在家中照顾临终谵妄患者的社区护士有哪些经历和支持需求？一项定性研究。
What are the experiences and support needs of district nurses caring for terminally ill people with delirium at home? A qualitative study.
作者信息
Arnold Elizabeth, Lugton Jean, Spiller Juliet, Finucane Anne
机构信息
Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK.
Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK.
出版信息
BMC Palliat Care. 2025 Mar 8;24(1):60. doi: 10.1186/s12904-024-01627-9.
BACKGROUND
Delirium is a serious neuropsychiatric syndrome, which is common amongst terminally ill people in the community. District nurses have a key role in supporting terminally ill people to remain at home.
OBJECTIVES
To explore the experience and support needs of district nurses caring for people with delirium in home settings.
METHODS
Semi-structured individual and small group interviews were conducted via Microsoft Teams with 12 district nurses in Scotland, UK. Data was analyzed using framework analysis. Data was coded both deductively and inductively.
RESULTS
Overarching themes were (i) challenges of delirium detection in the community, (ii) challenges managing delirium in the community, (iii) family carers as providers and recipients of care and (iv) education, training and support needs. Participants valued clinical judgement alone in detecting delirium, over use of formal assessment tools. Patients were referred to district nursing services at an advanced stage of their illness, with nurses needing to make rapid decisions about their care, sometimes with limited information. Participants were familiar with non-pharmacological strategies and the importance of family carer support, but uncertainty remained regarding pharmacological management of distressing symptoms. The term 'delirium' was rarely used. Challenges accessing timely advice and practical support from other health and social care professionals were reported. Participants identified delirium detection and the pharmacological management of persistent delirium as priorities for training.
CONCLUSION
Caring for terminally ill people with delirium in the community is challenging. Educational interventions may be beneficial in developing district nurses' confidence in supporting terminally ill patients and their families. Responsive advice and support are required from specialist palliative care services.
背景
谵妄是一种严重的神经精神综合征，在社区中的临终患者中很常见。社区护士在支持临终患者居家方面发挥着关键作用。
目的
探讨社区护士在家庭环境中照顾谵妄患者的经验和支持需求。
方法
通过微软团队对英国苏格兰的12名社区护士进行了半结构化的个人和小组访谈。使用框架分析法对数据进行分析。数据采用演绎法和归纳法进行编码。
结果
总体主题包括：（i）社区中谵妄检测的挑战；（ii）社区中管理谵妄的挑战；（iii）家庭照顾者作为护理提供者和接受者；（iv）教育、培训和支持需求。参与者重视仅凭临床判断来检测谵妄，而不是过度使用正式评估工具。患者在疾病晚期才被转介到社区护理服务，护士需要在信息有限的情况下迅速做出护理决策。参与者熟悉非药物策略以及家庭照顾者支持的重要性，但对于痛苦症状的药物管理仍存在不确定性。“谵妄”一词很少被使用。报告了在从其他健康和社会护理专业人员那里获得及时建议和实际支持方面存在的挑战。参与者将谵妄检测和持续性谵妄的药物管理确定为培训重点。
结论
在社区中照顾患有谵妄的临终患者具有挑战性。教育干预可能有助于增强社区护士支持临终患者及其家庭的信心。专科姑息治疗服务需要提供及时的建议和支持。
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