School of Nursing & Midwifery, Deakin University, Burwood, Vic, Australia.
Int J Nurs Stud. 2012 Oct;49(10):1255-65. doi: 10.1016/j.ijnurstu.2012.04.005. Epub 2012 May 7.
Death has been identified as a known stressor for nurses and has been extensively researched in nursing populations. However, very little is known about the impact of a specific stressful event; that of the novice nurse's first encounter with patient death. Using a sequential quantitative-qualitative mixed methods design, a study was undertaken to explore the clinical circumstances, impact and challenges and rewards of nurses' early experiences with patient death. This paper reports the findings of the first phase: an exploratory survey of nurses' responses to this stressor.
A convenience sample of New Zealand Registered Nurses was recruited using email invitations; 174 respondents completed an online questionnaire exploring the clinical circumstances, preparedness, support mechanisms and impact of their earliest memorable patient death.
Most nurses reported that their earliest memory of patient death occurred during undergraduate training (61%) or in the first year of qualified practice (23%). Over 80% of these experiences occurred in acute medical, surgical or specialty settings in public hospitals, some involving paediatric or sudden unexpected deaths. Whilst some respondents described a rewarding, 'learning experience', others reported acute helplessness, guilt or marked on-going distress.
Whilst little can be done to control the clinical circumstances of nurses' early death encounters, by understanding more about the reactions to death, it may be possible to minimise negative factors such as unexpected elements, feelings of inadequacy, exclusion and role conflicts whilst facilitating coping, sharing of the experience, personal and professional growth, and other positive outcomes. Nurses' early experiences with patient death appear to have a lasting impact on their professional and personal lives.
死亡已被确定为护士的已知应激源，并在护理人群中进行了广泛研究。然而，对于一个特定的应激事件，即新手护士第一次面对患者死亡的影响，知之甚少。本研究采用序贯定量-定性混合方法设计，旨在探讨护士早期经历患者死亡的临床情况、影响以及挑战和回报。本文报告了第一阶段的研究结果：对护士对这种应激源的反应进行的探索性调查。
通过电子邮件邀请，对新西兰注册护士进行了方便样本招募；174 名受访者完成了一项在线问卷调查，调查了他们最早的记忆中患者死亡的临床情况、准备情况、支持机制和影响。
大多数护士报告说，他们最早的患者死亡记忆发生在本科培训期间（61%）或在合格实践的第一年（23%）。这些经历中有 80%以上发生在公立医院的急性医疗、外科或专科环境中，有些涉及儿科或突然意外死亡。虽然一些受访者描述了一次有益的、“学习经验”，但其他人报告了急性无助、内疚或持续的明显困扰。
虽然无法控制护士早期死亡遭遇的临床情况，但通过更多地了解对死亡的反应，可能可以尽量减少意外因素、不足感、排斥和角色冲突等负面因素，同时促进应对、经验分享、个人和职业成长以及其他积极结果。护士早期经历患者死亡似乎对他们的专业和个人生活产生持久影响。
