Gillett Karen, O'Neill Bernadette, Bloomfield Jacqueline G
King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London SE1 8WA, United Kingdom.
Clinical Communication, King's College London, School of Medicine, London, United Kingdom.
Nurse Educ Today. 2016 Jan;36:395-400. doi: 10.1016/j.nedt.2015.10.015. Epub 2015 Oct 26.
Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice.
The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students.
A qualitative study comprising five focus groups.
Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University.
Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input.
In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.
医护人员与临终患者及其家属之间沟通不畅会导致对临终关怀的投诉。临终沟通技巧应成为护理和医学教育的核心部分，但研究表明，合格的医生和护士发现这是一个具有挑战性的实践领域。
本研究的目的是探讨影响护理和医学专业学生临终沟通技巧发展的因素。
一项包括五个焦点小组的定性研究。
来自伦敦一所大学的本科二年级护理专业学生（2个焦点小组，共9人）和本科四年级医学专业学生（3个焦点小组，共10人）。
障碍和促进因素影响了护理和医学专业学生在临床实践中与临终患者及其家属沟通的体验。外部障碍包括合格工作人员的把关以及缺乏通过讨论来理解经历的机会。内部障碍包括不知道该说什么、应对情绪反应、浪费患者时间以及担心自己应对痛苦经历的能力。促进因素包括良好的榜样、以往经验和课堂教学。
除了临床实习外，还需要有正式的反思讨论机会，以促进学生在临终沟通方面的信心和技能发展。为了让学生和导师将临终沟通视为他们学习的一个合理组成部分，需要明确书面的实践学习成果。导师和督导员可能需要接受培训，以便能够帮助学生发展临终沟通技巧。
