School of Nursing, Queens Medical Centre, Nottingham, UK.
J Clin Nurs. 2011 Dec;20(23-24):3364-72. doi: 10.1111/j.1365-2702.2011.03860.x. Epub 2011 Oct 21.
This paper explores how emergency nurses manage the emotional impact of death and dying in emergency work and presents a model for developing expertise in end-of-life care delivery.
Care of the dying, the deceased and the bereaved is largely conducted by nurses and nowhere is this more demanding than at the front door of the hospital, the Emergency Department. Whilst some nurses find end-of-life care a rewarding aspect of their role, others avoid opportunities to develop a relationship with the dying and bereaved because of the intense and exhausting nature of the associated emotional labour.
Qualitative study using unstructured observations of practice and semistructured interviews.
Observation was conducted in a large Emergency Department over 12 months. We also conducted 28 in-depth interviews with emergency staff, patients with terminal illnesses and their relatives.
Emergency nurses develop expertise in end-of-life care giving by progressing through three stages of development: (1) investment of the self in the nurse-patient relationship, (2) management of emotional labour and (3) development of emotional intelligence. Barriers that prevent the transition to expertise contribute to occupational stress and can lead to burnout and withdrawal from practice.
Despite the emotional impact of emergency deaths, nurses who invest their therapeutic self into the nurse-patient relationship are able to manage the emotional labour of caring for the dying and their relatives through the development of emotional intelligence. They find reward in end-of-life care that ultimately creates a more positive experience for patients and their relatives.
The emergency nurse caring for the dying patient is placed in a unique and privileged position to make a considerable impact on the care of the patient and the experience for their family. This model can build awareness in managing the emotive aspects involved in care delivery and develop fundamental skills of nursing patients near the end of life.
本文探讨了急诊护士如何在急诊工作中应对死亡和濒临死亡的情绪影响，并提出了一个在临终关怀服务提供方面发展专业技能的模型。
临终关怀、死者和丧亲者的护理主要由护士承担，而在医院的前门，即急诊科，这种需求更为迫切。虽然有些护士觉得临终关怀是他们角色的一个有价值的方面，但由于与濒死和丧亲者相关的情感劳动的紧张和疲惫性质，其他护士则避免有机会与濒死和丧亲者建立关系。
使用非结构化观察实践和半结构化访谈的定性研究。
在一个大型急诊科进行了 12 个月的观察。我们还对 28 名急诊工作人员、患有绝症的患者及其家属进行了深入访谈。
急诊护士通过三个发展阶段发展临终关怀专业技能：（1）在护患关系中投入自我，（2）管理情感劳动，（3）发展情商。阻碍向专业技能过渡的障碍会导致职业压力，并可能导致倦怠和从实践中退出。
尽管急诊死亡带来了情绪影响，但那些将治疗自我投入到护患关系中的护士，通过发展情商，能够管理照顾临终患者及其亲属的情感劳动。他们在临终关怀中找到了回报，这最终为患者和他们的亲属创造了更积极的体验。
照顾临终患者的急诊护士处于一个独特而有利的位置，可以对患者的护理和他们的家庭的体验产生重大影响。该模型可以提高管理护理服务中涉及的情感方面的意识，并培养临终护理的基本技能。
