Refinement of an Emergency Department-Based, Advance Care Planning Intervention for Nurses.
Refinement of an Emergency Department-Based, Advance Care Planning Intervention for Nurses.
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完善基于急诊科的护士预先护理计划干预措施。
DOI：
10.1089/jpm.2021.0398
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发表时间：
2022
影响因子：
2.8
通讯作者：
Ouchi,Kei
中科院分区：
文献类型：
--
作者：
Rubin,BatshevaR;Chung,Michelle;Hasdianda,MohammadAdrian;Gray,TamrynF;Aaronson,EmilyL;Dundin,Andrew;Egorova,NatashaA;Revette,AnnaC;Berry,Donna;Ouchi,Kei
背景：大多数老年人在临终前去急诊科 (ED) 时没有预先护理计划 (ACP)，因此面临接受与他们的愿望和价值观不相符的护理的风险。ED GOAL 是由 ED 临床医生实施的行为干预措施，旨在让患有严重疾病的老年人在 ED 中参与严重疾病对话。病情严重的老年人认为在急诊室接受这种治疗是可以接受的。然而，其被护士使用的潜力仍不清楚。目的：本研究的目的是通过征求护士的观点来确定改进措施，以适应基于 ED 的 ACP 干预措施。设计：这是一项使用半结构化访谈的定性研究。使用轴向编码方法对数据进行分析。 背景/对象：我们在美国东北部地区的一所城市学术急诊室和一所城市社区急诊室招募了一批急诊护士。结果：对 25 名护士进行了访谈（平均年龄 46 岁，84% 为女性，平均临床经验为 16 年）。在六个领域中确定了新出现的主题：(1) 护士先前与严重疾病对话的经验，(2) 对 ED 目标的总体印象，(3) 对 ED 目标的改进，(4) ED 目标由 ED 护士实施，(5) 经过专门培训的护理模式，以及 (6) 在 ED 目标中使用远程医疗。 结论：ED 护士普遍支持使用 ED 目标，并深入了解如何在临床实践中最好地适应和实施它。将 ED GOAL 应用于护理实践的经验证据仍有待观察。
Background:Most older adults visit the emergency department (ED) near the end of life without advance care planning (ACP) and thus are at risk of receiving care that does not align with their wishes and values.ED GOALis a behavioral intervention administered by ED clinicians, which is designed to engage seriously ill older adults in serious illness conversations in the ED. Seriously ill older adults found it acceptable in the ED. However, its potential to be used by nurses remains unclear.Objective:The aim of this study is to identify refinements to adapt an ED-based ACP intervention by eliciting the perspectives of nurses.Design:This is a qualitative study using semistructured interviews. Data were analyzed using axial coding methods.Setting/Subjects:We recruited a purposeful sample of ED nurses in one urban academic ED and one urban community ED in the northeastern region of the United States.Results:Twenty-five nurses were interviewed (mean age 46 years, 84% female, and mean clinical experience of 16 years). Emerging themes were identified within six domains: (1) nurses' prior experience with serious illness conversations, (2) overall impression ofED GOAL, (3) refinements toED GOAL, (4) implementation ofED GOALby ED nurses, (5) specially trained nursing model, and (6) use of telehealth withED GOAL.Conclusions:ED nurses were generally supportive of usingED GOALand provided insight into how to best adapt and implement it in their clinical practice. Empirical evidence for adaptingED GOALto the nursing practice remains to be seen.