护士对患者生活意义的理解——一项关于荷兰成年人居家养老经历的定性研究。
Nurse's attunement to patient's meaning in life - a qualitative study of experiences of Dutch adults ageing in place.
作者信息
Hupkens Susan, Goumans Marleen, Derkx Peter, Machielse Anja
机构信息
1Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, The Netherlands.
2University of Humanistic Studies, Utrecht, the Netherlands.
出版信息
BMC Nurs. 2020 May 18;19:41. doi: 10.1186/s12912-020-00431-z. eCollection 2020.
BACKGROUND
Meaning in life (MiL) is considered to be an important part of health and is associated with many positive outcomes in older adults, such as quality of life and longevity. As health promotors, nurses may take patients' MiL into account in the care process. There is a knowledge gap in terms of what constitutes good care in relation to older patients' MiL, and what the benefits may be for patients when nursing is attuned to this aspect. The purpose of this study was to explore the experiences of home nursing older adults in relation to nurses' attunement to MiL.
METHODS
Gadamerian hermeneutic phenomenological design with semi-structured interviews. Participants were 24 aged home nursing patients. A framework of care ethical evaluation was used in the analysis. Multiple dialogues enhanced understanding.
RESULTS
Patients did not expect nurses' regard for their MiL. They rather expected 'normal contact' and adequate physical care. Nurses showed that they were open to patients' MiL by being interested in the patient as a person and by being attentive to specific and hidden needs. Participants explained that the nurse's behaviour upon arrival set the tone: they knew immediately if there was room for MiL or not. All participants had positive and negative experiences with nurses' behaviour in relation to MiL. Valued nursing care included maintaining a long, kind and reciprocal relationship; doing what was needed; and skilled personalised care. Participants mentioned 'special ones': nurses who attuned to them in a special way and did more than expected. Benefits of care that was attuned to patients' MiL were: experiencing a cheerful moment, feeling secure, feeling like a valuable person and having a good day. Older adults also stressed that consideration for MiL helps identify what is important in healthcare.
CONCLUSION
Aged homecare patients value nurses' attunement to their MiL positively. Although patients regard MiL mostly as their own quest, nurses play a modest yet important role. Managers and educators should support nurses' investment in reciprocal nurse-patient relationships.
背景
生活意义被认为是健康的重要组成部分，并且与老年人的许多积极结果相关，如生活质量和寿命。作为健康促进者，护士在护理过程中可能会考虑患者的生活意义。在与老年患者生活意义相关的优质护理的构成要素以及护理关注这一方面对患者可能带来的益处方面，存在知识空白。本研究的目的是探讨居家护理老年人在护士关注其生活意义方面的体验。
方法
采用带有半结构化访谈的伽达默尔诠释学现象学设计。参与者为24名居家护理的老年患者。分析中使用了护理伦理评价框架。多次对话增进了理解。
结果
患者并不期望护士关注他们的生活意义。他们更期望“正常交流”和充分的身体护理。护士通过将患者作为个体感兴趣并关注特定和隐藏的需求，表明他们对患者的生活意义持开放态度。参与者解释说，护士到达时的行为定下了基调：他们能立刻知道是否有空间关注生活意义。所有参与者在护士与生活意义相关的行为方面都有积极和消极的经历。有价值的护理包括维持长久、友善和相互的关系；做需要做的事；以及熟练的个性化护理。参与者提到了“特别的护士”：那些以特别的方式与他们合拍且做得比预期更多的护士。关注患者生活意义的护理的益处有：经历愉快时刻、感到安全、感觉自己是个有价值的人以及度过美好的一天。老年人还强调，对生活意义的考量有助于确定医疗保健中重要的东西。
结论
居家护理的老年患者积极重视护士对他们生活意义的关注。尽管患者大多将生活意义视为自己的追求，但护士发挥着适度而重要的作用。管理人员和教育工作者应支持护士在相互的护患关系方面的投入。
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