ICU护士临终护理真实感受质性研究的Meta整合

A Meta-integration of qualitative studies on ICU nurses'real experience of palliative care

目的Meta整合ICU护士临终护理的真实体验。方法计算机检索Cochrane Library、PubMed、EMbase、Web of Science、中国生物医学文献服务系统、CNKI、维普数据库和万方数据库中符合要求的所有质性研究,检索时限从建库至2020年6月30日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准(2017年版)对纳入文献进行质量评价,采用汇集性整合的方法对结果进行整合。结果共纳入17篇文章,其中英文16篇,中文1篇;最终归纳为11个类别,汇集成4个整合结果,分别为临终护理工作复杂(ICU护士在临终护理中的多重角色、对患者的护理、对家属的护理);临终护理准备不足(专业技能不足、沟通技能不足、心理准备不足);临终护理组织支持不足(心理支持不足、多学科团队合作不充分、缺乏专业临终护理服务系统);临终护理法律支持不足(缺乏临终护理决策权、临终护理伦理与法律问题)。结论ICU护士临终护理能力不足,缺乏可靠支持系统。管理者应该重视ICU护士临终护理的负性体验和需求,逐步开展教育培训,提升护理水平,改善临终患者生命质量。

Objective To carry out the Meta-integration of Intensive Care Unit(ICU)nurses'real experience of palliative care.Methods The qualitative study that met the criteria in the Cochrane Library,PubMed,EMbase,Web of Science,China Biology Medicine Literature Service System,China National Knowledge Infrastructure(CNKI),VIP and Wanfang Data were searched by computer from the establishment of the database to June 30,2020.The quality of the included literature was evaluated using the critical appraisal checklist for qualitative researches of the Australia Joanna Briggs Institute(JBI)Evidence-based Health Center(2017 edition).The collective integration method was used to integrate the results.Results A total of 17 articles were included,involving 16 in English and 1 in Chinese.Finally,it was summarized into 11 categories,and 4 integrated results were collected,which were the complex palliative care(multiple roles of ICU nurses in palliative care,patient care,and family care);insufficient preparation for palliative care(lack of professional skills,communication skills and psychological preparation);insufficient support from palliative care organizations(inadequate psychological support,multidisciplinary team cooperation,and lack of professional palliative care service systems);insufficient legal support for palliative care(lack of decision-making power for palliative care,ethics and legal issues in palliative care).Conclusions ICU nurses lack the ability to palliative care and lack a reliable support system.Managers should pay attention to the negative experience and needs of ICU nurses for palliative care,and gradually carry out education and training to improve the level of care and the quality of life of dying patients.