Dobrina Raffaella, Chialchia Sara, Palese Alvisa
Nursing Home Brioni, Trieste, Italy.
Si Cura S.R.L., Udine, Italy.
Eur J Oncol Nurs. 2020 May 11;46:101766. doi: 10.1016/j.ejon.2020.101766.
"Difficult patients", as labelled by staff members, have been studied for their peculiarities in primary care, family and internal medicine, physiotherapy, psychiatry, dermatology, and dentistry. However, no data has been documented on "difficult patients" in hospice care settings. The aim of the study was to address the following research questions: (a) When do nursing staff label a patient suffering from advanced cancer as "difficult" in a hospice care setting? (b) What are the problems that the nursing staff face in dealing with them, and (c) What are the specific strategies that nursing staff adopt in their daily practice to overcome issues and improve their relationship with "difficult patients"?
A qualitative descriptive study design was performed in 2018 and reported according to the COnsolidated criteria for REporting Qualitative research. Three focus groups were conducted in three hospice settings in Northern Italy by involving 10 nurses and six nurses' aides. Three trained researchers performed interviews based on a set of open questions. Qualitative content analysis of the data collected was then performed by the same researchers.
Participants were labelled "difficult patients" according to three main themes: (1) "Feeling rejected"; (2) "Feeling uncomfortable with the life story experienced by the patient" and (3) "Experiencing the limits of the profession". Participants reported feeling "Frustrated", "Exhausted", "Powerless", "Overwhelmed" or "Embarrassed" when dealing with "difficult patients". Strategies to overcome these issues emerged.
As in other settings, hospice care nursing staff perceive some patients as "difficult". However, differently from other contexts, "difficult patients" are perceived as such also due to their relatives, who are perceived, in some cases, as being even more "difficult" than the patients themselves. Nursing staff should be aware of their personal attitudes and emotions in caring for patients perceived as "difficult" in order to identify and timely apply strategies to overcome issues that may compromise the therapeutic relationship and quality of care.
“难相处的患者”这一标签是由医护人员给出的，此前已有研究对其在初级保健、家庭医学、内科、物理治疗、精神病学、皮肤科和牙科中的特点进行了探讨。然而，尚无关于临终关怀机构中“难相处的患者”的相关数据记录。本研究旨在回答以下研究问题：（a）在临终关怀机构中，护理人员何时会将晚期癌症患者标记为“难相处的患者”？（b）护理人员在与这些患者打交道时面临哪些问题？（c）护理人员在日常实践中采取了哪些具体策略来克服这些问题并改善与“难相处的患者”的关系？
2018年进行了一项定性描述性研究设计，并根据报告定性研究的统一标准进行报告。在意大利北部的三个临终关怀机构中开展了三个焦点小组，共有10名护士和6名护士助理参与。三名经过培训的研究人员基于一组开放式问题进行访谈。随后，由相同的研究人员对收集到的数据进行定性内容分析。
参与者被标记为“难相处的患者”主要基于三个主题：（1）“感觉被拒绝”；（2）“对患者经历的人生故事感到不适”以及（3）“体验到职业的局限性”。参与者表示在与“难相处的患者”打交道时会感到“沮丧”“疲惫”“无力”“不堪重负”或“尴尬”。同时也出现了克服这些问题的策略。
与其他环境一样，临终关怀护理人员也会将一些患者视为“难相处的患者”。然而，与其他情况不同的是，“难相处的患者”之所以被这样看待，部分原因还在于他们的亲属，在某些情况下，亲属被认为比患者本人更“难相处”。护理人员在照顾被视为“难相处的患者”时应意识到自己的个人态度和情绪，以便识别并及时应用策略来克服可能损害治疗关系和护理质量的问题。
