The nurses' process of recognizing the demented elderly patients' wills

本研究旨在探讨护理人员对老年痴呆症患者遗嘱的认知过程。研究方法为观察6名老年痴呆症患者与17名护理人员在日常护理中的互动，并在观察约30分钟后对护理人员进行访谈。采用定性方法对数据进行分析。护理人员在日常照护中与病患互动的主题为[意愿调适]<ascertainment of the will>三个构面。年<ascertainment of the will>，护士关注患者表情的变化（关注变化），通过询问患者变化的意义进行推断（推断意愿），再通过获取其他信息进行确认（确认意愿）。通过这个过程，护士根据自己的意愿对病人的护理做出决定（根据意愿做出决定）。[An顺应意愿]有三个维度：1）<ascertaining negative responses to instructions>是护士在日常护理中对病人对指示的否定反应的确认维度; 2）<appraising discomfort>是护士将病人的不适判断为疼痛的存在的维度; 3）<ascertaining the unacceptable complaints>是护士对病人不可接受的抱怨的确认维度。在每个维度上，<accepting the will>护士对病人意志的接受途径<compromisng with the will>、护士对病人意志的妥协途径和护士对病人意志<controling the will>的控制途径分别为三种途径。

The purpose of this study was to investigate the nurse's process of recognizing the demented elderly patients' wills. The data was collected by observing the interaction between six demented elderly patients and seventeen nurses in daily care and interviewing the nurses after the observation for about 30 minutes. The qualitative approach was used to analyze the data. For the nurses, main theme in interacting with the patients in daily care was [accommodation with the will] included <ascertainment of the will> and three dimensions. In <ascertainment of the will>, the nurses focused on the changes of the patients' expressions (focusing the change), made inference by asking the patients their questions about the meaning of the changes (infering the will), and then confirmed the inference by taking other informations (confirming the will). Through this process, the nurses made a decision about the patients' care based on their wills (making decision based on the will). [An accomodation with the will] had three dimensions ; 1) <ascertaining negative responses to instructions> was the dimension of the nurses' making sure of the patients' negative responses to the instructions in daily care 2) <appraising discomfort> was the dimension of the nurses' assessing the presence of the patients' discomfort as pain, 3) <ascertaining the unacceptable complaints> was the dimension of the nurses' making sure of patients' unacceptable complaints. In the each demension, there were three approaches ; 1) <accepting the will> was the approach of the nurses' accepting the patinets' will, 2) <compromisng with the will> was the approach of the nurses' comproming with the patients' will, 3) <controling the will> was the approach of nurses' controling the patients' will.