Friedrichsen Maria, Jaarsma Tiny, Thulesius Hans, Waldreus Nana, Hedman Christel, Jaarsma Pier, Lythell Caroline, Milovanovic Micha, Karlsson Marit, Milberg Anna, Söderlund Schaller Anne
Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
J Adv Nurs. 2023 Nov;79(11):4292-4303. doi: 10.1111/jan.15851. Epub 2023 Sep 11.
To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units.
A qualitative, reflexive thematic design with an inductive analysis was used.
Data were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR).
Two main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals.
Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst.
No patient or public contribution.
In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life.
The study was guided by the SRQR. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.
描述在专科姑息治疗（PC）病房中，助理护士对临终患者口渴的体验以及与口渴相关的伦理挑战。
采用定性、反思性主题设计并进行归纳分析。
于2021年11月至2023年1月期间收集数据。对瑞典不同医院的五个不同专科PC病房工作的助理护士进行了12次定性访谈。访谈内容逐字转录，并采用反思性主题分析法进行分析。本研究遵循定性研究报告标准（SRQR）。
本研究发现了两个主要主题。（1）“缓解口渴的实践世界”，助理护士呈现出一个以任务为导向的世界，其中对口渴的认识是一种基于经验的隐性知识，主要由常规操作主导。（2）伦理挑战呈现出他们在实践中遇到的不同伦理问题，例如当患者在生命末期表示口渴但病情过重无法饮水时，或者当他们看到其他医护人员在该领域缺乏知识时。
临终患者的口渴是一个被忽视的领域，助理护士在处理这个问题时却没有进行沟通。他们对口渴及口渴缓解的认识没有得到表达，很少被讨论，没有政策文件，患者记录中也没有对口渴的记录。护士需要带头改变关于口渴的护理实践。
无患者或公众参与。
在姑息治疗中，先前的研究表明临终患者可能会口渴。助理护士认识到临终患者的口渴，但团队中并未对此进行讨论。护士必须考虑患者的基本护理需求并解决口渴问题，例如在护理过程中，以确保患者在生命的最后日子里的生活质量。
本研究遵循SRQR。本文对更广泛的全球临床社区有何贡献？：口渴是所有人都会经历的痛苦症状。然而，当患者临终时，他或她会失去多种功能，无法再独立饮水。本文的知识有助于我们理解当前的实践，并指出了一个需要立即关注以改善基本姑息治疗的领域。
