Clayton Margaret F, Hulett Jennifer, Kaur Kirandeep, Reblin Maija, Wilson Andrew, Ellington Lee
University of Utah.
Brigham Young University.
Oncol Nurs Forum. 2017 Jul 1;44(4):457-464. doi: 10.1188/17.ONF.457-464.
PURPOSE/OBJECTIVES: To describe nurse-caregiver communication on the day of patient death. .
DESIGN: A descriptive secondary analysis of 44 audio-recorded home hospice nursing visits on day of death. .
SETTING: Nine hospices in Utah, Oregon, and Massachusetts. .
SAMPLE: 42 caregiver-patient dyads, 27 hospice nurses. .
METHODS: Transcripts of audio recordings were coded for supportive nursing communication and relative time spent in physical, psychosocial, and spiritual discussion. .
MAIN RESEARCH VARIABLES: Tangible, emotional, informational, esteem, and networking supportive communication; nurses' self-reported communication effectiveness; caregiver religious affiliation. .
FINDINGS: Nurses reported that their communication skills were less effective when discussing difficult topics as compared to their overall communication effectiveness. Eleven patients died before the nursing visit, 3 died during the visit, and 30 died post-visit. Nurses primarily engaged in discussions facilitating caregiver emotional, tangible, and informational support. More informational support was observed when patient death occurred during the nursing visit. Time spent in general conversation showed that physical care conversations predominated (80% of the average overall amount of conversation time), compared to lifestyle/psychosocial discussions (14%) and spiritual discussions (6%). Spiritual discussions were observed in only 7 of 44 hospice visits. Spiritual discussions, although short and infrequent, were significantly longer, on average, for caregivers without a religious affiliation. .
CONCLUSIONS: Nurses support caregivers on the day of patient death using multiple supportive communication strategies. Spiritual discussions are minimal. .
Communication skills programs can potentially increase self-reported communication effectiveness. Emerging acute spiritual concerns, particularly for caregivers without a previous religious affiliation, should be anticipated. Spiritual support is included in the hospice model of holistic care.
目的/目标：描述患者死亡当天护士与照护者之间的沟通情况。
对44次患者死亡当天的居家临终关怀护理访视录音进行描述性二次分析。
犹他州、俄勒冈州和马萨诸塞州的9家临终关怀机构。
42对照护者与患者组合，27名临终关怀护士。
对录音文本进行编码，分析支持性护理沟通以及在身体、心理社会和精神讨论方面所花费的相对时间。
实际、情感、信息、尊重和社交支持性沟通；护士自我报告的沟通效果；照护者的宗教信仰。
护士报告称，与整体沟通效果相比，在讨论困难话题时他们的沟通技巧效果较差。11名患者在护理访视前死亡，3名在访视期间死亡，30名在访视后死亡。护士主要进行促进照护者情感、实际和信息支持的讨论。当患者在护理访视期间死亡时，观察到更多的信息支持。一般对话时间显示，身体护理对话占主导（占平均总对话时间的80%），相比之下，生活方式/心理社会讨论占14%，精神讨论占6%。在44次临终关怀访视中，仅7次观察到精神讨论。精神讨论虽然简短且不频繁，但平均而言，对于没有宗教信仰的照护者来说时间明显更长。
护士在患者死亡当天使用多种支持性沟通策略为照护者提供支持。精神讨论最少。
沟通技巧培训项目可能会提高自我报告的沟通效果。应预见到新出现的急性精神问题，尤其是对于以前没有宗教信仰的照护者。精神支持包含在临终关怀整体护理模式中。
