Beckstrand Renea L, Moore Josie, Callister Lynn, Bond A Elaine
College of Nursing, Brigham Young University, Provo, UT, USA.
Oncol Nurs Forum. 2009 Jul;36(4):446-53. doi: 10.1188/09.ONF.446-453.
PURPOSE/OBJECTIVES: To determine the magnitude of selected obstacles and supportive behaviors in providing end-of-life (EOL) care to patients with cancer as perceived by oncology nurses.
Cross-sectional survey.
National survey sample.
A geographically dispersed national random sample of 1,000 Oncology Nursing Society members who had cared for inpatient patients with cancer, could read English, and had experience in EOL care.
Eligible respondents received a 68-item questionnaire in the mail adapted from previous studies and were asked to rate the size of obstacles and supportive behavior items in caring for patients with cancer at the EOL.
EOL, oncology, barriers, supportive behaviors, oncology nurses, and survey research.
Returns after three mailings yielded 375 usable questionnaires from 907 eligible respondents for a return rate of 41%. The items with the highest perceived obstacle magnitude were (a) dealing with angry family members, (b) families not accepting what they are told about patients' poor prognosis, and (c) nurses being called away from dying patients to care for other patients. The three-highest scoring supportive behaviors were (a) allowing family members adequate time alone with patients after they died, (b) having social work or palliative care staff as part of the patient care team, and (c) having family members accept that patients are dying.
EOL care can be improved by working to decrease the highest-rated barriers and by continuing to support the highest-rated supportive behaviors.
Oncology nurses are dedicated, experienced, and comfortable handling most issues in EOL care. Recommendations to support oncology nurses include strategies to interact effectively with angry, anxious, or overly optimistic family members as well as involving social work and palliative care staff on the oncology interdisciplinary team. In addition, the information regarding identified obstacles and supportive behaviors in oncology EOL care can be used to facilitate discussion and change within oncology interdisciplinary teams and improve EOL care for patients with cancer and their families.
目的/目标：确定肿瘤护理人员所感知到的在为癌症患者提供临终关怀时某些障碍及支持行为的程度。
横断面调查。
全国性调查样本。
从1000名肿瘤护理协会成员中选取的一个地理分布广泛的全国随机样本，这些成员曾护理过癌症住院患者，会读英语，且有临终关怀护理经验。
符合条件的受访者通过邮件收到一份改编自先前研究的68项问卷，被要求对在临终时护理癌症患者过程中障碍及支持行为项目的程度进行评分。
临终关怀、肿瘤学、障碍、支持行为、肿瘤护理人员及调查研究。
经过三次邮寄后，从907名符合条件的受访者中获得了375份可用问卷，回复率为41%。被感知到障碍程度最高的项目为：（a）应对愤怒的家庭成员；（b）家属不接受告知他们的患者预后不良的情况；（c）护士在患者临终时被叫走去护理其他患者。得分最高的三项支持行为为：（a）在患者去世后允许家属有足够时间单独陪伴患者；（b）让社会工作或姑息治疗人员作为患者护理团队的一部分；（c）让家属接受患者即将死亡的事实。
通过努力减少评级最高的障碍并持续支持评级最高的支持行为，可改善临终关怀护理。
肿瘤护理人员敬业、经验丰富，且能自如应对临终关怀护理中的大多数问题。支持肿瘤护理人员的建议包括与愤怒、焦虑或过度乐观的家属有效互动的策略，以及让社会工作和姑息治疗人员参与肿瘤学跨学科团队。此外，关于肿瘤学临终关怀护理中已确定的障碍和支持行为的信息，可用于促进肿瘤学跨学科团队内部的讨论和变革，改善对癌症患者及其家属的临终关怀护理。
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