, 胡夏晴, 徐琳, 蔡鑫健, 徐琴鸿. 基于社会生态系统理论的电话指导公众实施心肺复苏行为动机及需求的质性研究[J]. 护理学报, 2024, 31(9): 66-71.

Metrics

Viewed

Full text

Abstract

Cited

Shared