Noyes J
Department of Nursing/Institute for Health Research, University of Salford, Salford, England.
J Adv Nurs. 2000 May;31(5):1206-15. doi: 10.1046/j.1365-2648.2000.01376.x.
Discussion in this paper is drawn from a phenomenological study carried out in England describing the views and experiences of young 'ventilator-dependent' people aged 6-18 years, regarding their health and social care, education, and aspirations for the future. This study presented many methodological and ethical challenges in order to elicit and present their views in a meaningful way. Data were elicited through focused face-to-face interviews with 18 young people. Innovative methods of data collection were used with younger children and those who had a range of communication impairments. In addition, family members of 15 young people were interviewed. Presentation of findings is limited to views and experiences of the young people's care in hospitals. Findings reveal that a significant number of Articles in the United Nations (UN) Convention on the Rights of the Child were not respected or upheld. Young 'ventilator-dependent' people were discriminated against when trying to access health services because of their need for assisted ventilation. They were particularly excluded from making important decisions about their lives and were not always offered the full protection of the Children Act 1989 (England). Some young people were not able to maintain adequate contact with their families, first language, culture, nationality and religion. Almost all spent prolonged periods of time (in some cases years) in hospital when they no longer wanted or needed to be there. All those interviewed wanted to be discharged home far sooner. The generalizability of findings is unknown; however, important questions are posed in relation to nursing practice and research regarding the overall management of this group of young people. Issues include: respecting and upholding human rights; and challenging the boundaries of current nursing practice in order to move towards child-centred, appropriate and effective models of care.
本文的讨论内容源自一项在英国开展的现象学研究,该研究描述了6至18岁依赖呼吸机的年轻人在健康与社会护理、教育以及未来期望方面的观点和经历。为了以有意义的方式引出并呈现他们的观点,这项研究面临诸多方法学和伦理学挑战。通过与18名年轻人进行有针对性的面对面访谈来获取数据。针对年幼儿童以及有一系列沟通障碍的儿童,采用了创新的数据收集方法。此外,还对15名年轻人的家庭成员进行了访谈。研究结果的呈现仅限于年轻人在医院护理方面的观点和经历。研究结果显示,《联合国儿童权利公约》中的大量条款未得到尊重或维护。依赖呼吸机的年轻人在试图获得医疗服务时因需要辅助通气而受到歧视。他们在做出关于自己生活的重要决定时尤其被排除在外,并且并不总是能得到1989年《儿童法案》(英格兰)的充分保护。一些年轻人无法与家人、母语、文化、国籍和宗教保持足够的联系。几乎所有人都在医院度过了很长时间(在某些情况下是数年),而他们已经不再想或不再需要待在那里。所有接受访谈的人都希望能更早出院回家。研究结果的普遍性尚不清楚;然而,就这组年轻人的整体管理而言,在护理实践和研究方面提出了重要问题。问题包括:尊重和维护人权;挑战当前护理实践的界限,以迈向以儿童为中心、恰当且有效的护理模式。