北京市157名护士的死亡态度及临终关怀教育需求调查分析

Nurses' Attitude Toward Death and Needs for Hospice Care Education

目的通过调查北京市157名参加继续教育的临床护士对患者死亡所持有的态度现状,评估护士对临终关怀的相关教育需求,为开展临床护士有关临终关怀的相关继续教育活动提供参考。方法采用便利抽样方法,使用Wong,Reker和Gesse等编制的死亡态度量表、自行设计的临终关怀教育需求调查表,对157名临床护士进行有关死亡态度(包括死亡恐惧、死亡逃避、自然接受、趋近接受和逃离接受5个维度)和临终关怀教育需求的问卷调查。结果护士的死亡态度得分前3位分别为:自然接受(4.00±0.55)分,死亡逃避(2.90±0.68)分,死亡恐惧(2.80±0.59)分。护士的工作年限与趋近接受维度得分呈正相关(rs=0.199,P=0.025);护士的年龄(r=0.301,P<0.001)、工作年限(rs=0.343,P<0.001)与逃离接受维度得分呈正相关,护师及主管护师逃离接受维度得分高于护士(t=3.394,P=0.001),但经多元回归分析后,仅有护士的工作年限对逃离接受维度的得分有影响(t=4.093,P<0.001);护士死亡教育需求得分前3位分别为:如何与濒死患者家属进行沟通(4.08±0.66)分,面对濒死或死亡患者护士自身如何进行心理调适(4.08±0.74)分和濒死患者家属的心理变化特点(4.01±0.67)分。护士喜欢的继续教育方式前3位分别为:案例分析(73.3%),视频、录像、多媒体教学(70.5%)和课堂授课(53.4%)。结论多数护士对死亡持正向的自然接受态度,其死亡态度主要受年龄、工作年限、职称的影响。护士对临终关怀教育的需求较强,临床护理管理者及教育者可以综合多种教育形式,就如何同濒死患者及其家属交流,如何进行自我心理调节等内容有针对性地对其进行继续教育。

Objective To investigate nurses＇ attitude toward death and their needs for hospice care education and to provide reference for further education on hospice care. Methods With convenience sampling, Death Attitude Profile-Revised（Wong,Reker, Gesser, 1994） and a self-designed hospice care education need questionnaire were applied to survey 157 nurses receiving further education. Results Neutral acceptance, death avoidance and fear of death scored 4.00 ±0.55, 2.90±0.68, 2.80 ±0.59 respectively, which topped the scores of the subscales. There was positive relationship between nurses ＇ years of work and approach acceptance（rs=0.199, P=0.025）, and among nurses＇ age（r=0.301, P〈0.001）, nurses＇ years of work（rs=0.343, P〈0.001） and escape acceptance. Senior nurses and nurse-in-charge scored higher in escape acceptance than nurses did（t=3.394, P=0.001） but multiple regression analysis showed only nurses＇ years of working had influence on escape acceptance（t=4.093, P〈0.001）. Hospice care need focused on communication with families of dying patients 4.08±0.66, self psychological adjustment when facing death 4.08±0.74 and understanding psychological change of families of dying patients 4.01 ±0.67. The top three favorite approaches of further education were case study（73.3%）, multi-media teaching（70.5%） and classroom teaching（53.4%）. Conclusion Most nurses hold a positive and natural attitude toward death and age, years of working and professional titles exert influence on death attitude. There is urgent need for hospice care education with various education approaches.