Chen Chunyan, Lai Xiaobin, Zhao Wenjuan, Chen Menglei
Department of Nursing, Shanghai Cancer Center of Fudan University, Shanghai, China.
Department of Oncology, Shanghai Cancer Center of Fudan University, Shanghai, China.
Int J Nurs Sci. 2021 Nov 27;9(2):236-242. doi: 10.1016/j.ijnss.2021.11.002. eCollection 2022 Apr.
This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death.
The data of the study was collected using face-to-face semi-structured interviews. Through purposive sampling, 16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed. The interviews were analyzed using qualitative content analysis.
Six characteristics of a good death emerged: no suffering, companionship and care, no worries or concerns, dying with dignity, involvement and acceptance, and less impact on the family. Eighteen categories were identified: dying without experiencing suffering; being relieved of symptoms and suffering; being relieved of psychological suffering; avoiding the use of futile treatment and resuscitation; being cared for and accompanied by family; receiving good health care; having a meaningful life without regrets; making good arrangements for family issues; having a chance to say goodbye; having a quality life before death; dying in a decent environment; the personal will to be respected; maintaining the integrity of the body; death of the patient being accepted by the family and healthcare providers; the death occurred despite the best efforts to care for the patient; limited financial and care burden; shortly affected quality of life of the patient; and improved family cohesion.
Family members' early involvement in caring for patients at the end-of-life stage helps achieve a good death. For patients with a terminal illness, avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.
本研究旨在探讨上海内科医护人员对善终的理解。
本研究数据通过面对面半结构式访谈收集。采用目的抽样法,对上海16名有临终阶段照顾成年危重病患者经验的医生和13名护士进行了访谈。采用定性内容分析法对访谈进行分析。
出现了善终的六个特征:无痛苦、陪伴与关怀、无忧无惧、尊严离世、参与和接受、对家庭影响小。确定了18个类别:无痛苦离世;缓解症状和痛苦;缓解心理痛苦;避免使用无效治疗和复苏;得到家人照顾和陪伴;获得良好医疗护理;过有意义无悔的生活;妥善安排家庭事务;有机会道别;生前有质量的生活;在体面的环境中离世;个人意愿得到尊重;保持身体完整;患者的死亡得到家人和医护人员的接受;尽管尽最大努力照顾患者仍发生死亡;有限的经济和护理负担;对患者生活质量的短期影响;以及家庭凝聚力增强。
家庭成员在临终阶段早期参与照顾患者有助于实现善终。对于晚期绝症患者,避免不必要的医疗治疗和复苏可能是在中国内地实现更好的患者死亡并促进临终关怀规划发展的第一步。