Higgins Isabel, van der Riet Pamela, Sneesby Ludmilla, Good Phillip
Faculty of Health and Medicine, School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia; Centre for Practice Opportunity and Development, Hunter New England Local Health District, New Lambton, NSW, Australia.
J Clin Nurs. 2014 Sep;23(17-18):2609-17. doi: 10.1111/jocn.12478. Epub 2013 Dec 20.
To explore the perceptions of nurses regarding the provision and nonprovision of medical nutrition and hydration during the end stage of life when death is imminent in the acute care setting.
When people are dying, they often experience a loss of appetite and desire for drinking which are natural processes at this time. The cessation of eating and drinking challenges both family members and clinical staff. This article builds on previous studies that describe the perceptions of medical doctors and palliative care nurses regarding medical nutrition and hydration during the end stage of life when death is imminent.
Qualitative descriptive design.
This study included three focus group meetings with ten nurses in an acute care setting in medical, oncology and haematology units. An interview schedule was used to guide the discussions.
The main theme to emerge from this study was 'finding a comfort space/ambiguous spaces of unrest' that included four subthemes: (1) limited involvement in decision-making, (2) comfort vs. discomfort, (3) uncertainty and (4) the comfort of withdrawing treatment. Finding a comfort space captures the challenges nurses faced when speaking about the concerns of patients and family. In this space, there were ambiguities that created unease and unrest: a reluctance to talk about death; a reluctance to engage with the patient and the family.
Acute care nurses need to be more cognisant of the palliative approach to care and become more engaged with decision-making during the end stage of life when death is imminent.
Nurses in acute care settings need to be involved in decision-making and advocate for patients and family during the dying phase. Nurses in acute care need better understanding about the palliative approach to care and nutrition and hydration for people who are dying.
探讨在急症护理环境中，当患者生命末期濒临死亡时，护士对于提供和不提供医学营养及水分补充的看法。
当人们濒临死亡时，他们通常会出现食欲不振和不想饮水的情况，这在此时是自然过程。停止进食和饮水给家庭成员和临床工作人员都带来了挑战。本文基于之前的研究，这些研究描述了医生和姑息治疗护士对于生命末期濒临死亡时医学营养及水分补充的看法。
质性描述性设计。
本研究在急症护理环境中的内科、肿瘤科和血液科病房与十名护士进行了三次焦点小组会议。使用访谈提纲来指导讨论。
本研究中出现的主要主题是“寻找舒适空间/模糊的不安空间”，其中包括四个子主题：（1）决策参与有限；（2）舒适与不适；（3）不确定性；（4）停止治疗的舒适感。寻找舒适空间体现了护士在谈论患者及其家属的担忧时所面临的挑战。在这个空间里，存在一些造成不安和动荡的模糊之处：不愿谈论死亡；不愿与患者及家属接触。
急症护理护士需要更加了解姑息治疗方法，并在生命末期濒临死亡时更多地参与决策。
急症护理环境中的护士在患者临终阶段需要参与决策，并为患者及其家属进行倡导。急症护理护士需要更好地理解针对临终患者的姑息治疗方法以及营养和水分补充。
