摘要
姑息照护是对患有不可治愈性疾病患者实施的一种积极、整体的关怀照护,以提高患者及其家属的生存质量。姑息照护的服务质量与其服务提供者——护士对相关核心知识的掌握程度密切相关。国际社会十分重视姑息照护培训,WHO、国际癌症护理学会等国际组织制定了相关培训内容,美国、加拿大等国也相继形成了较为完善的培训知识体系。相比之下,我国在姑息照护培训领域的整体研究还是空白,因此,本课题的研究目的是构建适合于我国护理人员培训的姑息照护核心知识体系,提高护士从事临终患者及其家属照护的能力。
本课题以奥瑞姆的自护理论为理论基础,充分考虑姑息照护独特的专业理念,并结合知识选择模式要求,在专家咨询及广泛的文献研究基础之上,尤其是借鉴当前影响最广、最为权威的美国ELNEC姑息照护培训内容,拟定出姑息照护培训知识体系,经课题组专家对该知识体系的调整和修改,并按照重要程度将各知识点分为五个等级,依据likert-5分级评分法予以赋分,形成姑息照护知识需求调查表,包括姑息照护概述、症状护理、心理护理、沟通交流、道德伦理观念及终末护理6个方面,每个方面包括若干子知识点,共93个。
以姑息照护知识需求调查表为调查工具,调查我国340名护理人员对姑息照护的知识需求情况。描述性统计结果显示:1.护士对拟定的所有知识点态度均在3分以上;2.知识需求主要集中在心理护理、沟通交流以及症状护理中的疼痛护理;3.对于常见症状的护理、姑息照护的基本概念、道德伦理观念及终术护理的相关知识,需求较低;4.护士没有提出新的意见和建议。非参数Spearman秩相关检验显示:护士的工龄与对心理护理、沟通交流、道德伦理观念的知识需求成正相关;职称与对沟通交流的知识需求成正相关;学历与对6方面的知识需求均成负相关,无统计学意义。Ridit分析结果显示:三个层次医院的护士均认为非常重要的培训内容共有25项,重要程度均较低的培训内容有26项。一、二级医院护士培训需求重点集中在姑息照护基本概念、疼痛护理、基础护理,三级医院护士集中在症状护理、与姑息照护相关的法律知识。总体结果提示:心理护理、沟通交流为重点培训内容;不同学历护士均有相同的培训内容需求;可根据培训对象的不同,构建可以自由组合的、模块化的培训内容。
在初步构建的核心知识框架基础之上,按照国际劳工组织研发的模块培训法对培训内容制定的要求和步骤,将姑息照护核心知识体系模块化,同类知识点归结为同一模块,每个模块包含完成某一技能的全部知识,形成多个模块,各个模块相对独立,共同组成完成该专业的所有技能。采用德尔菲专家咨询法对拟定的模块化知识体系进行两轮专家咨询,最终确立适合于我国护理人员姑息照护培训核心知识体系,包括姑息照护概述、症状护理、心理护理、沟通交流、道德法律、丧亲后护理6个模块,69个知识点。
本研究构建了姑息照护培训的核心知识体系,明确了不同层次护理人员的知识需求,为开展姑息照护培训提供了理论和实践指导依据。
Palliative Care is providing active and holistic nursing to cureless patients, the aim of Palliative Care is to improve the quality of life of patients and their family members. Palliative Care's quality has close relationships with the level of nurses mastering the core knowledge. International community emphasized the Palliative Care training for nurses. WHO, International Cancer Nursing Association have built training contents. The United Stated, Canada have constructed complete training contents. However, Chinese Palliative Care training for nurse is still blank. The aim of this study is to construct Chinese nurse Palliative Care training core knowledge system and improve their abilities of caring terminal patients.
This study take for Orem's self-care theory to theoretical basis and give full consideration to the professional unique concept of Palliative Care, combined with knowledge selection model, based on the experts' advices and extensive literature review, specially analysed the American ELNEC training contents, which has most extensive effect in the world, then drafted the preliminary Palliative Care core knowledge system. Experts modified this knowledge system, and formed the Palliative Care knowledge demand questionnaire, including 6 aspects: Palliative Care Overview; Symptom Management; Psychological Care; Communication; Coral and Ethical; and Terminal Care, there were 93 sub-knowledge items.
The questionnaire was used to investigate 340 nurses about Palliative Care knowledge demands. The descriptive statistical analysis showed: 1. the scores of all knowledges were higher than 3; 2. the demands focused on psychological care, communication and pain management; 3. nurses had lower demands in common symptom management, Palliative Care Overview, Coral and Ethical; and Terminal Care; 4. there were no new suggestions. The spearman rank correlation showed: the seniority of nurse has positive correlation with psychological nursing, communication, moral and ethics; Profession title has positive correlation with communication; Education background has negative correlation with those six aspects. Ridit analysis showed: 25 items were very important and accepted by three-level hospital nurses. The training need of the first and second level hospital nurses focused on the Palliative Care concepts, pain management and basic nursing, the third level hospital nurses focused on symptom management and law knowledge. The whole results showed: psychological care and communication were key taining contents; nurses had the same training requirements; Training agency can provider training contents according to the different trainers, and nurses also can choose the modules according to their needs.
As the requirement and procedure of Modules of Employable Skill (MES) which made by International Labor Organization (IOL), cataloged the same items into one module, and every module contained all knowledge which need for a skill, then six independent modules were conformed after two rounds Delphi expert'consultion. The Palliative Care training core knowledge system was formed, including: Palliative Care Overview; Symptom Management; Psychological Care; Communication; Coral and Ethical; and Terminal Care, there were 69 sub-knowledge items.
This study constructed Palliative Care core knowledge system, and analyzed different level hospital nurses' different learning requirements, provided theoretical and practical guidlines for Palliative Care training.
引文
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