Satake Yoko, Arao Harue
Faculty of Nursing, Nara Medical University, Nara, Japan (Ms Satake); and Division of Health Science, Osaka University Graduate School of Medicine, Osaka, Japan (Ms Satake and Dr Arao).
J Trauma Nurs. 2019 May/Jun;26(3):154-163. doi: 10.1097/JTN.0000000000000441.
Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.
在急诊科，挽救生命是首要任务。然而，当患者生命无法挽救时，在这些科室为患者及其家属提供临终关怀（EOLC）也很重要。现有报告护理实践中的障碍和困难的研究发现，提供临终关怀的护士的认知包括困扰和冲突。本研究的主要目的是：（i）阐明急诊科提供临终关怀的护士所经历冲突的结构；（ii）探索影响这种冲突体验的因素。对日本急诊科工作的护士进行了问卷调查。参与者采用随机抽样设计选取。共有290名（55.3%）护士回复了调查，288份（55.0%）回复可用于分析。确定了由31个项目组成的七个组成部分：（1）临终关怀实践能力方面的冲突；（2）与医疗团队关系方面的冲突；（3）临终关怀环境方面的冲突；（4）决策方面的冲突；（5）家庭护理方面的冲突；（6）患者疼痛方面的冲突；（7）医疗局限性方面的冲突。发现护士的个人背景和支持系统会影响他们的冲突体验。为了支持在急诊科提供临终关怀的护士，我们需要了解他们所经历的冲突，包括他们的背景如何影响这种体验，并构建一个纳入临终关怀专业领域支持的系统。
