Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
J Adv Nurs. 2012 Oct;68(10):2175-84. doi: 10.1111/j.1365-2648.2011.05902.x. Epub 2011 Dec 11.
This article explores how cancer nurses experienced the threat of patients' mortality on malignant haematology units of one institution in Ontario, Canada.
Although patients with cancer are living longer with bone marrow transplantations, still they face possibilities of dying due to complications from treatment and their disease.
Interpretive phenomenology guided the process. Nineteen front-line registered nurses were purposively recruited from two inpatient bone marrow transplant units. Focused observations and individual interviews were analysed. Data were collected from April to August 2007.
The major findings emphasized nurses' internal conflict related to their simultaneous need to help patients fight their disease and to prepare them for the possibility of letting go. The authors used the terms 'letting go', not to reflect nurses' intents to abandon life but to release patients from perceived norms of the 'curative culture'. Nurses experienced 'bursting the bubble of hope' by circumstances not in their control, and were often not certain whether or not to respond and how to respond to the distress of patients and families about death and dying. When feeling reassured of meeting patients' and families' expectations, nurses enabled patients and families to let go when further treatment was futile, prevented technological intrusions, and helped patients have 'easier' deaths.
Results suggest enhancing nurses' capacity to negotiate more effectively the contradictory clinical tasks of fighting disease and preparing patients for the end of life. In this regard, nurses may minimize patients' distress by providing opportunities for them to share their fears and have them validated.
本文探讨了加拿大安大略省一家机构恶性血液病病房的护士在面对患者死亡威胁时的体验。
尽管癌症患者通过骨髓移植存活时间更长，但他们仍有可能因治疗和疾病的并发症而死亡。
解释现象学指导了整个过程。从两家骨髓移植病房中，有目的的招募了 19 名一线注册护士。对重点观察和个人访谈进行了分析。数据收集于 2007 年 4 月至 8 月。
主要发现强调了护士内心的冲突，他们既要帮助患者与疾病作斗争，又要为患者可能的放弃做好准备。作者使用了“放手”一词，不是为了反映护士放弃生命的意图，而是为了让患者摆脱“治疗文化”的固有观念。护士因无法控制的情况而“打破希望的泡沫”，并且经常不确定是否以及如何回应患者和家属对死亡和濒死的痛苦。当感到能够满足患者和家属的期望时，护士会在进一步治疗无效时让患者和家属放手，防止技术干预，并帮助患者有“更轻松”的死亡。
结果表明，需要增强护士更有效地协商对抗疾病和为生命末期做准备这两个相互矛盾的临床任务的能力。在这方面，护士可以通过为患者提供分享恐惧和确认恐惧的机会来减轻患者的痛苦。
