迈向西班牙姑息护理护理的一套能力：共识的障碍是什么？
Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus?
机构信息
Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain.
Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain.
出版信息
BMC Palliat Care. 2024 Feb 14;23(1):41. doi: 10.1186/s12904-024-01359-w.
BACKGROUND
Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36.
METHODS
Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories.
RESULTS
Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death.
CONCLUSIONS
Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.
背景
西班牙目前缺乏姑息护理护理能力框架。拥有这样一个框架将有助于在学术、政府和卫生管理背景下推动这一领域的发展。在混合方法顺序研究的第一阶段，我们收集了定量数据，向一组姑息护理护士提出了 98 项能力。他们接受了其中的 62 项，拒绝了 36 项。
方法
第二阶段是一个定性阶段，我们使用共识技术与两个经过修改的名义小组来解释定量结果，目的是理解为什么 36 项能力被拒绝。来自姑息护理不同领域的 20 名护士（直接护理、教学、管理、研究）参与了这项研究。我们使用 NVivo12 进行了主题分析，以识别意义单位并将它们分组为更大的主题类别。
结果
参与者将对 36 项能力缺乏共识归因于四个主要原因：拒绝标准化护理语言、护士开展姑息护理的背景以及护理本身以外的其他因素、所提出的能力的特异性程度（太小或太大）以及与生命末期和/或死亡相关的护理复杂性。
结论
根据结果，我们提出了修复措施，例如用护理术语重新表述能力，将其描述为具体行为，并坚持让护士参与制定机构政策和战略，以便能够实施与发展、领导和专业承诺相关的能力。根据复杂性标准，促进对护理干预的定义和水平达成更大共识，并倡导姑息护理专家实践的适当培训、监管和认证至关重要。在当地，了解为什么 36 项能力被拒绝可以帮助西班牙姑息护理护士达成共同的能力框架。更广泛地说，我们的共识方法和我们关于拒绝原因的发现可能对其他正在正式确定或审查其姑息护理护理模式的国家有用。
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