预立医疗照护计划在香港地区的临床实践及过程评价
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摘要
本文报告在医院推广预立医疗照护计划(ACP)的实践及过程评估结果,通过对已接受ACP培训的护士进行焦点小组访谈,使其分享ACP实践过程中的经验。研究中ACP干预方案的设计,既针对华人文化特点,也参考了《严重疾病对话指南》的形式。参与本研究的受访护士均体会到护理人员在ACP的实施过程中承担着不可或缺的倡议者和沟通者的角色,但要推动ACP的实施也需要来自宏观环境的支持。受访护士的分享主要反映了推动ACP实施所需的三项与宏观环境相关的支持性条件是:社区死亡教育、医务人员ACP教育与培训以及机构管理层的重视度。
This paper reports the findings of focus study interviews that explores the experiences of trained nurses in the implementation of ACP. It was a process evaluation of a study that promotes ACP in hospital setting. The ACP programme in this study was developed with reference to the relevant cultural issues in the Chinese community and the format of the Serious Illness Conversation Guide. The nurses as study informants identified the exceptional roles of nurses in advocacy and communication throughout the ACP process, yet the promotion of ACP requires support at the level of macro-environment.Three themes in relation to the support needed emerged from their sharing, namely life and death education in the community,fundamental training for health care providers, as well as support and recognition from organization and management.
This paper reports the findings of focus study interviews that explores the experiences of trained nurses in the implementation of ACP. It was a process evaluation of a study that promotes ACP in hospital setting. The ACP programme in this study was developed with reference to the relevant cultural issues in the Chinese community and the format of the Serious Illness Conversation Guide. The nurses as study informants identified the exceptional roles of nurses in advocacy and communication throughout the ACP process, yet the promotion of ACP requires support at the level of macro-environment.Three themes in relation to the support needed emerged from their sharing, namely life and death education in the community,fundamental training for health care providers, as well as support and recognition from organization and management.
引文
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[15]Gilissen J,Pivodic L,Smets T,et al.Preconditions for successful advance care planning in nursing homes:a systematic review.Int J Nurs Stud,2017,66(1):47-59.
[16]Blackford J,Street A.Tracking the route to sustainability:a service evaluation tool for an advance care planning model developed for community palliative care services.J Clin Nurs,2012,21(15/16):2136-2148.
[2]Lin CP,Evans CJ,Koffman J,et al.The conceptual models and mechanisms of action that underpin advance care planning for cancer patients:a systematic review of randomised controlled trials.Palliat Med,2019,33(1):5-23.
[3]Chan HYL,Ng JSC,Chan KS,et al.Effects of a nurse-led post-discharge advance care planning programme for community-dwelling patients nearing the end of life and their family members:a randomised controlled trial.Int J Nurs Stud,2018,87(7):26-33.
[4]Chan CWH,Chui YY,Chair SY,et al.The evaluation of a palliative care programme for people suffering from life-limiting diseases.J Clin Nurs,2014,23(1/2):113-123.
[5]韩素红,李厚伸,夏丽娜,等.预立医疗照护计划的实践与研究进展.中国护理管理,2018,18(3):298-302.Han SH,Li HS,Xia LN,et al.Implementation and research progress of Advance Care Planning:a review.Chinese Nursing Management,2018,18(3):298-302.
[6]邓仁丽,陈柳柳,史宝欣,等.中国文化背景下预立医疗照护计划的研究进展.中华护理杂志,2015,50(9):1117-1121.Deng RL,Chen LL,Shi BX,et al.Research progress of advanced care planning under Chinese culture.Chin J Nurs,2015,50(9):1117-1121.
[7]Chan HYL,Pang SMC.Let me talk-an advance care planning programme for frail nursing home residents.J Clin Nurs,2010,19(21/22):3073-3084.
[8]Bernacki R,Hutchings M,Vick J,et al.Development of the serious illness care program:a randomised controlled trial of a palliative care communication intervention.BMJ Open,2015,5(10):e009032.
[9]Izumi S.Advance care planning:the role of the nurse.Am J Nurs,2017,117(6):56-61.
[10]Hsieh JG,Wang YW.Promoting advance care planning in Taiwan-a practical approach to Chinese culture.BMJ Support Palliat Care,2011,1(1):79-79.
[11]Shin DW,Lee JE,Cho B,et al.End-of-life communication in Korean older adults:with focus on advance care planning and advance directives.Geriatr Gerontol Int,2016,16(4):407-415.
[12]Liu TW,Wen FH,Wang CH,et al.Terminally ill Taiwanese cancer patients'and family caregivers'agreement on patterns of life-sustaining treatment preferences is poor to fair and declines over a decade:results from two independent cross-sectional studies.J Pain Symptom Manage,2017,54(1):35-45.
[13]Periyakoil VS,Neri E,Kraemer H.No easy talk:a mixed methods study of doctor reported barriers to conducting effective end-of-life conversations with diverse patients.PLoS One,2015,10(4):1-13.
[14]Barnes S,Gardiner C,Gott M,et al.Enhancing patient-professional communication about end-of-life issues in life-limiting conditions:a critical review of the literature.J Pain Symptom Manage,2012,44(6):866-879.
[15]Gilissen J,Pivodic L,Smets T,et al.Preconditions for successful advance care planning in nursing homes:a systematic review.Int J Nurs Stud,2017,66(1):47-59.
[16]Blackford J,Street A.Tracking the route to sustainability:a service evaluation tool for an advance care planning model developed for community palliative care services.J Clin Nurs,2012,21(15/16):2136-2148.