Stone Whitney, Mixer Sandra J, Mendola Annette
Whitney Stone, BSN, RN, is staff nurse, Intensive Care Unit, East Tennessee Children's Hospital. She was former honors student nurse at The University of Tennessee, Knoxville, College of Nursing. Sandra J. Mixer, PhD, RN, CTN-A, is associate professor, College of Nursing, University of Tennessee, Knoxville. Annette Mendola, PhD, is assistant professor and chief, Division of Clinical Ethics, University of Tennessee, Graduate School of Medicine, and The University of Tennessee Medical Center, Knoxville.
J Hosp Palliat Nurs. 2019 Oct;21(5):350-357. doi: 10.1097/NJH.0000000000000530.
Although the process of dying is a universal human experience, it often magnifies individuals' unique cultural differences. Persons experiencing homelessness (PEHs) have unique barriers, challenges, and wishes for end-of-life care. There is insufficient evidence about how to provide culturally congruent advance care planning (ACP) through advance directive (AD) completion for PEHs. This study addressed this knowledge gap, and its findings serve as the basis for developing additional strategies to promote a satisfying ACP experience for this population when they complete an AD. The purpose of this study was to discover if an AD form recreated for PEHs would positively affect their completion of the AD as well as their overall experience with ACP. Guided by the culture care theory and qualitative ethnonursing methodology, 38 individuals (30 PEHs and 8 student nurses) were interviewed. Data were analyzed using the 4 phases of ethnonursing analysis. The 3 themes abstracted were (1) "it needs to be done," (2) the presence or absence of trusted family support, and (3) ACP for PEHs is facilitated by an AD workshop. Nursing interventions based on study findings can be used to help promote a dignified, meaningful ACP experience for vulnerable populations.
尽管死亡过程是一种普遍的人类经历，但它往往会放大个体独特的文化差异。无家可归者在临终关怀方面存在独特的障碍、挑战和愿望。关于如何通过为无家可归者完成预先指示（AD）来提供符合文化的预先护理计划（ACP），证据不足。本研究填补了这一知识空白，其研究结果为制定额外策略提供了基础，以便在无家可归者完成预先指示时，为他们提供令人满意的预先护理计划体验。本研究的目的是探究为无家可归者重新设计的预先指示表格是否会对他们完成预先指示以及他们在预先护理计划方面的整体体验产生积极影响。以文化护理理论和质性民族护理方法为指导，对38人（30名无家可归者和8名学生护士）进行了访谈。使用民族护理分析的四个阶段对数据进行了分析。提炼出的三个主题分别是：（1）“需要完成”；（2）是否有可信赖的家庭支持；（3）预先护理计划工作坊有助于无家可归者完成预先指示。基于研究结果的护理干预措施可用于帮助为弱势群体促进有尊严、有意义的预先护理计划体验。
