Department of Public Health and Pediatrics, University of Torino, Via Santena 5 bis, 10126 Turin, Italy.
Direction of Health Professions, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Turin, Italy.
Int J Environ Res Public Health. 2022 Feb 22;19(5):2504. doi: 10.3390/ijerph19052504.
End-of-life conversations are among the most challenging of all communication scenarios and on the agenda of several healthcare settings, including nursing homes (NHs). They may be also difficult for experienced healthcare professionals (HCPs). This study explores the difficulties experienced by Italian NH staff in end-of-life conversations with family caregivers (FCs) during COVID-19 pandemic to uncover their educational needs. A qualitative descriptive study based on inductive thematic analysis was performed. Twenty-one HCPs across six Italian NHs were interviewed. Four themes described their experiences of end-of-life conversations: (1) communicating with FCs over the overall disease trajectory; (2) managing challenging emotions and situations; (3) establishing a partnership between HCPs and FCs; (4) addressing HCPs' communication skills needs. HCPs had to face multiple challenging situations that varied across the care period as well as complex emotions such as anxiety, guilt, uncertainty, fear, anger, or suffering, which required tailored answers. COVID-19 pandemic increased FCs' aggressive behaviors, their distrust, and uncertainty due to visitation restrictions. HCPs had to overcome this by developing a set of strategies, including adoption of an active-listening approach, supportive communication, and explicit acknowledgement of FCs' emotions. Since communication needs were mostly practical in nature, HCPs valued practical communication training.
生命末期对话是所有沟通场景中最具挑战性的之一，也是包括养老院在内的多个医疗保健环境的议程之一。即使是经验丰富的医疗保健专业人员（HCPs）也可能会觉得这些对话很困难。本研究旨在探讨意大利养老院工作人员在 COVID-19 大流行期间与家庭护理人员（FCs）进行生命末期对话时所经历的困难，以揭示他们的教育需求。这是一项基于归纳主题分析的定性描述性研究。我们采访了来自意大利六家养老院的 21 名 HCPs。四个主题描述了他们进行生命末期对话的经验：（1）在整个疾病轨迹上与 FCs 进行沟通；（2）管理具有挑战性的情绪和情况；（3）在 HCPs 和 FCs 之间建立合作伙伴关系；（4）满足 HCPs 的沟通技巧需求。HCPs 不得不面对多种在护理期间有所不同的具有挑战性的情况，以及焦虑、内疚、不确定、恐惧、愤怒或痛苦等复杂情绪，这需要有针对性的回应。COVID-19 大流行由于探视限制增加了 FCs 的攻击性行为、不信任和不确定性。HCPs 必须通过采用积极倾听的方法、支持性沟通和明确承认 FCs 的情绪等策略来克服这一点。由于沟通需求主要是实践性的，HCPs 重视实践性的沟通培训。
