Arai Kazuko, Saiki Takuya, Imafuku Rintaro, Kawakami Chihiro, Fujisaki Kazuhiko, Suzuki Yasuyuki
Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
Nagasaki Public Health Center, 3-6-24 Nagasaki, Totshima City, Tokyo, 171-0051, Japan.
BMC Med Educ. 2017 Nov 13;17(1):205. doi: 10.1186/s12909-017-1029-6.
How medical residents' experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents' emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL) care on professional identity formation.
Semi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb's experiential learning cycle.
Eight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients' family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age.
This study revealed Japanese residents' perceptions, emotions and learning processes in caring for dying patients by applying Kolb's experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.
住院医师对临终患者的护理经历如何影响他们的情绪健康、学习成果以及职业身份的形成，目前尚未完全明确。我们研究了住院医师在为临终患者提供护理期间的情绪状态和学习情况，并特别讨论了提供临终护理对职业身份形成的影响。
对13名在过去3至5年毕业的住院医师进行了半结构化访谈。采用主题理论分析方法，并基于科尔布的体验式学习循环形成关键主题。
分析得出八个关键主题。住院医师在面对医疗不确定性的现实以及情绪状态和自我效能感受到干扰时经历了困境。尽管住院医师感到无助和内疚，但他们能够反思以患者为中心且需要真诚态度的医疗护理应对策略。他们还思考了姑息治疗以及与患者、患者家属和医护人员沟通的重要性。基于这些经历，住院医师重新建立了一种意识，使他们能够直接参与随着人口持续老龄化他们未来可能需要提供的医疗护理类型。
本研究通过应用科尔布的体验式学习理论揭示了日本住院医师在护理临终患者方面的认知、情感和学习过程。本研究结果可能为未来临终护理教育提供有价值的知识。
