Department of Nursing, University of Málaga, Málaga, Spain.
Emergency Department, Hospital Universitario Torrecárdenas, Almería, Spain.
J Adv Nurs. 2023 Jan;79(1):269-280. doi: 10.1111/jan.15432. Epub 2022 Sep 5.
To explore and understand the experiences of patients with advanced illness in relation to dignity during end-of-life care in emergency departments.
Qualitative study based on Gadamer's hermeneutics.
Between September 2019 and February 2020, 16 in-depth interviews were carried out with advanced illness patients who attended emergency departments. The participants were informed priorly and signed informed consent. The data were analysed using an inductive strategy for finding emerging themes. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study's report.
In the data analysis process, two main themes emerged that glean the experiences of patients in relation to dignity during end-of-life care in emergency departments. 'Dignity as an individual's attribute' and 'Acting with dignity: Dignity as a behavioural attribute'.
Patient dignity in end-of-life care is centred around the principle of control (of oneself, one's death and one's emotions). The strategies required for patients to preserve their dignity can be somewhat incompatible with the dynamics and objectives of healthcare professionals who work in emergency departments.
The dignity of patients with advanced illness who attend emergency departments is a relevant issue that merits being addressed from the patients' perspective. Participants have identified that dignity is a way of being and behaving in the face of illness. Emergency departments need to respect end-of-life patients' desires by supporting and accompanying them, avoiding therapeutic obstinacy. We recommend care to be centred on patients' well-being, to respect their autonomy and decision-making processes, and to allow prompt referrals to palliative care services.
Managers from the Emergency Departments participated in the study design and patients' recruitment. Patients' relatives were informed about the study's aim, and they contributed to the development of the interview protocol.
探讨并理解在急诊科临终关怀中，晚期疾病患者的尊严体验。
基于伽达默尔解释学的定性研究。
2019 年 9 月至 2020 年 2 月，对 16 名在急诊科就诊的晚期疾病患者进行了深入访谈。参与者事先被告知并签署了知情同意书。采用归纳策略对数据进行分析，以发现新出现的主题。采用《定性研究的综合报告标准》报告研究。
在数据分析过程中，出现了两个主题，分别是患者在急诊科临终关怀中尊严体验的两个方面。“尊严作为个人的属性”和“表现出尊严：尊严作为行为属性”。
临终关怀中患者的尊严围绕着控制（自我、死亡和情绪）的原则。患者为保持尊严所需的策略可能与在急诊科工作的医护人员的动态和目标有些冲突。
在急诊科就诊的晚期疾病患者的尊严是一个相关问题，值得从患者的角度来解决。参与者认为，尊严是一种面对疾病的存在和行为方式。急诊科需要通过支持和陪伴患者，避免治疗固执，来尊重临终患者的愿望。我们建议以患者的福祉为中心进行护理，尊重他们的自主权和决策过程，并允许及时转介到姑息治疗服务。
急诊科管理人员参与了研究设计和患者招募。向患者的亲属告知了研究目的，并为访谈方案的制定做出了贡献。
