Palese Alvisa, Cadorin Lucia, Testa Marco, Geri Tommaso, Colloca Luana, Rossettini Giacomo
Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy.
Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
J Clin Nurs. 2019 May;28(9-10):1966-1978. doi: 10.1111/jocn.14809. Epub 2019 Feb 18.
AIMS AND OBJECTIVES: To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. BACKGROUND: Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. DESIGN: A national cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. METHODS: A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software exploring: (a) CFs definition, (b) beliefs, (c) case-by-case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. RESULTS: Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88-2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. CONCLUSIONS: Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence-based nursing interventions. RELEVANCE TO CLINICAL PRACTICE: The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.
目的与目标:描述护士用于增强安慰剂效应和预防反安慰剂效应的情境因素(CFs)。 背景:护理领域已对安慰剂效应进行了研究,但反安慰剂效应仍未得到探索。最近,已描述了一组作为安慰剂/反安慰剂效应触发因素的CFs;然而,其在日常护理中的应用迄今尚未有文献记载。 设计:根据互联网电子调查结果报告清单指南和加强流行病学观察性研究报告(STROBE),于2016年开展了一项全国性横断面调查。 方法:纳入了来自四个全国性协会的大量意大利护士样本。基于CFs文献编制了一份问卷,并通过SurveyMonkey软件进行发放,该问卷探讨了:(a)CFs的定义,(b)信念,(c)逐案使用频率,(d)应用情况,(e)参与者认为其可能产生有益效果的临床状况,(f)伦理影响以及(g)与患者的沟通问题。 结果:在1411名符合条件的护士中,455人进行了回复(32.2%),425份问卷(30.1%)可用于分析。共有211名护士(49.6%)将CFs定义为一种可能具有非特异性效应的干预措施;参与者相信CFs(2.91;95%置信区间2.88 - 2.94),每月使用次数>2次,主要是在护理干预之外用于优化临床结局(n = 79;18.6%)。心理和生理治疗效果主要在慢性疼痛(n = 259;60.9%)和失眠(n = 243;57.2%)中被感知到。据参与者报告,当CFs产生有益的心理效应时,其在伦理上是可接受的(n = 148;34.8%);然而,103名(24.2%)护士在使用CFs时未与患者沟通。 结论:护士意识到CFs是在实施循证护理干预的同时增强安慰剂效应和预防反安慰剂效应的因素。 与临床实践的相关性:护士重视且认为有效的CFs主要基于护士的内在素质以及护士与患者之间关系的质量。这些素质需要大量的个人投入;因此,自护士毕业起就应支持他们培养这些素质。
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