Development of Nursing skill for Terminally ill Patients

目的：为明确临终病人有效的护理技能，重点研究三个方面：1)护士有效护理临终病人所需的支持；2)有效的护患对话方式；3)症状管理方法。方法：研究小组使用以下归纳方法获得数据：a)与护士的访谈；b)临床研究人员对护患互动的参与性观察；c)临终病人问题的个案研究陈述。症状管理问题源自使用症状管理综合模型的案例研究。对每一项研究的重点数据集的分析都是在不断进行的基础上进行的，采用不断比较的方法。研究小组一致同意研究结果。调查结果：1)护士需要支持：护士必须首先在计划的会议时间内意识到自己对死亡和临终的感受b…在临终关怀经验丰富的护士的帮助下，更多地与同龄人分享他们的感受。研究小组协助护士同龄人小组支持每个护士个体的情绪反应。在护理临终病人的护士-研究人员的指导下，对临终病人的个案研究报告在确定临终病人所需的有效护理技能方面尤为重要。2)护士与病人之间关于死亡和临终的对话：每当病人表示需要谈论死亡和临终时，护士都需要听取病人的意见。对于一些病人，护士会提供一些触发词语，帮助他们用言语表达自己对死亡和临终的感受。例如，研究发现，让病人用言语表达他们对自己身体的看法，往往会引发关于他们自己死亡的对话。3症状管理：症状管理综合模型对患者症状管理状况的分析表明，该模型明确了患者的自我护理缺陷。较少

Purpose : To identify effective nursing skills for terminally ill patients, three areas were focused on : 1)support needed by nurses to effectively care for terminally ill patients ; 2)effective approaches to nurse-patient conversations about death and dying ; and , 3)symptom menagement approaches. Methods : the research team utilized the following inductive methods to obtain data : a)interviews with nurses ; b)participant observations by the clinical researchers of nurse-patient interactions ; c)case study presentations of problems of terminally ill patients. Symptom management issues were derived from the case studies using the Integrated Model for Symptom Management. Analysis of each of the studys focus data-set was on an on-going basis using a constant-comparative approach. Consensus of findings was by agreement by the research team. Findings : 1)Support needed by nurses : Nurses must first gain an awareness of their own feelings about death and dying during planned meeting times b … More y sharing their feelings with their peers that was facilitated by an nurse experienced in terminal care. The research team assisted the nurse peer group to be supportive of each individual nurses emotional response. Case study presentations of terminally ill patients, under the direction of a nurse-researcher know ledgeable in the care of terminally ill patients, was particularly important in identifying effective nursing skills needed by terminally ill patients. 2)Nurse-patient conversations about death and dying : Nurses need to listen to patient whenever the patient indicated a need to talk about death and dying. For some patients nurses provided trigger words which would help thier verbalization about thier feelings about death and dying. For example, it was found that having patients verbalize thier perception of thier body often initaited conversations about their own dying. It was important that nurses return to useal conversations whenever thier perceived patients were becoming uncomfortable talking about death.3 Symptom Management : Analysis of the patients symptom management conditions by the Integrated Model for symptom Management indicated that the model made clear patient's self care deficits. Less