Department of Biomedicine and Prevention, University of Rome "Tor Vergata, Rome, Italy.
CNEC Center for Clinical Excellence and Quality of Care, Istituto Superiore di Sanità, Rome, Italy.
JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1220-1233. doi: 10.1002/jpen.1772. Epub 2020 Feb 21.
This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses' involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses' involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: "nurses' role in the decision-making process," with the 2 subcategories of "mediator" and "activator." The category and subcategories are influenced by the following generic categories: "being," "feeling," and "knowing," each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the "being" category. The category "feeling" represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category "knowing" includes nurses' clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.
本次综述旨在总结现有的护理文献，概述护士在生命末期参与人工营养和水合作用（ANH）的程度、范围和性质，并绘制出护士参与 ANH 的关键概念图。研究采用 Arksey 和 O'Malley 的方法框架指南和 Levac 等人提出的推进方法建议设计了一个范围综述。根据 Elo 和 Kyngäs 的指导进行了归纳性定性内容分析。确定了 39 篇文章。内容分析揭示了 1 个主要类别：“护士在决策过程中的角色”，其下有 2 个子类别：“调解人”和“促进者”。该类别和子类别受以下通用类别影响：“存在”、“感觉”和“知道”，每个类别又由 2 个子类别构成。护士扮演促进者和调解人的角色。他们建立良好关系的能力和态度使团队合作和与患者及家属的亲近成为可能：关系和态度是“存在”类别的子类别。“感觉”类别代表了护士对决策过程的体验方式，这可能会引发伦理道德困境和情绪反应。出于这些原因，护士必须在个人自我和专业自我之间取得正确的平衡。“知道”类别包括护士对 ANH 的临床和伦理知识。研究结果表明，对 ANH 的深入临床和伦理知识对于提供生命末期的一致、充分的护理至关重要。
