Pepler C J, Lynch A
Department of Nursing, Royal Victoria Hospital, Montreal, Quebec, Canada.
J Palliat Care. 1991 Spring;7(1):18-29.
When dying patients are young adults or have a contagious disease, nursing staff may feel acutely uncomfortable and the patients may become isolated and alone. Nurses who work in palliative care units (PCU) develop special interactive skills that are generally acknowledged but not clearly defined or understood. Admission of patients with Acquired Immune Deficiency Syndrome (AIDS) to the PCU was expected to provide a unique opportunity for study. The project was an analysis of nurse-patient verbal interactions during physical care for the purpose of understanding communication patterns during the longest usual block of uninterrupted time nurses spend with patients. Included were six terminally ill patients with AIDS in an acute medical unit and nine other patients of differing ages in the medical unit and PCU. Data were tape recordings of up to six hours with each patient, a total of 78 days of taping. These were transcribed and analyzed to examine the content of interactions and communication techniques for identification of themes. The major overall themes were control, well-being, humor, uncertainty, and routines. The process themes identified were validation, problem solving, and therapeutic interaction. A framework for analysis of the relational messages of control was developed and detailed analysis conducted. The most frequent behavior was that of nurses offering control. Nurses and patients took control with approximately the same frequency, and by far the least frequent situation was that of the patient offering control to the nurse. The complexities of dying with a disease such as AIDS have made the care of these patients extremely demanding for all concerned. This analysis will help to delineate the content and process of nurse-patient interaction which is basic to comprehensive care of all patients.
当濒死患者是年轻成年人或患有传染病时，护理人员可能会深感不安，而患者可能会变得孤立无援。在姑息治疗病房（PCU）工作的护士会培养出特殊的互动技巧，这些技巧虽得到普遍认可，但并未得到明确界定或理解。预计将获得性免疫缺陷综合征（艾滋病）患者收治到PCU会提供一个独特的研究机会。该项目旨在分析护士与患者在身体护理过程中的言语互动，以了解在护士与患者相处的最长连续时间段内的沟通模式。研究对象包括急性医疗病房的6名晚期艾滋病患者以及该医疗病房和PCU的9名其他不同年龄段的患者。对每位患者进行长达6小时的录音，总共录制78天。对这些录音进行转录和分析，以检查互动内容和沟通技巧，从而确定主题。主要的总体主题包括控制权、幸福感、幽默、不确定性和日常事务。确定的过程主题包括确认、解决问题和治疗性互动。开发了一个用于分析控制权相关信息的框架，并进行了详细分析。最常见的行为是护士给予控制权。护士和患者行使控制权的频率大致相同，而到目前为止最不常见的情况是患者给予护士控制权。像艾滋病这样的疾病导致的死亡复杂性使得照顾这些患者对所有相关人员来说都极具挑战性。这项分析将有助于阐明护士与患者互动的内容和过程，这是全面护理所有患者的基础。
