Concord Repatriation General Hospital, Concord, NSW, Australia.
University of Sydney, Susan Wakil School of Nursing & Midwifery, NSW, Australia.
J Clin Nurs. 2018 Oct;27(19-20):3530-3543. doi: 10.1111/jocn.14536. Epub 2018 Jul 27.
To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI).
CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia. While a wealth of clinical outcome data on CLI and amputation exists internationally, little is known about the patient/family-centred experience of hospitalisation to inform preservation of personhood and patient-centred care planning.
Longitudinal qualitative study using Heideggerian phenomenology.
Fourteen patients and 13 family carers provided a semistructured interview after advice for major amputation. Where amputation followed, a second interview (6 months postprocedure) was provided by eight patients and seven family carers. Forty-two semistructured interviews were audio-recorded and transcribed verbatim. Hermeneutic phenomenological analysis followed.
Hospitalisation for CLI, with or without amputation, created a sense of chaos, characterised by being fragile and needing more time for care (fragile body and fragile mind, nurse busyness and carer hypervigilance), being adrift within uncontrollable spaces (noise, unreliable space, precarious accommodation and unpredictable scheduling) and being confused by missed and mixed messages (multiple stakeholders, information overload and cultural/linguistic diversity).
Patients and families need a range of strategies to assist mindful decision-making in preparation for amputation in what for them is a chaotic process occurring within a chaotic environment. Cognitive deficits increase the care complexity and burden of family advocacy.
A coordinated, interprofessional response should improve systems for communication, family engagement, operation scheduling and discharge planning to support preparation, adjustment and allow a sense of safety to develop. Formal peer support for patients and caregivers should be actively facilitated.
阐明在为严重肢体缺血（CLI）患者建议进行大截肢时，患者及其家属在医院的体验。
CLI 给医疗系统和家庭带来了巨大的负担，尤其是当 CLI 患者接近截肢时。大截肢通常是 CLI 的晚期干预措施，目的是应对缺血肢体的显著恶化、活动能力下降导致的功能衰退、无法控制的疼痛、感染和/或中毒。虽然国际上有大量关于 CLI 和截肢的临床结果数据，但对于患者/家庭为中心的住院体验知之甚少，无法为保留人格和以患者为中心的护理计划提供信息。
使用海德格尔现象学的纵向定性研究。
在建议进行大截肢后，14 名患者和 13 名家属接受了半结构化访谈。在进行截肢手术后，8 名患者和 7 名家属提供了第二次访谈（术后 6 个月）。共进行了 42 次半结构化访谈，并逐字记录下来。采用解释学现象学分析。
CLI 住院治疗，无论是否进行截肢，都会导致一种混乱感，其特征是脆弱且需要更多时间进行护理（脆弱的身体和脆弱的思维、护士忙碌和照顾者过度警惕）、在无法控制的空间中漂泊（噪音、不可靠的空间、不稳定的住宿和不可预测的安排）以及对错过和混淆的信息感到困惑（多个利益相关者、信息过载和文化/语言多样性）。
在对他们来说是在混乱环境中发生的混乱过程中，患者及其家属需要一系列策略来协助有意识地做出决策，以准备截肢。认知缺陷增加了护理的复杂性和家庭倡导的负担。
协调的跨专业反应应该改善沟通、家庭参与、手术安排和出院计划的系统，以支持准备、调整并允许建立安全感。应积极促进为患者和护理人员提供正式的同伴支持。
