在非姑息治疗环境中照顾终末期患者的体验：一项定性研究。
The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study.
机构信息
School of Nursing, Fudan University, Shanghai, China.
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
出版信息
BMC Palliat Care. 2018 Oct 17;17(1):116. doi: 10.1186/s12904-018-0372-7.
BACKGROUND
More patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings.
METHODS
This is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis.
RESULTS
Three themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment.
CONCLUSION
The end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole.
背景
在非姑息治疗环境中死亡的患者比在姑息治疗环境中死亡的患者多。在非姑息治疗环境中，医疗保健提供者如何照顾终末期成年患者尚未得到充分探讨。本研究旨在探讨医疗保健提供者在非姑息治疗环境中照顾终末期患者的经验。
方法
这是一项定性研究。2016 年 8 月至 2017 年 2 月期间，对来自上海 8 家医疗机构的 26 名医疗保健提供者进行了单独访谈。医疗机构提供了三级护理、亚急性护理或初级护理。采用定性内容分析法对访谈进行分析。
结果
访谈中出现了三个主题：（i）终末期的定义：主要是根据治疗的变化来定义的。（ii）终末期的医疗保健：大多数患者在三级/二级医院度过最后几周，从一个地方转移到另一个地方，并接受以疾病和症状为中心的治疗。在讨论治疗方案时，以家庭为主导的决策很常见。护士本能地为患者提供额外的护理关注，但护理仍然以任务为导向。（iii）挑战、困难和未来。访谈发现，来自家庭的压力是医疗保健提供者面临的主要挑战。从访谈中确定了在未来广泛开展临终关怀之前需要完成的三项紧急任务，包括对公众进行死亡教育、扩大政府支持和创造更好的医疗保健环境。
结论
未来的临终关怀体系应包括各级医疗机构，并建立机构间合作的机制。应在姑息治疗和非姑息治疗环境中为患有各种危及生命疾病的患者提供护理。但首先，必须解决临终关怀发展的障碍，这涉及医疗保健提供者、患者及其家属以及整个医疗保健系统。
Zotero 插件