Linköping University, Sweden.
Eur J Cardiovasc Nurs. 2014 Apr;13(2):152-61. doi: 10.1177/1474515114521746. Epub 2014 Jan 30.
Many heart failure (HF) patients have palliative care needs, but communication about prognosis and end-of-life care is lacking. HF nurses can play an important role in such communication, but their views on this have rarely been sought.
This study aims to describe HF nurses' perspectives on, and daily practice regarding, discussing prognosis and end-of-life care with HF patients in outpatient care. It further aims to explore barriers, facilitators and related factors for discussing these issues.
A national survey including nurses from outpatient clinics and primary health care centres was performed. Data was collected using a questionnaire on communication with HF patients about prognosis and end-of-life care.
In total, 111 (82%) of the HF nurses completed the questionnaire. Most of them reported that physicians should have the main responsibility for discussing prognosis (69%) and end-of-life care (67%). Most nurses felt knowledgeable to have these discussions, but 91% reported a need for further training in at least one of the areas. Barriers for communication about prognosis and end-of-life care included the unpredictable trajectory of HF, patients' comorbidities and the opinion that patients in NYHA class II-III are not in the end-of-life.
Although HF nurses feel competent discussing prognosis and end-of-life care with the HF patient, they are hesitant to have these conversations. This might be partly explained by the fact that they consider the physician to be responsible for such conversations, and by perceived barriers to communication. This implies a need for clinical policy and education for HF nurses to expand their knowledge and awareness of the patients' possible needs for palliative care.
许多心力衰竭（HF）患者有姑息治疗的需求，但缺乏预后和临终关怀的沟通。HF 护士可以在这种沟通中发挥重要作用，但很少有人征求他们的意见。
本研究旨在描述 HF 护士在门诊护理中与 HF 患者讨论预后和临终关怀的观点和日常实践，并进一步探讨讨论这些问题的障碍、促进因素和相关因素。
进行了一项全国性调查，包括门诊和初级保健中心的护士。使用关于与 HF 患者讨论预后和临终关怀的沟通的问卷收集数据。
共有 111 名（82%）HF 护士完成了问卷。他们中的大多数人报告说，医生应该对讨论预后（69%）和临终关怀（67%）负主要责任。大多数护士认为自己有能力进行这些讨论，但 91%的人报告至少在一个领域需要进一步培训。讨论预后和临终关怀的障碍包括 HF 的不可预测轨迹、患者的合并症以及认为 NYHA 分级 II-III 级的患者不在临终阶段的观点。
尽管 HF 护士认为自己有能力与 HF 患者讨论预后和临终关怀，但他们对这些对话犹豫不决。这可能部分解释了他们认为医生负责这些对话，以及沟通障碍的原因。这意味着需要为 HF 护士制定临床政策和教育计划，以扩大他们对患者可能需要姑息治疗的知识和认识。
