家庭护理者在姑息治疗中在护理环境之间转移患者的体验：一项访谈研究。

Family carers' experiences regarding patient transfers between care settings in palliative care: an interview study.

机构信息

Department of Public Health and Primary Care, Ghent University, Gent, Belgium; Vrije Universiteit Brussel, Brussel, Belgium; End-of-Life Care Research Group, Ghent University, Gent & Vrije Universiteit Brussel, Brussel, Belgium.

Department of Public Health and Primary Care, Ghent University, Gent, Belgium.

出版信息

Ann Palliat Med. 2023 Jul;12(4):767-782. doi: 10.21037/apm-23-20. Epub 2023 Jul 4.

DOI:10.21037/apm-23-20

PMID:37431219

Abstract

BACKGROUND

To understand how family carers experienced the illness trajectory of their next of kin related to transfers taken place between care settings in palliative care, their experiences and attitude regarding the transfer decision and their experiences regarding patient transfers across settings.

METHODS

Semi-structured interviews were held with 21 family carers. A constant comparative approach was used to analyze data.

RESULTS

Three themes were identified after data analysis: (I) patient transfer dynamics, (II) experiences regarding the changed care environment and (III) impact of the transfer on the family carer. The dynamics of the patient's transfer were affected by the balance between the care provision (professional and informal care) and the changes in the patient's needs. Experiences regarding patient transfers strongly varied depending on the setting and were based on the personnel's conduct and the quality of receiving information. Study results revealed shortcomings in perceived inter-professional communication and continuity of information during a patient's hospitalization. Concomitant feelings of relief, anxiety or feeling insecure could arise in situations of a patient's transfer.

CONCLUSIONS

This study highlighted the adaptability of family carers when caring for their next of kin with palliative care needs. To support carers in coping with their role as caregivers and to share the responsibility of caregiving, involved healthcare professionals should timely evaluate family carers' preferences and needs and adapt the care organization accordingly. A pro-active attitude, which anticipates on the possibility of an impending decompensation of the family carer, is recommended. When the decision for a patient's transfer is taken, multiple factors influenced the choice of the care setting. Healthcare professionals need to take these factors into account when discussing, with patients and carers, the need for a transfer. Continuity of information can be improved. Further development and evaluation of interventions, aimed at improving informational continuity can be recommended.

摘要

背景

为了了解家庭护理人员在姑息治疗中经历亲属转院的情况，他们对转院决策的体验和态度，以及他们在不同环境下对患者转院的体验，本研究旨在了解家庭护理人员在姑息治疗中经历亲属转院的情况。

方法

对 21 名家庭护理人员进行半结构化访谈。采用恒定比较法对数据进行分析。

结果

数据分析后确定了三个主题：（一）患者转院动态，（二）对改变的护理环境的体验，（三）转院对家庭护理人员的影响。患者转院的动态受到护理提供（专业和非专业护理）与患者需求变化之间平衡的影响。患者转院的体验强烈取决于环境，并基于人员的行为和接收信息的质量。研究结果显示，在患者住院期间，存在感知到的跨专业沟通和信息连续性方面的不足。在患者转院的情况下，可能会产生解脱、焦虑或不安的感觉。

结论

本研究强调了家庭护理人员在照顾有姑息治疗需求的亲属时的适应性。为了支持护理人员应对照顾者角色，并分担照顾责任，参与的医疗保健专业人员应及时评估家庭护理人员的偏好和需求，并相应地调整护理组织。建议采取积极主动的态度，预测家庭护理人员即将出现的代偿失调的可能性。当决定患者转院时，多个因素影响了护理环境的选择。医疗保健专业人员在与患者和护理人员讨论转院需求时，需要考虑这些因素。信息连续性可以得到改善。可以推荐进一步开发和评估旨在提高信息连续性的干预措施。