Lindahl Elisabeth, Norberg Astrid, Söderberg Anna
Department of Nursing, Umeå University, Umeå, Sweden.
J Adv Nurs. 2008 Apr;62(2):163-71. doi: 10.1111/j.1365-2648.2007.04551.x. Epub 2008 Mar 6.
This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers.
Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge.
A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological-hermeneutic method.
Themes were formulated: 'Facing the wound' when nurses reveal what is meant to be concealed and perceive patients' vulnerability; 'Facing one's own defencelessness' when feeling invaded, helpless and ashamed; 'Struggling to shield one's own defencelessness' was achieved by striving to be in control, striving to endure and seeking a way out. 'Struggling to shield patients' vulnerability' was about alleviating patients' additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients' vulnerability, nurses run the risk of experiencing desolation.
Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.
本文是一项研究报告，旨在阐明护理有恶臭渗出性溃疡患者的意义。
溃疡护理工作复杂，在评估和治疗方面难以达成共识。护士需要知识和技能才能提供优质护理。他们必须与患者密切接触，面临感染和患者痛苦。他们必须在不侵犯患者权益的情况下提供护理，我们需要进一步探索这一挑战。
招募了10名便利样本参与者。参与者均有护理有恶臭渗出性溃疡患者的经验，且受雇于瑞典的初级卫生保健机构或医院。2002年末至2005年初进行了叙事访谈，并采用现象学诠释学方法进行解读。
提炼出以下主题：护士揭示本应隐藏的内容并感知患者脆弱性时的“直面伤口”；感到被侵犯、无助和羞愧时的“直面自身的无助”；通过努力掌控局面、努力忍受和寻找出路来实现“努力保护自身的无助”；通过努力使患者免受伤害、突破界限、做出艰难决定和共同分担来减轻患者额外痛苦的“努力保护患者的脆弱性”。当无法保护自身的无助和患者的脆弱性时，护士有陷入绝望的风险。
身体上的近距离接触和患者的痛苦会影响护士。护理溃疡患者需要加强跨专业合作，以提供最佳治疗和护理。这些护士需要进一步接受教育，同时也需要管理层和组织的支持。
