Searle Christina, McInerney Fran
Clinical Nursing Education Department, Austin Health, Heidelberg, Victoria, Australia.
Contemp Nurse. 2008 Jun;29(2):147-58. doi: 10.5172/conu.673.29.2.147.
The aim of this paper is to report the results of a study exploring the pressure care management of patients during their last 48 hours of life, from the perspective of registered nurses caring for such patients in an acute care hospital setting. A qualitative approach of interpretative description was used. Semi-structured interviews were conducted with twelve registered nurses working in palliative care/haematology/oncology wards in a metropolitan hospital in Melbourne, Australia. Analysis of the experiences of nurses in pressure care management of the patient in the last hours of life offered understandings into the nurse's role as a moral agent in the clinical setting. As moral agents, nurses were motivated by a desire to 'do the best for the patient'; in this instance to provide comfort and a peaceful death. They made decisions based on their past experience, knowledge and beliefs. However, their actions could be constrained by the beliefs of their colleagues, the culture of the organisation, and respect for the wishes of both patients and family members, which contributed to moral dilemmas that could give rise to clinician distress. Nurses need to strive for consensus in clinical practice as to what is the best care for the patient and where possible include the patient and family in these discussions. The development of policies such as advance directives and processes that highlight quality communication and conflict management may assist nurses in clinical decision making in this area.
本文旨在报告一项研究的结果，该研究从澳大利亚墨尔本一家急症医院中照顾此类患者的注册护士的角度，探讨患者生命最后48小时的压力护理管理。采用了解释性描述的定性方法。对在澳大利亚墨尔本一家大都市医院的姑息治疗/血液学/肿瘤学病房工作的12名注册护士进行了半结构化访谈。对护士在患者生命最后时刻的压力护理管理经验的分析，有助于理解护士在临床环境中作为道德主体的角色。作为道德主体，护士的动机是渴望“为患者做到最好”；在这种情况下，是为了提供舒适和安详的死亡。他们根据自己过去的经验、知识和信念做出决定。然而，他们的行动可能会受到同事的信念、组织文化以及对患者和家属意愿的尊重的限制，这导致了可能引发临床医生困扰的道德困境。护士需要在临床实践中努力就什么是对患者最好的护理达成共识，并尽可能让患者和家属参与这些讨论。诸如预先指示等政策的制定以及强调高质量沟通和冲突管理的流程，可能有助于护士在该领域的临床决策。
