Palese Alvisa, Petean Marco, Cerne Diana
Udine University, Udine, Italy.
J Clin Nurs. 2014 Sep;23(17-18):2599-608. doi: 10.1111/jocn.12477. Epub 2013 Dec 20.
To explore nurses' narratives of unexpected patient deaths during nightshifts.
Despite the importance of patient care and safety during the night, little attention has been paid to this issue in scientific literature. Very few studies have investigated the outcome of night-time nursing care in patients, and there is a distinct paucity of knowledge regarding the experiences of nurses who discover a patient who has died unexpectedly during a night shift.
A qualitative study design using semi-structured interviews, interpreted by a narrative inquiry methodology, was adopted.
A purposeful sample of 15 nurses working in Italian medical wards who had found a patient who had died unexpectedly during a night shift, and who had given their informed consent were interviewed in the period from 2009-2011. An inductive content analysis of the narrated experiences was performed.
A patient's unexpected death during a night shift is something that nurses fear, and when it occurs, the experience is remembered as a nightmare. From the narratives of the participant nurses, five categories described what happened at night when a patient who had died unexpectedly was discovered: (1) the night started by nurses selecting patients needing intensive surveillance; (2) patients were reprioritised for intensive surveillance; (3) nurses were deceived by apparently normal findings; (4) nurses realised the failure of their protective role; and (5) as a consequence, more intrusive surveillance measures were adopted after the event.
From the narratives, a number of failures in cumulative and individual surveillance occurred during the night when a patient died unexpectedly. The deaths were recognised late, causing intense pain in nurses; this experience affected the following night shifts, when the nurses' surveillance was more intensive, insistent and intrusive towards patients, even if this was unnecessary.
The continuing belief that the night shift is a time when fewer nurses are needed means that the number of registered nurses is reduced and reliance is placed on nursing aides instead, placing patients at risk by compromising the effectiveness of surveillance and the consequent clinical decisions made by nurses and physicians.
探讨护士对夜班期间患者意外死亡的叙述。
尽管夜间患者护理与安全至关重要，但科学文献对此问题关注甚少。极少有研究调查夜间护理对患者的结果，且对于在夜班期间发现患者意外死亡的护士的经历，相关知识明显匮乏。
采用定性研究设计，运用半结构化访谈，并通过叙事探究方法进行解读。
2009年至2011年期间，对15名在意大利医疗病房工作、曾在夜班期间发现患者意外死亡且已签署知情同意书的护士进行了有目的抽样访谈。对所叙述的经历进行了归纳性内容分析。
夜班期间患者意外死亡是护士所惧怕的事情，一旦发生，这段经历会被铭记为一场噩梦。从参与访谈护士的叙述中，五个类别描述了发现意外死亡患者当晚所发生的情况：（1）夜班开始时护士挑选需要密切监测的患者；（2）对患者进行重新排序以进行密切监测；（3）护士被看似正常的检查结果所误导；（4）护士意识到自己保护角色的失败；（5）结果，事后采取了更具侵入性的监测措施。
从叙述中可知，在患者意外死亡的夜间，累积监测和个体监测出现了若干失误。死亡发现得很晚，给护士带来了巨大痛苦；这段经历影响了随后的夜班，此时护士对患者的监测更加密集、持续且具有侵入性，即便这并无必要。
一直以来认为夜班所需护士较少，这意味着注册护士数量减少，转而依赖护理助手，从而因损害监测效果以及护士和医生随后做出的临床决策，将患者置于危险之中。
