Wright Kerri
University of Greenwich, School of Health, Southwood Site, Avery Hill Campus, Eltham, London.
Br J Nurs. 2002;11(18):1180-5. doi: 10.12968/bjon.2002.11.18.10576.
This study aimed to explore the role of the district nurse in terminal care in order to understand and clarify the work that district nurses undertake in this area. District nurses view themselves as having a central and valued role in terminal care, yet studies have highlighted concerns that they may not have the necessary skills to provide effective terminal care. In order to target the educational and developmental needs of district nurses the role of the district nurse in terminal care was explored using a qualitative approach. Six semi-structured interviews, including the use of vignettes, were undertaken with district nurses from one community trust. Interviews were all taped and transcribed verbatim. Transcriptions were analysed using coding and categorizing with constant comparison of recurring themes. Common themes relating to how district nurses viewed their role in terminal care were then developed. The district nurses viewed their role as centring on the development of a relationship with the client and family. The relationship was a foundation to understanding and knowing the clients' and families' needs and was the medium through which all other care was given. The focus of care was determined by those needs identified through the relationship. Care needs identified within the study were complex and difficult to distinguish but fell within four themes: (1) emotional; (2) social; (3) physical; (4) informational. The importance of the relationship between the district nurse, the terminally ill client and the carer has not been clearly identified before and this study points towards the importance of formal structures to be put in place within palliative care and the provision of district nurse training to allow the opportunity and skills for this relationship to be fostered and developed.
本研究旨在探讨社区护士在临终关怀中的作用，以便理解和阐明社区护士在该领域所承担的工作。社区护士认为自己在临终关怀中扮演着核心且重要的角色，但研究也凸显了人们对他们可能缺乏提供有效临终关怀所需技能的担忧。为了明确社区护士的教育和发展需求，采用定性研究方法对社区护士在临终关怀中的作用进行了探讨。对来自一个社区信托机构的社区护士进行了六次半结构化访谈，包括使用案例。访谈均进行了录音并逐字转录。通过编码和分类对转录内容进行分析，并不断比较反复出现的主题。随后形成了与社区护士如何看待自己在临终关怀中的角色相关的共同主题。社区护士认为他们的角色核心是与患者及其家人建立关系。这种关系是理解和知晓患者及其家人需求的基础，也是提供所有其他护理的媒介。护理重点由通过这种关系确定的需求所决定。研究中确定的护理需求复杂且难以区分，但可归为四个主题：（1）情感方面；（2）社会方面；（3）身体方面；（4）信息方面。社区护士、临终患者和护理者之间关系的重要性此前尚未得到明确确认，本研究指出了在姑息治疗中建立正式架构以及提供社区护士培训的重要性，以便有机会培养和发展这种关系并提升相关技能。
