Concord Repatriation General Hospital, Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
J Clin Nurs. 2023 Sep;32(17-18):6559-6573. doi: 10.1111/jocn.16644. Epub 2023 Feb 14.
To explore the notion of Being-with and authentic discourse for people making decisions about major amputation.
Chronic limb-threatening ischaemia is a devastating disease with a high burden of pain and complex wounds. Patients may deteriorate suddenly after multiple revascularisation procedures and, amputation is offered when further reperfusion is considered futile. Delayed decisions about amputation have negative consequences for patients, families and health systems, yet little attention is given to training clinicians for the sophisticated communication required. Clinicians need to engage in authentic discourse about amputation to create shared meaning and facilitate decision-making.
Qualitative study using hermeneutic Heideggerian phenomenology.
Twelve patients offered major amputation, and 13 family participants from three vascular units in Australia engaged in 42 semi-structured interviews, representing 19 cases of chronic limb-threatening ischaemia. Hermeneutic phenomenology using the Heideggerian tenet of Being-with as an analytic framework, a philosophically based understanding of Being-with and Discourse related to treatment discussions and decisions was derived. The research was reported in accordance with the COREQ checklist.
Effective discourse between the person and family was hampered by changed circumstances of Being-with, characterised by guilt, and a retreat from discourse through deficient discourse and filtering information. Clinician Being-with was hampered by discourse that was deficient, poorly delivered, discordant and disconnected through a lack of empathetic listening. There were also examples of enhanced clinician Being-with that made room for more constructive discourse and more timely decisions about amputation.
Heidegger's construct of Being-with provides a useful framework to reveal the role of authentic discourse in improving patient and family experience and decisions about treatment.
This study did not engage consumers other than as patient and carer participants.
Decisions about amputation are often difficult for patients or family members who may be substitute decision-makers. A better understanding of the experience may assist clinicians in their interactions with patients and families.
探索存在论和真实话语在决定大截肢患者中的概念。
慢性肢体威胁性缺血是一种破坏性疾病，具有高疼痛负担和复杂伤口。患者在多次血管再通手术后可能会突然恶化，如果进一步再灌注被认为是徒劳的，就会提供截肢。对截肢的延迟决策对患者、家庭和卫生系统都有负面影响，但对培训临床医生进行复杂的沟通关注甚少。临床医生需要进行关于截肢的真实对话，以创造共同的意义并促进决策。
使用解释学海德格尔现象学的定性研究。
来自澳大利亚三个血管单位的 12 名接受大截肢的患者和 13 名家庭参与者参与了 42 次半结构化访谈，代表了 19 例慢性肢体威胁性缺血病例。解释学海德格尔现象学使用存在论作为分析框架，从哲学上理解存在论和与治疗讨论和决策相关的话语。研究结果按照 COREQ 清单进行了报告。
人与家庭之间的有效对话受到存在状况变化的阻碍，其特征是内疚，以及通过缺乏话语和过滤信息来逃避话语。临床医生的存在也受到阻碍，表现为话语不足、表达不当、不和谐和脱节，缺乏同理心倾听。也有一些增强临床医生存在的例子，为更具建设性的话语和更及时的截肢决策创造了空间。
海德格尔的存在论构建提供了一个有用的框架，可以揭示真实话语在改善患者和家庭体验以及治疗决策方面的作用。
这项研究没有让除患者和护理人员以外的消费者参与。
截肢决定对患者或可能是替代决策者的家属来说往往很困难。对这种体验的更好理解可能会帮助临床医生与患者和家属互动。
