Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.
J Clin Nurs. 2022 Jul;31(13-14):1864-1873. doi: 10.1111/jocn.15618. Epub 2021 Jan 2.
To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia.
By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers.
In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed.
Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies.
To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed.
In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.
描述并讨论与晚期痴呆症患者的替代决策人合作的护士的临床策略。
通过为患有晚期痴呆症的患者提供以患者为中心的护理，护士可以与做出与高级护理相关的医疗决策的替代决策人合作。由于替代决策人的体验是复杂和有压力的，护士需要与替代决策人合作的技能。
在这篇论述性论文中，提出了与替代决策人合作的创新框架。
系统评价的循证发现为伙伴关系框架提供了五个领域的重点。在每个领域，都提出了两种临床策略。临床策略是根据研究结果和作者的护理经验提出的假设。然后，对专题文献进行了搜索，并利用研究结果来支持论述性提出的策略。
为了应对替代决策人的复杂性和减轻压力，提出并讨论了一种用于晚期痴呆症背景的创新的护士-替代决策人伙伴关系框架。该伙伴关系框架由五个领域组成：建立信任、探索情绪、翻译生活质量、鼓励主动性和协商家庭。在这些领域中，讨论了支持临床护士与替代决策人合作的十种策略。
在该框架中，十种临床护理策略旨在为替代决策人提供针对性的护理，这些策略是在已知会给他们带来复杂性和压力的领域设计的。护士-替代决策人伙伴关系框架旨在改善护士-替代决策人之间的伙伴关系，并减轻替代决策人在处理与晚期痴呆症相关的复杂性时所经历的压力。
