专业照护者感知的儿童安宁疗护实践影响因素的质性研究

目的 深入了解专业照护者感知的儿童安宁疗护实践影响因素，为提升安宁疗护服务质量提供参考依据。方法 2021年11月至2022年3月，目的抽样法选取上海市2所儿童专科医院和4所社区医院的3名医生、15名护士、3名社工为研究对象，采用现象学研究方法，对其进行深度访谈，对访谈资料进行转录、编码、分析、提炼主题。结果 专业照顾者感知的儿童安宁疗护实践的影响因素分别来自微观系统(患儿的诊疗经历、对疾病的认知、身心需求)、中观系统(家庭成员对安宁疗护的认识、对安宁疗护信息的获取、情绪状态，专业照护者开展安宁疗护的意愿、服务能力，医疗机构的服务模式、资源配置)和宏观系统(社会文化、政策机制)3个层面。结论 儿童安宁疗护实践面临多重影响，需要普及安宁疗护理念，增强社会各层面对其关注度和参与度，提升专业照顾者的服务能力，加强医院、社区、家庭安宁服务的连续性，开发适合国内临床情景的个性化安宁疗护服务，提高患儿和家庭的生活质量。     

血液肿瘤病人对安宁疗护的需求调查

[目的]了解血液肿瘤病人对安宁疗护的认知、需求以及影响因素。[方法]通过深入访谈的形式,访谈12例血液肿瘤病人,将获得的资料进行分析、整理,提炼主题。[结果]共提炼出3个主题9个副主题,生理方面为放弃有创抢救,减轻躯体的痛苦,保持身体完整性;心理方面为得到尊重、得到关心,达成心愿;社会方面为医疗资源、经济支持、专业的团队。[结论]安宁疗护需要关注病人及家属生理、心理及社会多方面的需求,为了更好地开展安宁疗护,应该增加教育力度,提高医护人员专业技能,增加社会宣传,普及优逝理念,组建安宁疗护团队,加大社会支持,增加安宁疗护病房及宁养机构,为临终病人提供高质量的安宁疗护。     

安宁疗护护士职业悲伤体验的质性研究

目的 了解安宁疗护护士在经历患者病死事件后的内心感受及悲伤体验。方法 采用目的抽样结合滚雪球抽样的方法,于2020年11月—2021年3月选取广州市4所社区卫生服务中心和2所医院的15名安宁疗护护士进行半结构式深度访谈。运用解释现象学分析法分析访谈资料,提炼主题。结果 安宁疗护护士经历患者病死事件的职业悲伤体验可归纳为3个主题,包括职业悲伤的特征（被剥夺的悲伤、悲伤易被唤起）、应对方式（回避、否认、心理脱离、调整对患者病死的认知、寻求支持）和职业悲伤的累积影响（职业倦怠、成长）。结论 安宁疗护护士普遍存在被剥夺的悲伤,且悲伤易被唤起,具有隐匿性、长期性和累积性的特点;调适悲伤的方式消极与积极并存,成长者与职业倦怠者均存在,建议对安宁疗护护士提供职业悲伤的教育和组织支持,引导其正确表达,促进成长。     

医护人员在新生儿安宁疗护中真实体验的质性研究

目的 了解医护人员实施新生儿安宁疗护的真实体验,探讨实施过程中存在的困难和需求,为构建新生儿安宁疗护模式提供依据。方法 采用主题分析法,通过目的性抽样,选取新生儿科的16名医护人员进行访谈。结果 医护人员实施新生儿安宁疗护的心理体验包括认知体验、情感体验和意志体验3个主题。结论 医护人员能认识到新生儿安宁疗护的重要性,但其安宁疗护的知识培训仍需加强,尤其是面对临终患儿家庭的沟通技巧、心理支持培训等。     

实习护生安宁疗护实践体验的质性研究

目的了解实习护生安宁疗护的实践体验,为完善护理教学和探索提高护生安宁疗护胜任力的教育策略提供参考依据。方法采用目的抽样法选取15名实习护生进行半结构式深度访谈,用Colaizzi 7步分析法分析访谈资料并提炼主题。结果提炼出2大主题:实习护生经历多重情感体验(压抑和同情)、面临观念转变困难与技能缺失挑战(安宁疗护理念与传统医疗观相冲突、沟通交流经验欠缺和灵性照护能力不足)。结论护理教育者应关注护生在安宁疗护工作中的情感变化,提高护生对安宁疗护理念的认识,加强护患沟通能力与灵性照护能力的培养,提升实习护生安宁疗护胜任力。     

医护人员对新生儿安宁疗护感受和经验的质性研究

目的 了解医务人员关于新生儿安宁疗护的感受和经验,为新生儿安宁疗护的开展提供参考依据.方法 采用描述性质性研究,于2020年5月—7月对13名新生儿科医生和护士、护理管理者、医务社会工作者、安宁疗护医生和护士进行半结构式访谈,运用定向内容分析法对资料进行分析.结果 提炼出5个主题,临终新生儿的需求、临终新生儿家长的需求...     

