University of montpellier CEPS platform, site Saint Charles, 34000, Montpellier, France.
Maison de Santé Pluriprofessionnelle Universitaire Avicenne, 2 rue IBN Sinai dit Avicenne, 66330, Cabestany, France.
BMC Palliat Care. 2020 Mar 20;19(1):34. doi: 10.1186/s12904-020-0536-0.
Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams.
Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate.
Nurses recognize their role as being witnesses to the patient's experience through their constant presence. This is in line with their professional values and gives them an "alert role" that can anticipate a patient-centered palliative approach. The physician's positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, "rethinking care within a team environment" allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses "balance" while providing personal and professional support.
The Physician's positioning and attitude toward palliative approach sets the tone for its early implementation and determines the behavior of different staff members within healthcare service. "Recognition at work", specifically "recognition of the individual role of nurse" is an essential concept for understanding what causes the delay in the implementation of a palliative approach. Interprofessional training (physicians and nurses) could optimize sharing expertise. Registered nurses consider MPCT as a "facilitating intermediary" within the healthcare service improving communication. Restoring a balance in sharing care and decision between physicians and other caregivers lead care teams to an anticipated and patient-centered palliative approach according to guidelines.
尽管有广泛的共识和建议，但许多国际报告或研究表明，在医疗保健服务中实施姑息治疗存在困难。本研究的目的是了解医院医疗和外科护理病房注册护士的姑息治疗方法以及他们对流动姑息治疗团队的使用。
使用个体深入半结构化访谈和焦点小组对注册护士进行定性研究。使用半现象学分析方法对数据进行分析。流动姑息治疗团队的专家护士进行了这项研究。法国三家不同医院的 20 名注册护士同意参与。
护士通过持续的存在认识到自己作为患者体验见证人的角色。这符合他们的专业价值观，并赋予他们一种“预警角色”，可以预期以患者为中心的姑息治疗方法。医生对姑息治疗的定位在其实施中起着关键作用。对护士个人角色的不认可导致对其专业价值观的质疑，从而导致不当行为和痛苦。根据护士的说法，“在团队环境中重新思考护理”可以预期以患者为中心的姑息治疗方法。流动姑息治疗团队强调了医生-护士“平衡”的主要作用，同时提供个人和专业支持。
医生对姑息治疗方法的定位和态度为其早期实施定下基调，并决定了医疗保健服务中不同工作人员的行为。“工作中的认可”，特别是“对护士个人角色的认可”，是理解导致姑息治疗方法实施延迟的原因的重要概念。医生和护士之间的跨专业培训可以优化专业知识的共享。注册护士认为 MPCT 是医疗保健服务中的“促进中介”，可以改善沟通。在医生和其他护理人员之间重新平衡护理和决策分担，使护理团队根据指南采用预期和以患者为中心的姑息治疗方法。
