以临终患者为中心的家庭会议开设及指导手册构建:一项基于三级医院安宁疗护中心的田野研究  

Developing a family meeting centered on dying patients and creating a guidebook:a field study based on hospice centers in tertiary hospitals

作　　者：王蒙蒙 秦苑[3] 岳鹏[1] Wang Mengmeng;Qin Yuan;Yue Peng(School of Nursing,Capital Medical University,Beijing 100069,China;Department of Nursing,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Department of Palliative Care,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]首都医科大学护理学院,北京100069 [2]山东中医药大学附属医院护理部,济南250014 [3]北京市海淀医院安宁疗护科,北京100080

出　　处：《中国实用护理杂志》2024年第28期2172-2179,共8页Chinese Journal of Practical Nursing

基　　金：国家社会科学基金(22BSH150);北京市教育委员会科研计划项目(SZ202310025008)。

摘　　要：目的观察三级医院安宁疗护中心家庭会议,明确以临终患者为中心的沟通经验和操作方法。方法2020年8月至2021年1月,在北京市海淀医院安宁疗护病房开展为期6个月的田野研究,采用目的抽样法进行抽样,对家庭会议进行录音、录像或文字记录,采用内容分析法对资料进行分析。结果共收集25例家庭会议录音与文字记录资料和21例个案观察资料。25例患者,男10例,女15例,年龄39~90岁。明确了家庭会议的3个主题和9个次主题:以临终患者为中心的基础保障和抓手——家庭会议的准备工作(环境准备、信息准备);以临终患者为中心的沟通实施路径——家庭会议如何展开(沟通具有结构化、沟通体现专业化、沟通凸显主体化);以临终患者为中心的沟通成效——家庭会议的反馈(直面现状、明晰选择、减少遗憾、感受人文关怀);形成家庭会议指导手册1本。结论以临终患者为中心的家庭会议是三级医院实现医务工作者、患者和家属系统化沟通的重要平台,医务工作者、患者和家属通过家庭会议实现信息共享,患者和家属感受到多学科团队的支持和人文关怀,家庭会议指导手册有望提升医务工作者对家庭会议的组织能力和沟通能力。ObjectiveTo observe family meetings in hospice care centers of tertiary hospitals and to clarify the experience and methods of patient-centered communication.MethodsFrom Agust 2020 to January 2021,the field research was conducted in the hospice wards of Beijing Haidian Hospital for 6 months.Audio,video,and verbatim transcripts were collected from palliative care family meetings by purposive sampling method.Family meeting transcripts were analyzed by a content analysis approach.ResultsA total of 25 family meeting recordings and transcripts and 21 case observation data were collected.There were 10 males and 15 females,aged 39-90 years old.Three themes and nine sub-themes were identified to summarize family meetings:patient-centered foundational support and key measures--preparation for family meeting(environmental preparation,information preparation);patient centered communication implementation path--how the family meeting was conducted(structured communication,professional communication,patient-centered communication);patient-centered communication effectiveness--outcomes after the family meeting(directly facing the current situation,clarifying choices,reducing regrets,feeling humanistic).A family meeting instruction manual had been developed.ConclusionsThe patient-centered family meeting for terminal patients is an important platform for tertiary hospitals to achieve systematic communication among medical workers,patients,and their families.Through the family meeting,medical workers,patients,and their families can share information,with patients and their families feeling supported by a multidisciplinary team and humanistic care.The family meeting guidebook is anticipated to enhance the organizational and communication skills of healthcare professionals in facilitating family meetings.

关 键 词：安宁疗护 家庭会议 以患者为中心 沟通 临终 

分 类 号：R48[医药卫生—临床医学]