Institute of Applied Nursing Science, University of Applied Sciences St. Gallen, Rosenbergstrasse 59, Postfach, 9001, St. Gallen, Switzerland.
Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Strasse 12, 58453, Witten, Germany.
BMC Palliat Care. 2018 Feb 5;17(1):22. doi: 10.1186/s12904-018-0275-7.
When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances.
A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000-2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories.
In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles.
In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients' and families' perspectives.
在接受姑息治疗时，患者及其家属会经历生活状况的改变，他们必须应对日常生活中的挑战、增加的护理和新的角色。由于时间有限，他们还会经历与未来不确定相关的情绪变化。在这种情况下经历的过渡通常通过关注单个方面进行研究，这些方面在以下研究中得到了综合。目的是进行定性元综合，以探讨姑息治疗环境中患者及其家属在过渡中获得的经验。
采用桑德洛维奇和巴罗索提出的归纳法进行定性元综合。纳入标准为处于姑息治疗情况的成年患者的研究和以英文或德文发表的文章。通过检索 Pubmed 和 Cinahl 数据库以及在期刊和参考文献中进行手工搜索，确定了 2000 年至 2015 年期间的相关文章。使用初始编码分析每个研究的结果，然后依次进行轴向和选择性编码。因此，从类别中得出了一个概念模型。
文献检索中总共确定了 2225 篇文章。经过选择过程，最终纳入了 14 项研究。姑息治疗患者及其家属观察到的中心现象是在过渡期间保持正常。过渡最初是无意识地经历的，直到发生危机并需要采取应对措施，这鼓励患者和家属有意识地感知情况并制定谈判策略。患者仍然陷入绝望和珍惜剩余生命时间之间。随着疾病的进展，非专业护理人员重新确定和平衡他们的角色，死亡后，家庭成员不可避免地处于改变的角色中。
在姑息治疗环境中，患者及其家属在不断的现象中以不同的方式经历过渡，该现象在过渡的无意识和有意识感知之间波动。推导的概念模型为现有模型提供了额外的视角，并有助于在实际环境中阐明该现象。该研究促进了对过渡的差异化概念观点，并强调了患者和家属的观点。
