12292University at Buffalo, The State University of New York, USA.
Nurs Ethics. 2021 Jun;28(4):529-542. doi: 10.1177/0969733020952128. Epub 2020 Oct 14.
Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.
The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care.
Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes.
A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews.
The study received approval from the university's Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent.
Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout.
Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices.
Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.
进入生命的最后阶段是一个具有特定需求和风险的发展过渡阶段。促进过渡是护士工作的重要组成部分。当治疗干预不再有效时，护士在照顾患者和家庭方面发挥着关键作用。
本研究旨在探讨急症护理环境中注册护士的经验，他们如何与患者和家属合作，促进向以舒适为重点的护理过渡。
抽样、数据收集和数据分析受建构主义扎根理论的指导，选择该理论是因为其在识别和阐明社会过程方面的优势。
来自美国东北部一个社区的 26 名急症护理医院的注册护士通过半结构化访谈参与了这项研究，采用了目的性抽样。
该研究获得了大学保护人类受试者机构审查委员会的批准。参与者提供了知情同意。
护士通过对患者和家属的道德承诺来促进向以舒适为重点的护理过渡。他们专注于建立关系、尊重患者的自主决定以及维护对人性的尊重。在这种情况下，他们意识到需要过渡，开启了讨论，并使用各种策略来促进患者、家属和护理提供者达成共识。无论过渡过程如何展开，护士都会提供支持。
所有利益相关者达成共识对于向以舒适为重点的护理过渡至关重要。本研究深入了解了作为道德代理人的护士如何利用特定策略来协助朝着共识前进。它还通过倾听他们的声音，为承认护士的道德代理提供了一个范例。
增加对促进以舒适为重点的护理过渡的有效护理策略的理解，对于为卓越护理制定必要的证据和加强临终护理教育至关重要。
