Saiani Luisa, Viviani Debora, Lenzi Elena, Chissalè Anna, Palese Alvisa
Associate Professor of Nursing Sciences, University of Verona, Verona, ItalySociologist, PhD student in Sociology and Social Research, University of Verona, Verona, ItalyRovereto Hospital, Rovereto (TN), ItalyS. Maurizio Hospital, Bolzano (BZ), ItalyAssociate Professor of Nursing Sciences, University of Udine, Udine, Italy.
J Clin Nurs. 2008 Nov;17(11c):390-9. doi: 10.1111/j.1365-2702.2008.02576.x.
The aim of this study was to discover whether problems experienced by older people with multiple chronic diseases were considered to be avoidable from the perspective of nurses.
The concept of avoidability is defined as 'that which can be avoided'; when something is perceived as avoidable, action is taken 'to prevent the occurrence'. It is possible that the nurses' perception on the avoidability of problems in chronically-ill older people, could have a role in the decisions they make about the most suitable type of care (e.g. therapeutic, preventive) while if they perceive a problem to be unavoidable they adopt palliative interventions. No literature is available on the factors that nurses take into account when judging whether a patient's problem could be avoided or not, and no nursing diagnosis title includes the concept of an 'unavoidable' problem (e.g. unavoidable depression related to nursing home institutionalisation).
A phenomenological method was used to identify and understand the meaning of a human being's experience by means of direct reporting and interviews.
Participants were forty 40 nurses working in homecare services and nursing homes in Northern Italy.
Various factors were assumed to make certain problems inescapable, such as the interaction of multiple diseases, older people refusing care and inadequate surveillance. Other problems were judged to be completely or partially avoidable such as aspects relating to families' reactions (the burden of providing care, family members' inability to provide adequate care), and to healthcare management dysfunctions (poor exchange of information, limited resources).
The nurses perceived they could only marginally modify the older person's problems however, they could take action instead to improve the organisational processes, the involvement of family members, and their own skills and sense of purpose.
To reflect on unavoidable nursing problems and related factors is important for the potential consequences of clinical judgment on patients and on nursing care and for ethical implications. The factors affecting avoidable or unavoidable problems need strategic and individualised action to develop healthcare plans including the older people themselves, their families, and members of a multidisciplinary team and to provide adequate resources and educational programmes.
本研究旨在从护士的角度探讨患有多种慢性病的老年人所经历的问题是否被认为是可以避免的。
可避免性的概念被定义为“可以避免的事情”；当某件事被认为是可避免的时，就会采取行动“防止其发生”。护士对慢性病老年人问题可避免性的认知，可能会在他们决定最合适的护理类型（如治疗性、预防性）时发挥作用，而如果他们认为某个问题不可避免，就会采取姑息性干预措施。目前尚无关于护士在判断患者问题是否可避免时所考虑因素的文献，且没有护理诊断名称包含“不可避免”问题的概念（如与养老院机构化相关的不可避免的抑郁）。
采用现象学方法，通过直接报告和访谈来识别和理解人类经历的意义。
参与者为意大利北部家庭护理服务机构和养老院的40名护士。
多种因素被认为会使某些问题不可避免，如多种疾病的相互作用、老年人拒绝护理以及监测不足。其他问题被判定为完全或部分可避免，如与家庭反应相关的方面（提供护理的负担、家庭成员无法提供充分护理）以及医疗管理功能障碍（信息交流不畅、资源有限）。
护士认为他们只能在一定程度上改变老年人的问题，然而，他们可以采取行动来改善组织流程、家庭成员的参与度以及自身的技能和使命感。
反思不可避免的护理问题及相关因素对于临床判断对患者和护理的潜在后果以及伦理影响至关重要。影响可避免或不可避免问题的因素需要采取战略和个性化行动，以制定包括老年人自身、其家庭以及多学科团队成员的医疗保健计划，并提供充足的资源和教育项目。
