Tursunov Olga, Cherny Nathan I, Ganz Freda DeKeyser
Shaare Zedek Medical Center.
Director of the clinical masters program, Henrietta Szold Hadassah Medical Organization, Jerusalem, Israel.
Oncol Nurs Forum. 2016 Nov 1;43(6):E226-E232. doi: 10.1188/16.ONF.E226-E232.
PURPOSE/OBJECTIVES: To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time. .
DESIGN: Descriptive comparative study. .
SETTING: Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel. .
SAMPLE: A convenience sample of 34 family members of dying patients receiving palliative sedation. .
METHODS: A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time. .
MAIN RESEARCH VARIABLES: Experiences of family members and time. .
FINDINGS: Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time. .
CONCLUSIONS: Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication. .
Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a part of the core nursing curriculum. Nursing administrators in areas that use palliative sedation should enforce good nursing clinical practice as recommended by international practice guidelines, such as those of the European Association for Palliative Care.
目的/目标：描述患者接受姑息性镇静治疗开始时及患者死亡后其家庭成员的经历，并比较这些经历随时间的变化。
描述性比较研究。
以色列耶路撒冷沙雷兹德克医疗中心的肿瘤科病房。
34名接受姑息性镇静治疗的临终患者的家庭成员组成的便利样本。
在姑息性镇静治疗期间以及患者死亡后1至4个月，发放一份经过修改的问卷，该问卷描述了家庭成员对姑息性镇静治疗的经历。使用描述性统计来描述问卷结果，并进行适当的统计分析以比较随时间的变化。
家庭成员的经历和时间。
大多数亲属对镇静治疗和工作人员的支持感到满意。姑息性镇静被视为缓解痛苦的一种符合伦理的方式。然而，三分之一的人认为这缩短了患者的生命。不到一半的时间会对治疗进行解释，且通常在治疗开始当天进行。解释由医生和护士给出。许多人觉得他们没有为患者病情的变化做好准备，希望有更多机会与肿瘤护理人员讨论治疗方案。随着时间的推移，未发现经历上有统计学显著差异。
亲属对姑息性镇静治疗的经历总体上是积极且随时间稳定的。重要经历包括镇静开始的时机、解释的时机和质量以及沟通。
护士应尝试在出现难治性症状时就镇静治疗的可能作用展开讨论，并持续进行讨论。临终时难治性症状的管理、镇静的作用以及与姑息性镇静治疗决策相关的沟通技巧应成为核心护理课程的一部分。在使用姑息性镇静治疗的地区，护理管理人员应按照国际实践指南（如欧洲姑息治疗协会的指南）所建议的那样，加强良好的护理临床实践。
