“这很艰难。非常艰难”：一项针对照护患有谵妄的临终关怀住院患者的员工和志愿者的定性访谈研究。
'It's tough. It is hard': A qualitative interview study of staff and volunteers caring for hospice in-patients with delirium.
机构信息
Department of Health Sciences, University of York, York, UK.
Hull York Medical School, University of Hull, Hull, UK.
出版信息
Palliat Med. 2023 Jul;37(7):993-1005. doi: 10.1177/02692163231170655. Epub 2023 May 2.
BACKGROUND
Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting.
AIM(S): To explore hospice staff and volunteers' practice, its influences and what may need to change to improve hospice delirium care.
DESIGN
Qualitative interview study using behaviour change theory from a critical realist stance.
SETTING/PARTICIPANTS: Thirty-seven staff, including different professional groups and roles, and volunteers were purposively sampled from two in-patient hospices.
RESULTS
We found that participants' practice focus was on managing hyperactive symptoms of delirium, through medication use and non-pharmacological strategies. Delirium prevention, early recognition and hypoactive delirium received less attention. Our theoretically-informed analysis identified this focus was influenced by staff and volunteers' emotional responses to the distress associated with hyperactive symptoms of delirium as well as understanding of delirium prevention, recognition and care, which varied between staff groups. Non-pharmacological delirium management was supported by adequate staffing levels, supportive team working and a culture of person-centred and family-centred care, although behaviours that disrupted the calm hospice environment challenged this.
CONCLUSIONS
Our findings can inform hospice-tailored behaviour change interventions that develop a shared team understanding and engage staff's emotional responses to improve delirium care. Reflective learning opportunities are needed that increase understanding of the potential to reduce patient distress through prevention and early recognition of delirium, as well as person-centred management. Organisational support for adequate, flexible staffing levels and supportive team working is required to support person-centred delirium care.
背景
谵妄是临终关怀住院患者经常经历的一种痛苦状况。为了在这一环境中制定干预措施，需要更多地了解当前多学科治疗谵妄的方法。
目的
探讨临终关怀工作人员和志愿者的实践、影响因素以及需要改变哪些方面以改善临终关怀谵妄护理。
设计
采用批判现实主义立场的行为改变理论进行定性访谈研究。
地点/参与者：从两家住院临终关怀机构中，有目的地选取了 37 名工作人员，包括不同的专业群体和角色，以及志愿者。
结果
我们发现，参与者的实践重点是通过药物治疗和非药物策略来管理谵妄的活动过度症状。谵妄预防、早期识别和活动不足型谵妄则受到较少关注。我们的理论分析表明，这种关注受到工作人员和志愿者对与活动过度型谵妄相关的痛苦的情绪反应以及对谵妄预防、识别和护理的理解的影响，而这些理解在不同的工作人员群体中有所不同。非药物性谵妄管理得到了充足的人员配备水平、支持性团队合作以及以患者和家庭为中心的护理文化的支持，尽管一些破坏宁静的临终关怀环境的行为对这一点构成了挑战。
结论
我们的研究结果可以为临终关怀量身定制行为改变干预措施提供信息，这些干预措施可以培养团队对共同的理解，并激发工作人员对改善谵妄护理的情绪反应。需要提供反思性学习机会，以增加对通过预防和早期识别谵妄来减轻患者痛苦的潜力的理解，以及对以患者为中心的管理的理解。需要为充足、灵活的人员配备水平和支持性的团队合作提供组织支持，以支持以患者为中心的谵妄护理。
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