Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
PLoS One. 2019 Nov 21;14(11):e0225269. doi: 10.1371/journal.pone.0225269. eCollection 2019.
To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.
Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory.
Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to.
Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.
探讨工作人员对识别终末期肾病患者轻度至中度痛苦和提供情绪支持的障碍的看法。
对两家医院的工作人员进行了定性半结构化访谈（n=31），使用混合方法对数据进行分析，即主题分析与扎根理论的某些方面相结合。
工作人员似乎非常清楚许多终末期肾病患者都感到痛苦，大多数人认为应该将痛苦的患者作为常规护理的一部分进行帮助。然而，实际情况各不相同，寻找和处理痛苦并没有嵌入护理途径。访谈确定了六个主题：i）工作人员对痛苦表现和引起痛苦的原因的看法各不相同；ii）工作人员对患者的看法可能导致痛苦被忽视，因为患者被认为隐藏了痛苦，而一些群体被认为比其他群体更容易感到痛苦；iii）角色认知存在差异，许多工作人员认为这是他们的角色，但对此并不感到自在，医生的态度尤为矛盾；iv）一些工作人员存在恐惧心理，他们担心在谈论痛苦时可能会发生什么，或者他们认为自己的情绪负担过高；v）工作人员感到缺乏技能、信心和培训；vi）反应能力可能受到限制，因为工作人员认为时间不足，几乎没有或没有专门的支持服务来转介患者。
工作人员认为在识别和应对患者痛苦方面存在重大障碍。与技能和知识相关的障碍可以通过培训来解决，培训的理想对象是态度积极但目前缺乏技能和信心的工作人员。与角色认知相关的障碍更难解决。该研究在国际上具有相关性，是改善长期疾病途径的一部分。
