晚期痴呆症患者的临终关怀与疼痛：瑞典养老院的一项定性研究
End-of-life care for people with advanced dementia and pain: a qualitative study in Swedish nursing homes.
作者信息
Lundin Emma, Godskesen Tove E
机构信息
Nacka Senior Centre Talliden, Helgesons väg 5, SE-131 37, Nacka, Sweden.
Centre for Research Ethics & Bioethics, Uppsala University, BMC, Box 564, SE-751 22, Uppsala, Sweden.
出版信息
BMC Nurs. 2021 Mar 20;20(1):48. doi: 10.1186/s12912-021-00566-7.
BACKGROUND
Of the Swedish people with advanced dementia, the majority die in nursing homes. Unresolved pain can occur in people with a terminal illness such as dementia. However, pain management in people with advanced dementia is often suboptimal and inadequate, with fewer palliative care interventions than offered to cancer patients. Although they are largely responsible for the care of these people, few studies have addressed the experiences of registered nurses in this respect. Therefore, the aim of this study was to describe the experiences of nurses in caring for people with advanced dementia and pain at the end of life.
METHODS
The study had a descriptive explorative design. Individual qualitative, semi-structured interviews were carried out with 13 nurses from 12 nursing homes in Sweden. The results were analysed using thematic content analysis.
RESULTS
The nurses described communicative, relational and organisational challenges. One major issue involved difficulties communicating with the person with advanced dementia, resulting in uncertain pain assessment. Other difficulties involved the differentiation of pain from anxiety, the balance of benefits and risks with morphine administration, and the creation of good relationships with healthcare personnel and the persons' relatives. Relatives can greatly affect the assessment and management of pain, both because of their ability to interpret pain behaviour and by questioning the care given. Good pain management was facilitated by good communication and relationships with healthcare staff and relatives, extensive professional nursing experience, and already knowing the person with advanced dementia.
CONCLUSIONS
This study highlights the need for nursing homes to employ specialist nurses who have been trained in the appropriate knowledge and skills to deal with the challenges of end-of-life care for people with advanced dementia and pain. Additionally, there should be resources and strategies available for providing information to family members and for involving them in the decision-making process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administer morphine or not.
背景
在患有晚期痴呆症的瑞典人中，大多数人在养老院去世。患有痴呆症等绝症的人可能会出现未得到解决的疼痛。然而，晚期痴呆症患者的疼痛管理往往不够理想且不充分，与癌症患者相比，姑息治疗干预措施较少。尽管注册护士在很大程度上负责照顾这些患者，但很少有研究探讨他们在这方面的经历。因此，本研究的目的是描述护士在照顾晚期痴呆症和临终疼痛患者方面的经历。
方法
本研究采用描述性探索性设计。对瑞典12家养老院的13名护士进行了个人定性、半结构化访谈。结果采用主题内容分析法进行分析。
结果
护士们描述了沟通、关系和组织方面的挑战。一个主要问题是与晚期痴呆症患者沟通困难，导致疼痛评估不确定。其他困难包括区分疼痛与焦虑、吗啡给药的利弊权衡以及与医护人员和患者亲属建立良好关系。亲属会极大地影响疼痛的评估和管理，这既是因为他们能够解读疼痛行为，也是因为他们会对所提供的护理提出质疑。良好的沟通以及与医护人员和亲属的良好关系、丰富的专业护理经验以及对晚期痴呆症患者的预先了解，有助于实现良好的疼痛管理。
结论
本研究强调养老院需要聘用经过适当知识和技能培训的专科护士，以应对晚期痴呆症和疼痛患者临终护理的挑战。此外，应该有资源和策略向家庭成员提供信息，并让他们参与决策过程，因为他们通常不熟悉诸如是否使用吗啡等决策中涉及的众多考虑因素。
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