摘要
Objective:This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death.Methods:The data of the study was collected using face-to-face semi-structured interviews.Through purposive sampling,16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed.The interviews were analyzed using qualitative content analysis.Results:Six characteristics of a good death emerged:no suffering,companionship and care,no worries or concerns,dying with dignity,involvement and acceptance,and less impact on the family.Eighteen categories were identified:dying without experiencing suffering;being relieved of symptoms and suffering;being relieved of psychological suffering;avoiding the use of futile treatment and resuscita-tion;being cared for and accompanied by family;receiving good health care;having a meaningful life without regrets;making good arrangements for family issues;having a chance to say goodbye;having a quality life before death;dying in a decent environment;the personal will to be respected;maintaining the integrity of the body;death of the patient being accepted by the family and healthcare providers;the death occurred despite the best efforts to care for the patient;limited financial and care burden;shortly affected quality of life of the patient;and improved family cohesion.Conclusion:Family members’early involvement in caring for patients at the end-of-life stage helps achieve a good death.For patients with a terminal illness,avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.
目的探讨综合医院内科医护人员对善终内涵的理解。方法采用面对面半结构式访谈收集资料。于2020年10月至2021年1月,在上海市8所综合医院中有目地的选取有内科工作、照顾终末期慢性病患者经验的16名医生和13名护士进行访谈,并采用内容分析法对资料进行分析。结果善终的内涵可以概括为六个主题,包括无痛苦、家人的陪伴与照顾、无牵挂、有尊严、尽力与接受、对家庭影响小。并提炼出一系列子主题,包括感知不到痛苦地离世、缓解症状、避免无效医疗措施及有创抢救措施、缓解心理痛苦;家人的陪伴照顾和医疗护理服务;人生圆满、做好安排、完成告别;在体面的环境中离世、个人意愿得到尊重、躯体完整、生活有质量;家属及医护人员对患者死亡的接受和家属及医护人员在照顾临终患者过程中的尽力感;对家庭负担影响小、对患者生活质量影响小、提高家庭凝聚力。结论患者临终过程中家人参与照顾对最终达到善终有积极作用。避免和减少使用无效医疗措施及有创抢救措施是促进我国终末期患者获得善终以及推动预立医疗照护计划发展的第一步。
作者
Chunyan Chen
Xiaobin Lai
Wenjuan Zhao
Menglei Chen
陈春雁;来小彬;赵文娟;陈萌蕾(Department of Nursing,Shanghai Cancer Center of Fudan University,Shanghai,China;Department of Oncology,Shanghai Cancer Center of Fudan University,Shanghai,China;School of Nursing,Fudan University,Shanghai,China;Department of Integrated Therapy,Shanghai Cancer Center of Fudan University,Shanghai,China)
