Offen John
Community Staff Nurse, York Teaching Hospitals NHS Foundation Trust, York, UK.
Int J Palliat Nurs. 2015 Mar;21(3):134-41. doi: 10.12968/ijpn.2015.21.3.134.
To explore the role of UK district nurses in providing care for adult patients with a terminal diagnosis by reviewing qualitative research.
Meta-ethnography was used to conduct the synthesis.
CINAHL, MEDLINE and British Nursing Index (BNI) were searched comprehensively for primary research relating to the role of UK district nurses in palliative care.
The abstracts and titles of 700 papers were screened against inclusion criteria, of these 97 full papers were appraised. Some 24 studies reported in 25 papers were selected for inclusion in the synthesis.
In total, five key themes were identified: valuing the role; practical role; relationships with patients and families; providing psychological support; and role uncertainty. Further synthesis yielded two 'lines of argument'. The concept of the 'expert friend' argues that the atypical relationship district nurses cultivate with patients underpins district nurses' provision of palliative care and profoundly influences the nature of psychological support given. Secondly, the concept of 'threat and opportunity' encapsulates the threat district nurses can feel to their traditional role in palliative care through changing health and social policy, while recognising the benefits that access to specialist knowledge and better training can bring.
The findings have implications for understanding the motivators and barriers experienced by district nurses delivering palliative care in a time of unprecedented change to community health services.
通过回顾质性研究，探讨英国社区护士在为终末期诊断的成年患者提供护理方面的作用。
采用元民族志进行综合分析。
全面检索了CINAHL、MEDLINE和英国护理索引（BNI），以获取与英国社区护士在姑息治疗中作用相关的原始研究。
根据纳入标准筛选了700篇论文的摘要和标题，对其中97篇全文进行了评估。从25篇论文中报道的约24项研究中选择纳入综合分析。
共确定了五个关键主题：重视该角色；实际角色；与患者及家属的关系；提供心理支持；以及角色不确定性。进一步的综合分析得出了两条“论证线索”。“专家朋友”的概念认为，社区护士与患者建立的非典型关系是其提供姑息治疗的基础，并深刻影响所给予心理支持的性质。其次，“威胁与机遇”的概念概括了社区护士在姑息治疗中的传统角色可能因健康和社会政策变化而感受到的威胁，同时认识到获取专业知识和更好培训所能带来的益处。
这些发现有助于理解在社区卫生服务发生前所未有的变革时期，提供姑息治疗的社区护士所经历的动机和障碍。
