Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Palliat Support Care. 2020 Dec;18(6):676-682. doi: 10.1017/S147895152000022X.
Bereavement care is one of the major components of hospice palliative care. Previous studies revealed the barriers to the success of the system, including lack of time or support from mental health professionals. Few studies have explored the intrapersonal barriers to bereavement care by clinical staff. The aims of the study were to explore (1) the emotional and cognitive barriers of bereavement care by hospice palliative care staff and (2) the demographic and work characteristics related to these emotional and cognitive barriers.
The participants were clinical staff (n = 301) who were working in hospice palliative care units, including hospice wards, home care, and hospital-based palliative care teams. Their professional backgrounds included physicians (n = 12), nurses (n = 172), social workers (n = 59), psychologists (n = 34), spiritual care specialists (n = 15), and others (n = 9). A cross-sectional design was used and a standardized questionnaire including emotional and cognitive barriers was developed. Information on demographic and work characteristics was also collected. Content validity index, an exploratory factor analysis, and multiple regression analysis were conducted.
One emotional barrier, "negative emotional reactions" (13 items, Cronbach's α = 0.92), and three cognitive barriers, "lack of ability" (7 items, Cronbach's α = 0.85), "belief in avoidance" (5 items, Cronbach's α = 0.86), and "outcome expectancy" (4 items, Cronbach's α = 0.85) were identified. Clinical staff who had higher working stress, lower self-rated ability for bereavement care, and higher negative impact from major life loss tended to have higher emotional and cognitive barriers.
Clinical staff should be aware of intrapersonal barriers to bereavement care. Educational programs should be developed to improve the ability to engage in bereavement care.
丧亲关怀是缓和医疗的主要组成部分之一。既往研究揭示了该体系成功的障碍，包括精神卫生专业人员缺乏时间或支持。鲜有研究探索临床工作人员在丧亲关怀方面的内在障碍。本研究旨在探讨：（1）缓和医疗临床工作人员在丧亲关怀方面的情绪和认知障碍；（2）与这些情绪和认知障碍相关的人口统计学和工作特征。
研究对象为 301 名在缓和医疗照护单位工作的临床工作人员，包括临终关怀病房、居家照护以及医院缓和医疗团队。他们的专业背景包括医生（n=12）、护士（n=172）、社工（n=59）、心理学家（n=34）、精神关怀专家（n=15）以及其他（n=9）。采用横断面设计，制定了包括情绪和认知障碍在内的标准化问卷。还收集了人口统计学和工作特征信息。进行了内容效度指数、探索性因子分析和多元回归分析。
确定了 1 项情绪障碍，即“负面情绪反应”（13 个条目，克朗巴赫α系数=0.92），以及 3 项认知障碍，即“缺乏能力”（7 个条目，克朗巴赫α系数=0.85）、“回避信念”（5 个条目，克朗巴赫α系数=0.86）和“结果预期”（4 个条目，克朗巴赫α系数=0.85）。工作压力较高、自我评估丧亲关怀能力较低、重大生活损失负面影响较高的临床工作人员，其情绪和认知障碍往往更高。
临床工作人员应意识到丧亲关怀方面的内在障碍。应开发教育计划以提高从事丧亲关怀的能力。
