利益相关者视角下生前预嘱签署的困境与挑战  

Dilemmas and challenges of signing living will from stakeholders'perspective

作　　者：龚霓 成美静 张子晴 符隆文 GONG Ni;CHENG Meijing;ZHANG Ziqing;FU Longwen(School of Nursing,Jinan University,Guangzhou,510632,China)

机构地区：[1]暨南大学护理学院健康与社会照护研究中心,广州市510632 [2]中山大学附属第七医院临床医学人文研究中心

出　　处：《中国护理管理》2024年第2期175-180,共6页Chinese Nursing Management

基　　金：国家社会科学基金项目(21CSH026)。

摘　　要：目的:分析在生前预嘱签署过程中各利益相关群体面临的困境与挑战,为优化生前预嘱的签署策略提供参考。方法:采用现象学研究方法,于2023年7月—11月对来自深圳市的生前预嘱(潜在)签署主体、家属、医护人员、社工、志愿者共33人进行半结构化访谈,采用Colaizzi 7步分析法进行资料分析。结果:共提炼出3个主题和6个子主题,分别为空间错位(医院之外、医院之内),时间错位(为时尚早、为时已晚),主体错位(家属“越位”、患方“让位”)。结论:生前预嘱签署在实践过程中,签署地点、签署时间、决策主体3个维度存在错位,导致生前预嘱在推广实施中遭受冷遇。提示未来需要搭建各利益相关群体的沟通平台,加强生命教育,在公众中建立生前预嘱的理念,从而推动生前预嘱签署的相关共识的达成。Objective:To analyze the dilemmas and challenges faced by various stakeholder groups in the process of signing living wills,and to provide reference for optimizing the signing strategy of living wills.Methods:This study adopted a phenomenological research method to conduct semi-structured interviews with a total of 33 people from Shenzhen city from July to November 2023,including(potential)signers of living wills,family members,healthcare professionals,social workers,and volunteers,and analyzed the data by using the Colaizzi 7-step analysis method.Results:Three themes and six sub-themes were identified:spatial mismatch(outside the hospital,inside the hospital),temporal mismatch(it is too early,it is too late),and subject mismatch(family members"overstepping the bounds",patients"giving way").Conclusion:The mismatch of the three dimensions of place,time,and subject of decision-making in the practice of signing living wills has led to the cold reception of living wills in the promotion and implementation of living wills.It is suggested that in the future,it is necessary to build a communication platform for all stakeholder groups,strengthen life education,and establish the concept of living wills among the public,so as to promote the consensus related to the signing of living wills.

关 键 词：生前预嘱 利益相关群体 签署过程 错位 现象学研究 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]