护士对家庭照顾者药物管理支持及减药的看法。
Nurses' Perspectives on Family Caregiver Medication Management Support and Deprescribing.
作者信息
Tjia Jennifer, DeSanto-Madeya Susan, Mazor Kathleen M, Han Paul, Nguyen Bryan, Curran Tess, Gallagher Julia, Clayton Margaret F
机构信息
Jennifer Tjia, MD, MSCE, is associate professor of population and quantitative health sciences, University of Massachusetts Medical School, Worcester. Susan DeSanto-Madeya, PhD, APRN, CNS, is associate clinical professor, Wm. F. Connell School of Nursing, Boston College, Massachusetts. Kathleen M. Mazor, EdD, is professor, University of Massachusetts Medical School; and associate director, Meyers Primary Care Institute, Worcester, Massachusetts. Paul Han, MD, MA, MPH, is director, Center for Outcomes Research & Evaluation (CORE), Maine Medical Center, Scarborough; and associate professor of Medicine, Tufts University School of Medicine. Bryan Nguyen, BS, is candidate for doctor of Medicine, University of Massachusetts Medical School, Worcester. Tess Curran, BS, is candidate for doctor of Medicine, University of Massachusetts Medical School, Worcester. Julia Gallagher, MD, is medical director, Home-Based Palliative Care Program, Division of Palliative Care, Massachusetts General Hospital; and instructor in Medicine, Harvard Medical School, Boston, Massachusetts. Margaret F. Clayton, PhD, APRN-BC, FAAN, is professor, College of Nursing; and auxiliary faculty member, Department of Communication, University of Utah, Salt Lake City.
出版信息
J Hosp Palliat Nurs. 2019 Aug;21(4):312-318. doi: 10.1097/NJH.0000000000000574.
Nurses who care for patients with life-limiting illness operate at the interface of family caregivers (FCGs), patients, and prescribers and are uniquely positioned to guide late-life medication management, including challenging discussions about deprescribing. The study objective was to describe nurses' perspectives about their role in hospice FCG medication management. Content analysis was used to analyze qualitative interviews with nurses from a parent study exploring views on medication management and deprescribing for advanced cancer patients. Ten home and inpatient hospice nurses, drawn from 3 hospice agencies and their referring hospital systems in New England, were asked to describe current practices of medication management and deprescribing and to evaluate a pilot tool to standardize hospice medication review. Analysis of the 10 interviews revealed that hospice nurses are receptive to a standardized approach for comprehensive medication review upon hospice transition and responded favorably to opportunities to discuss medication discontinuation with FCGs and prescribers. Effective framing for discussions included focus on reducing harmful and nonessential medications and reducing caregiver burden. Results indicate that nurses who care for hospice-eligible and enrolled patients are willing to discuss deprescribing with FCGs and prescribers when conversations are framed around medication harms and their impact on quality of life.
照顾患有晚期疾病患者的护士处于家庭护理人员、患者和开处方者之间，在指导晚期药物管理方面具有独特的地位，包括进行关于减药的具有挑战性的讨论。本研究的目的是描述护士对其在临终关怀家庭护理人员药物管理中所扮演角色的看法。内容分析法被用于分析对来自一项母研究的护士进行的定性访谈，该母研究探讨了对晚期癌症患者药物管理和减药的看法。从新英格兰的3家临终关怀机构及其转诊医院系统中抽取了10名家庭和住院临终关怀护士，要求他们描述药物管理和减药的当前做法，并评估一种用于规范临终关怀药物审查的试点工具。对这10次访谈的分析表明，临终关怀护士乐于接受在临终关怀过渡时进行全面药物审查的标准化方法，并且对与家庭护理人员和开处方者讨论停药的机会反应良好。讨论的有效框架包括关注减少有害和不必要的药物以及减轻护理人员负担。结果表明，照顾符合临终关怀条件并已登记患者的护士，当围绕药物危害及其对生活质量的影响来组织谈话时，愿意与家庭护理人员和开处方者讨论减药问题。
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