School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA.
J Adv Nurs. 2021 Apr;77(4):1888-1898. doi: 10.1111/jan.14739. Epub 2021 Jan 27.
To identify the process that homecare nurses use when recognizing serious illness, engaging patients and families in goals-for-care discussions and guiding transitions to comfort-focused care.
Constructivist grounded theory.
Semi-structured focus group interviews of 31 homecare Registered Nurses were recorded and transcribed (June-August 2019). Line-by-line coding using the constant comparative method until saturation was achieved and a grounded theory was identified. Credibility, transferability, and confirmability establish study rigor.
A grounded theory of relationship-based care. Nurses cogitate and act when recognizing serious illness. They have difficult conversations and support care transitions with wisdom and knowing, by identifying changes in illness trajectories and being informed and alert to diminishing quality of life. Nurses are skilled at engaging patients, families, and the team and accommodate care in the home for as long as possible, while manoeuvring through complex systems of care; ultimately relinquishing and guiding care to other providers and settings. However, nurses feel inadequately prepared and frustrated with a fragmented healthcare system and lack of collaboration among the team.
This study identifies a grounded theory to support clinical decision-making and position homecare nurses as leaders in guiding goal care discussions and transitions to comfort-focused care. These findings reinforce the importance of developing health policy that ensures care continuity in serious illness. Further research is needed to improve relationships across care settings and enhance training for the delivery of comfort-focused care in the home as changing needs emerge during serious illness management.
确定家庭护理护士在识别重病、让患者及其家属参与目标护理讨论以及指导向以舒适为中心的护理过渡时所采用的流程。
建构主义扎根理论。
对 31 名家庭护理注册护士进行半结构式焦点小组访谈，并进行录音和转录（2019 年 6 月至 8 月）。采用线性比较法进行逐行编码，直到达到饱和状态并确定扎根理论。可信度、可转移性和可证实性确立了研究的严谨性。
基于关系的护理的扎根理论。护士在识别重病时会进行思考和行动。他们通过识别疾病轨迹的变化，了解并警惕生活质量的下降，进行艰难的对话，并提供智慧和知情的支持，以实现护理过渡。护士擅长与患者、家属和团队进行互动，并在可能的情况下在家中提供护理，同时在复杂的护理系统中进行操作；最终将护理移交并引导至其他提供者和环境。然而，护士感到自己准备不足，对碎片化的医疗保健系统和团队之间缺乏协作感到沮丧。
本研究确定了一个扎根理论，以支持临床决策，并使家庭护理护士成为指导目标护理讨论和向以舒适为中心的护理过渡的领导者。这些发现强调了制定确保严重疾病护理连续性的卫生政策的重要性。需要进一步研究以改善跨护理环境的关系，并加强家庭中舒适为中心的护理培训，因为在严重疾病管理过程中，需求会不断变化。