肿瘤安宁疗护患者亲属照顾者照护体验的质性研究

目的了解肿瘤安宁疗护患者的亲属照顾者真实心理体验和需求,为制定科学的支持方案,促进亲属照顾者身心健康,提高生活质量提供参考。方法运用质性研究中的现象学分析法,对9例肿瘤安宁疗护患者的亲属照顾者进行深入访谈,运用Colaizzi的分析程序进行分析、整理,提炼出主题。结果提炼出5个主题:心理体验多维、社会角色适应不良、经济负担改变、信息需求强烈、在照顾过程中建立积极应对方式。结论安宁疗护患者照顾者的照护体验需要得到医护人员的关注和支持,应加强生死教育,提供专业的知识、社会和精神支持,进行家庭会议,帮助他们度过这一特殊时期。     

安宁疗护志愿者对体验式教学真实体验的研究

目的:研究安宁疗护志愿者在体验式教学培训中的真实体验,为未来的安宁疗护志愿者培训提供借鉴和参考.方法:采用质性研究的方法,对参与本次培训的志愿者进行半结构化访谈,了解他们在培训中的真实体验.结果:共访谈了9位参与培训的安宁疗护志愿者,提炼出8个主题:激发参与病房服务的动力、感受到已身处安宁疗护病房、领悟到安宁疗护的理念...     

晚期癌症病人对安宁疗护的需求现状及安宁疗护对病人生活质量的影响

[目的]探讨晚期癌症病人对安宁疗护的需求现状分析及安宁疗护对病人生活质量的影响。[方法]2016年6月—2017年6月应用晚期癌症病人安宁疗护需求问卷对128例晚期癌症病人进行安宁疗护需求进行调查,分析安宁疗护对病人生活质量的影响。[结果]晚期癌症病人对安宁疗护的需求总评分为52.58分±3.25分,其中生理需求方面评分最高的条目是睡眠质量得到保证,其次是疼痛能有效控制、皮肤及口腔保持清洁完整,心理需求方面评分最高的是家人支持及陪伴,其次是与家人探讨死亡问题、宗教人员精神支持等。病人经安宁疗护后躯体功能、角色功能、社会功能、情绪功能、认知功能及总生活质量评分较干预前明显提高(P0.05)。[结论]晚期癌症病人对安宁疗护的需求较高,护理人员应重视病人安宁疗护需求,最大限度减轻病人生理及心理不适,提高病人生活质量。     

护生为癌症终末期病人提供安宁疗护的意愿及影响因素

目的:调查护生为癌症终末期病人提供安宁疗护的意愿及影响因素。方法:采用自行设计的护生安宁疗护意愿评估问题、杰弗逊共情量表护生版（JSPE-NS）、安宁疗护知识量表（PCQN）和临终关怀态度量表（FATCOD-B）对杭州市某医学院校644名护生进行问卷调查。结果:护生安宁疗护意愿得分为（5.98±1.84）分，安宁疗护知识、对安宁疗护社会认可度评价、亲友死亡经历、癌症终末期病人接触经历、安宁疗护课程学习经历、临终关怀态度、共情能力和社会志愿服务经历为护生从事癌症终末期病人安宁疗护工作意愿的影响因素。结论:护生对癌症终末期病人提供安宁疗护意愿处于中等偏上水平，有待加强。应加快安宁疗护教育体系建设，促进安宁疗护社会认可度的提升，并注重培养护生的共情能力，引导其形成正向态度，从而逐步提高意愿。     

Women's emotions and concerns during pregnancy following perinatal loss

PURPOSE: To determine the specific emotions and concerns of women who are pregnant following a perinatal loss. STUDY DESIGN AND METHODS: Data were collected through a mailed questionnaire using an open response format. The sample consisted of 73 women on the membership mailing lists from two pregnancy-after-loss support groups. A content analysis was conducted on women's self-reports; five primary emotions and five main concerns were expressed during their pregnancies. RESULTS: "Anxious," "nervous," and "scared" were the most frequent emotions reported by these women. However, most women also included a positive emotion in their list, indicating the mixed emotions of their pregnancy experience. Eight categories of profound concerns were identified: "losing another baby," "overall health of the baby," "emotional stability of self," "impact of another loss on my future," "lack of support from others," "fear of bad news," "own impact on the baby," and "worries never end." Responses of currently pregnant women as compared with women retrospectively reporting on their last pregnancy experiences were essentially similar. CLINICAL IMPLICATIONS: Women pregnant after a previous perinatal loss are skeptical about pregnancy. Clinicians should be cognizant of the constellation of concerns and the simultaneous contrasting emotions experienced by these women in order to provide supportive prenatal care. Because the women's concerns are ongoing, responsive care should include asking about specific concerns throughout the pregnancy.     

