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首页> 外文期刊>Prehospital and disaster medicine : >Balancing between closeness and distance: Emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death
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Balancing between closeness and distance: Emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death

机译：距离与距离之间的平衡：紧急医疗服务人员在院外心脏骤停和猝死中照顾家庭的经验

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Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members. Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel's knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel's experiences of caring for families when patients suffer cardiac arrest and sudden death. Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden. Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people's existential questions and needs was essential. It was dependent on the EMS personnel's balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel's own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence. Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.
机译：简介：院外心脏骤停（OHCA）是致命的健康问题，每年在美国影响236,000至325,000的人。由于在90-98％的OHCA病例中未进行复苏尝试，因此紧急医疗服务（EMS）人员经常面临失去亲人家属的需求。问题：继续或终止在OHCA进行复苏的决定受患者临床特征以外的因素影响，例如EMS人员的知识，态度和有关家庭情绪准备的信念。但是，很少有研究探索EMS人员如何照顾失去亲人的家庭成员，或者他们如何受到家庭动态和情感环境的影响。这项研究的目的是分析当心脏骤停和猝死患者时，EMS人员的家庭护理经历。方法：该研究基于诠释性的生活世界方法。对来自瑞典南部EMS机构的10名EMS人员进行了定性采访。结果：接受采访的EMS人员感到对患者护理和家庭护理均负有责任，有时由于他们自己的看法，感觉和反应而未能将这些责任放在优先位置。从患者护理转向家庭护理意味着从结构合理的指导过渡到情境响应，在这种情况下，工作人员可以自行决定在解释性推理与更直接的情感响应之间进行平衡。在决策中采取这种情感反应时，人员冒着错误的结论和照顾关系的风险，包括不诚实，误导的仁慈和错误的希望。认识并回应人们存在的问题和需求的能力至关重要。这取决于EMS人员在亲密程度和距离之间的平衡，以及他们面对家庭情感表达的勇气以及人员自身的脆弱性。家庭成员的存在对决策过程中的流动性（从患者护理到家庭护理的转变）提出了很高的要求，从而引发了对道德能力的需求。结论：在失去亲人的家庭成员的照顾中，需要有道德的关怀能力，以避免额外的痛苦。需要有机会在护理伦理，持续的道德教育和临床伦理培训的框架内反思这些情况。应对个人不适的支持以及明确的家庭支持准则可以使EMS人员受益。

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