Implementing advance care planning: a qualitative study of community nurses' views and experiences.
Implementing advance care planning: a qualitative study of community nurses' views and experiences.
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DOI：
10.1186/1472-684x-9-4
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发表时间：
2010-04-08
影响因子：
3.1
通讯作者：
Kennedy S
中科院分区：
文献类型：
--
作者：
Seymour J;Almack K;Kennedy S
预先护理计划（ACP）是一个讨论护理目标的过程，也是一种记录未来可能失去能力或沟通能力的患者的护理偏好的方法。政策制定者广泛促进非加太国家方案的执行。本研究探讨如何在英格兰社区姑息治疗护士了解ACP和ACP内他们的角色。它试图确定社区护士实施ACP的因素和护士的教育需求。采用了行动研究策略。来自英国两个癌症网络的23名社区护士被招募参加6个焦点小组讨论和3个后续讲习班。使用常数比较法分析数据。护士理解ACP是实践的重要组成部分，并有可能成为良好护理的庆祝活动。护士认为他们在ACP中的角色是与患者接触，以引出护理偏好，促进家庭沟通，并使护理重点转向姑息治疗。他们认为ACP面临的挑战包括：时机，如何影响团队在ACP工作，政策的重点是教学指令，相关性差的病人的关注;管理病人和家属的意见的差异。人们认为的障碍包括：缺乏资源;公众对非加太方案缺乏认识;难以谈论死亡。护士们建议将以下内容纳入教育计划：设计现实的场景;设计流程图;关于沟通和记录的实用建议;对ACP实践临床监督需求的见解。在社区工作的护士集中参与病人的姑息治疗的需要，谁可能希望记录他们对未来的护理和治疗的意见。这项研究揭示了一些重要的领域的实践和教育发展，以提高护士的使用和了解ACP。
Advance care planning (ACP) is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.