Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
J Adv Nurs. 2024 Dec;80(12):5018-5028. doi: 10.1111/jan.16152. Epub 2024 Mar 24.
To describe ambulance clinicians' experiences of self-determination in older patients.
The study had an inductive and explorative design, guided from a life-world perspective.
Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes.
The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers.
Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role.
The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes.
This study adhered to COREQ guidelines.
None.
描述救护车临床医生在老年患者中自主权的体验。
该研究采用归纳和探索性设计，从生活世界的角度进行指导。
2019 年 11 月，32 名瑞典救护车临床医生在 6 个焦点小组中接受了采访。使用内容分析法分析数据，开发显性类别和潜在主题。
救护车临床医生通过对话和视觉警觉来评估老年患者的自主决策能力，最终对他们的决策能力有一个整体的了解。这种评估是在告知老年患者其权利时作为一个平台，从而促进他们参与护理。时间有限和指导方针狭窄，这与救护车临床医生支持老年患者避免住院的普遍愿望相矛盾，导致他们急于将责任转移给外部决策者。
期望有决策障碍的老年患者会做出一致的反应，这意味着存在增加的年龄歧视态度和对患者自主权的简化看法的风险。这种态度有可能隐瞒医疗保健专业人员不希望老年患者选择的选择方案的信息。在决策困难时，扩大指导方针的要求可能会与专业护理角色产生冲突。
研究结果表明，当遇到有决策障碍的老年患者时，救护车临床医生不愿意承担其专业责任。在假设所有老年患者都以相同的方式思考时，救护车临床医生在患者自主权方面倾向于采取简单化且有些年龄歧视的方法。这表明在伦理能力方面存在缺陷，因此需要增加伦理支持，以促进和发展伦理能力。这种支持可以提高根据专业伦理准则作为自主专业人员采取行动的能力。
本研究遵循 COREQ 指南。
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