Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses.
Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses.
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DOI：
10.1016/j.jpainsymman.2009.11.315
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发表时间：
2010-06
影响因子：
4.7
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
--
作者：
Reinke, Lynn F.;Shannon, Sarah E.;Engelberg, Ruth A.;Young, Jessica P.;Curtis, J. Randall
临床医生常常感到面临挑战，因为需要向患有生命限制性疾病的患者提供困难的预后信息，同时支持他们的希望。很少有研究考察护士对其在满足这些患者和家庭需求方面的作用的看法。我们的目标是 1) 描述护士对于满足患者对希望和疾病信息的需求的看法； 2) 为旨在改善患者及其家人临终关怀沟通的干预措施提供见解。我们聘请经验丰富的采访者，对 22 名护理晚期慢性阻塞性肺病或癌症患者的护士进行了一对一的半结构化采访。使用扎根理论的有限应用来分析访谈。出现了三个主题：1）护士通过了解这些希望的各个方面、关注患者的生活质量并与患者建立信任来支持患者的希望； 2) 护士通过评估患者的了解并遵循他们的指导来提供预后信息。护士报告独立进行这两项活动； 3) 护士确定与提供预后信息相关的需要与医生合作的活动。确定了使与患者和家属有效讨论预后复杂化的重要障碍。护士们描述了一些行为，这些行为在满足患者和家属的希望需求时很有用，而且他们在实践中也能轻松实施这些行为，而无需与其他临床医生合作。相比之下，大多数与满足患者和家属对预后信息的需求相关的行为都是与医生合作完成的。这些发现为针对临终关怀沟通的跨学科干预措施的发展提供了见解。
Clinicians often feel challenged by the need to deliver difficult prognostic information to patients with a life-limiting illness while, at the same time, supporting their hopes. Few studies have examined nurses’ perspectives on their roles in meeting these patient and family needs. Our objectives were to 1) describe nurses’ perspectives on meeting patients’ needs for hope and illness information; and 2) offer insights for interventions designed to improve communication about end-of-life care for patients and their families. Using experienced interviewers, we conducted one-on-one, semi-structured interviews with 22 nurses caring for patients with advanced chronic obstructive pulmonary disease or cancer. Interviews were analyzed using a limited application of grounded theory. Three themes emerged: 1) Nurses support patients' hopes by understanding individual aspects of these hopes, focusing on patient quality of life, and building trust with patients; 2) Nurses provide prognostic information by assessing what the patient knows and following their lead. Nurses report doing these two activities independently; and 3) Nurses identify activities associated with the provision of prognostic information that required collaboration with physicians. Important barriers that complicate effective discussion of prognosis with patients and families were identified. Nurses describe behaviors that are useful when meeting patients’ and families’ needs for hope and which they are comfortable implementing in practice, without collaboration with other clinicians. By contrast, most behaviors related to meeting patients’ and families’ needs regarding prognostic information are completed collaboratively with physicians. These findings provide insight for the development of interdisciplinary interventions targeting communication around end-of-life care.
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影响因子：
--
作者：
Curtis, JR;Patrick, DL;Collier, AC
通讯作者：
Collier, AC
影响因子：
2.2
作者：
Evans, Wendy G.;Tulsky, James A.;Arnold, Robert M.
通讯作者：
Arnold, Robert M.
影响因子：
3.8
作者：
HERTH, K
通讯作者：
HERTH, K
影响因子：
9.6
作者：
Knauft, E;Nielsen, EL;Curtis, JR
通讯作者：
Curtis, JR
影响因子：
45.3
作者：
Back, AL;Arnold, RM;Fryer-Edwards, KA
通讯作者：
Fryer-Edwards, KA