Huang Shu-He, Tang Fu-In, Liu Chang-Yi, Chen Mei-Bih, Liang Te-Hsin, Sheu Shuh-Jen
School of Nursing, National Yang Ming University, Taipei, Taiwan; Department of Nursing, National Yang-Ming University Hospital, Taipei, Taiwan.
School of Nursing, National Yang Ming University, Taipei, Taiwan.
Eur J Oncol Nurs. 2014 Oct;18(5):492-8. doi: 10.1016/j.ejon.2014.04.010. Epub 2014 Jun 3.
Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions.
A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored.
Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%).
Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.
护士在日常护理工作中面临着向患者告知绝症病情（TTPTI）的挑战，尤其是对于在普遍存在家庭保护主义和医疗家长主义文化环境中工作的护士而言。本研究旨在调查肿瘤护理人员处理这一问题的主要应对方式，并探讨哪些因素可能解释肿瘤护理人员的不同行为。
设计了一项初步定量研究，以描述台北一家肿瘤中心全职护士（n = 70）的告知真相经历。还探讨了护士的人口统计学数据、临床特征和告知真相态度的潜在影响因素。
大多数护士表示告知真相是医生的责任。然而，70.6%的护士回应称她们曾进行过告知真相的行为，20名护士（29.4%）报告没有相关经验。不采取行动的原因是“告知真相不是我的职责”、“家属要求我隐瞒真相”以及“对我来说告知真相很困难”。基于逐步回归分析，可根据与患者谈论“不进行心肺复苏”时感知到的难度较小、从科室获得的更高授权感以及更多的肿瘤护理工作经验来预测护士的告知真相行为（调整后R² = 24.1%）。
肿瘤护理经验、与晚期患者沟通时的舒适感以及科室授权是培养护士在告知真相方面专业责任感的重要因素。护理领导者和教育者应考虑减少告知真相的护理障碍，提高肿瘤护理人员的专业责任感，并为晚期患者营造更好的优质护理环境。
