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[护士在预先护理计划制定过程中的角色]

[The nurse's role in the process of advance care planning].

作者信息

Bolt Sascha R, van der Steen J T, Schols Jos M G A, Zwakhalen Sandra M G, Janssen D J A, Meijers J M M

机构信息

Program Development Centre, CIRO+, expertisecentrum voor chronisch orgaanfalen, Hornerheide 1, The Netherlands.

出版信息

Tijdschr Gerontol Geriatr. 2021 Mar 23;52(1). doi: 10.36613/tgg.1875-6832/2021.01.02.

Abstract

The COVID-19 pandemic and its impact on older and frail people underlines the importance of advance care planning (ACP). ACP is a dynamic communication process involving patients, families and healthcare providers, which serves to discuss and document wishes and goals for future care. Currently, ACP practice is often suboptimal. This implies that important decisions about care and treatment may need to be made acutely in crises. Many factors contribute to suboptimal ACP practice. One such factor is ambiguity regarding roles and responsibilities of different disciplines in the ACP-process. The perception that having ACP conversations is primarily a physician's task is a misconception. Specific skills that could contribute to a holistic and person-centered ACP-process are largely lacking in nursing curricula and therefore, may be insufficient and under-utilized. For instance, nursing staff could involve persons in conversations about meaning, quality of life, loss and grief as a part of ACP. Moreover, they may communicate a patient's wishes to other healthcare providers including physicians. Acknowledgement of this potential role, by physicians as well as by nursing staff themselves, is needed for ACP to become a truly interprofessional process.

摘要

新冠疫情及其对老年人和体弱人群的影响凸显了预先护理计划(ACP)的重要性。预先护理计划是一个涉及患者、家属和医疗服务提供者的动态沟通流程,旨在讨论并记录未来护理的意愿和目标。目前,预先护理计划的实施往往不尽如人意。这意味着在危机情况下可能需要紧急做出有关护理和治疗的重要决策。许多因素导致了预先护理计划实施效果不佳。其中一个因素是在预先护理计划流程中,不同学科的角色和职责存在模糊性。认为进行预先护理计划对话主要是医生的任务,这是一种误解。护理课程中很大程度上缺乏有助于实现全面且以患者为中心的预先护理计划流程的特定技能,因此这些技能可能不足且未得到充分利用。例如,护理人员可以让患者参与关于意义、生活质量、失落和悲伤的对话,作为预先护理计划的一部分。此外,他们可以将患者的意愿传达给包括医生在内的其他医疗服务提供者。要使预先护理计划成为一个真正的跨专业流程,医生以及护理人员自身都需要认识到这一潜在作用。

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