Miyashita Mitsunori, Nakai Yuko, Sasahara Tomoyo, Koyama Yurie, Shimizu Yoichi, Tsukamoto Naoko, Kawa Masako
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Am J Hosp Palliat Care. 2007 Jun-Jul;24(3):202-10. doi: 10.1177/1049909106298396.
The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (beta = .19, P = .001), death avoidance domain of the DAI (beta = -.14, P = 0.03), life purpose domain of the DAI (beta = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (beta = -.17, P = .02), patients' rights domain of the PNQ (beta =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.
本研究的目的是阐明护理自主性以及其他与照顾临终患者态度相关的因素之间的关系。2003年11月，我们使用自填式问卷对护士进行了横断面调查。我们收集了178名（75%）参与者的人口统计学数据，并使用了《弗罗梅尔特临终关怀态度量表B版》日文版（FATCOD - Form B - J）、《潘克拉茨护理问卷》（PNQ）和《死亡态度量表》（DAI）。FATCOD - Form B - J用于测量护士对照顾临终患者的态度。它包括两个子量表：对照顾临终患者的积极态度以及对以患者和家庭为中心护理的认知。PNQ用于测量个体护士的护理自主性，有三个子量表：护理自主性与倡导、患者权利以及对传统角色限制的拒绝。DAI在日本文化特征背景下测量对死亡的态度。它包括七个子量表：来世信念、死亡焦虑、死亡解脱、死亡回避、生活目的、对死亡的关注以及超自然信念。我们调查了与FATCOD - Form B - J相关的因素。多变量分析选择了导师对临终问题的支持（β = 0.19，P = 0.001）、DAI的死亡回避领域（β = -0.14，P = 0.03）、DAI的生活目的领域（β = 0.23，P = 0.001）以及PNQ的对传统角色限制的拒绝领域（β = 0.51，P = 0.001）作为评估护士对照顾临终患者积极态度的显著独立变量。多变量分析选择了DAI的死亡焦虑领域（β = -0.17，P = 0.02）、PNQ的患者权利领域（β = 0.46，P = 0.001）以及PNQ的对传统角色限制的拒绝领域（β = 0.34，P = 0.001）作为评估护士对以患者和家庭为中心护理认知的显著独立变量。总之，护理自主性在日本照顾临终患者的护士态度中起着重要作用。加强护理自主性的教育和管理努力是必要的。
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