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首页> 外文期刊>The Journal of cardiovascular nursing >When all else has failed: Nurses' perception of factors influencing palliative care for patients with end-stage heart failure.
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When all else has failed: Nurses' perception of factors influencing palliative care for patients with end-stage heart failure.

机译：当所有其他方法均无效时：护士对影响终末期心力衰竭患者姑息治疗的因素的理解。

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The purpose of this study was to describe registered nurses' (RNs') perceptions of factors influencing care for patients in the palliative phase of end-stage heart failure (ESHF). Seventeen senior RNs across 3 acute care and 5 community centres in metropolitan Adelaide, Australia, participated in the study. In this descriptive, exploratory research project, we analyzed audiotaped indepth, semistructured interviews, using a computer-assisted (NVIVO) thematic procedure. According to participants, the care of patients with ESHF is dominated by a focus on symptom management and optimal pharmacologic therapies, with a perceived deficit in other aspects of palliative management. Key mitigating factors against quality palliative care for this population included the difficulty in recognising ESHF and reluctance by physicians to negotiate end-of-life decisions. In the acute care sector, nurses believed ESHF was medicalized and characterized by paternalistic care, with treatment generally curative to the last breath. Nursing care and patient advocacy were also negatively influenced by a lack of awareness in patients and families concerning the inevitability of death in ESHF until the last few days or hours before death. Involvement of the palliative care team was often an afterthought rather than an integral component of care. Nurses in acute care settings embraced the concept of a multidisciplinary team approach, but stressed the need for the cardiac team to be the overall coordinator of care for the ESHF population. Care of patients with ESHF should promote the amalgamation of technological and pharmaceutical advances in the treatment of heart failure with more timely end-of-life care. All involved parties must work toward advancing a common middle ground for appropriate end-of-life care for patients with ESHF. Recommendations for practice include the need for greater education for patients and their families and greater collaboration between the members of the multidisciplinary healthcare team to assist patients with ESHF and their families prepare more timely for the final trajectory of the illness.
机译：这项研究的目的是描述注册护士（RNs）对终末期心力衰竭（ESHF）姑息治疗阶段影响患者护理的因素的看法。来自澳大利亚阿德莱德都会区的3个急诊和5个社区中心的17位高级RN参加了该研究。在这个描述性，探索性研究项目中，我们使用计算机辅助（NVIVO）主题程序分析了深度录音，半结构化访谈。参加者认为，ESHF患者的护理主要集中在症状管理和最佳药物治疗上，而姑息治疗的其他方面则存在缺陷。针对该人群的优质姑息治疗的主要缓解因素包括难以识别ESHF，以及医生不​​愿谈判寿命终了的决定。在急诊部门，护士们认为ESHF已被医学化并以家长式监护为特征，治疗通常可治愈最后一口气。患者和家属对直到死前最后几天或几小时内ESHF死亡不可避免性的认识不足，也对护理和患者拥护产生了负面影响。姑息治疗团队的参与通常是事后才想到的，而不是护理的组成部分。急性护理环境中的护士接受了多学科团队方法的概念，但强调心脏团队必须成为ESHF人群总体护理协调员。 ESHF患者的护理应通过更及时的临终护理促进心力衰竭治疗中技术和药物的融合。所有相关方都必须努力为ESHF患者的临终关怀提供一个共同的中间立场。实践建议包括需要对患者及其家属进行更多的教育，以及多学科医疗团队成员之间的更大合作，以帮助ESHF患者及其家属更及时地为疾病的最终轨迹做准备。

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