孕产妇围产期服务需求的调查分析

目的了解孕产妇围产期的服务需求。方法在2008年6—8月便利抽取全国7个省,2个直辖市中29家医院2436名孕妇,在产后3—5d即将出院时填写一般资料及自行设计的孕产妇围产期服务需求量表。结果孕产妇围产期服务需求反映在生理需求、心理需求、环境和设备需求及服务需求4个纬度,多数需求条目得分大于3分,处于需要至极需要之间。结论产科护理人员应从孕产妇生理、心理、环境和设备及服务需求4个方面了解孕产妇围产期的需求状况．以便根据孕妇的意愿制订切实可行的服务计划,使围产期保健工作更加深入地开展。     

孕产妇围产期服务需求量表的研制

目的 研制孕产妇围产期服务需求量表.方法 2007年11-12月对北京某妇产医院住院分娩后3～5 d即将出院的产妇进行访谈,根据访谈录音内容及书面记录结果整理形成孕产妇围产期服务需求量表.结果 孕产妇围产期服务需求量表包含60个条目,按内容归纳为4个维度,生理需求9项、心理需求8项、环境和设备需求15项、医院服务需求28项.量表的内容效度为0.877,内部一致性系数0.984.结论 孕产妇围产期服务需求量表具有较好的信效度,从孕产妇生理需求、心理需求、环境和设备需求及服务需求四个方面反映孕产妇在围产期的需求状况,可用于临床工作中评估孕产妇在围产期的需求,根据孕妇的意愿制定切实可行的服务计划,使围产期保健工作更加深入地开展.     

基于舒缓疗护理念的告别仪式在畸胎引产病人中的应用效果

[目的]探讨基于舒缓疗护理念的胎体告别仪式对畸胎引产病人负面情绪及住院满意度的干预效果。[方法]选择在本院妇科接受畸胎引产同时参加胎体告别仪式的病人30例作为观察组,另选在本院妇科接受畸胎引产但未参加胎体告别仪式的病人32例为对照组。在住院当天、出院当天、引产后30 d采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、爱丁堡产后抑郁量表(EPDS)对产妇进行评估;出院当天采用医院自制住院满意度调查表评估病人住院满意度。比较两组病人出院当天、引产后30 d SAS、SDS、EPDS评分及住院满意度评分。[结果]观察组病人出院当天、引产后30d的SAS、SDS、EPDS评分均低于对照组,差异有统计学意义(P<0.05);观察组病人住院满意度高于对照组,差异有统计学意义(P<0.05)。[结论]基于"舒缓疗护"理念的胎体告别仪式能缓解畸胎引产病人紧张、焦虑情绪,减轻病人痛苦,减少产后抑郁的发生,提高病人住院满意度。     

Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss

BACKGROUND: Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally. OBJECTIVES: To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss. METHODS: In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70. RESULTS: Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping. DISCUSSION: Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.     

Effects of an educational bereavement program on health care professionals' perceptions of perinatal loss

BACKGROUND: The purpose of this study was to examine the differences in health care professionals' perceptions of perinatal loss situations before and after an educational program on perinatal bereavement. METHOD: A quasi-experimental design was used in a pretest and posttest format. RESULTS: Scores were significantly higher (p = .000) on each of the posttest vignettes. Overall scores were lowest for the miscarriage pretest, whereas scores for the pretest vignettes for the stillbirth and neonatal loss were similar. A similar pattern occurred in the posttest vignette scores. CONCLUSION: Health care professionals' perceptions of the emotional care needs of families experiencing perinatal loss were significantly increased after an educational program. The miscarriage vignette had the largest change score and the lowest mean scores on the pretest and posttest, which indicates professionals do not view miscarriage as significant a loss as stillbirth and neonatal loss.     

Exploring fathers' experiences of pregnancy after a prior perinatal loss

PURPOSE: To explore fathers' experiences of pregnancy after a prior perinatal loss. STUDY DESIGN AND METHODS: This phenomenological study used unstructured, in-depth interviews with four men whose wives were currently pregnant subsequent to previous perinatal loss in the second or third trimester. RESULTS: Regardless of the timing of the loss or their investment in the previous pregnancy, fathers expressed anxiety about the outcome of the subsequent pregnancy, a heightened sense of risk, and a need for increased vigilance. Themes concerning the intensity of the loss experience, dealing with grief, spirituality, supporting their spouse, influence of the previous loss, replacement of the loss, the importance of milestones, and change in world view were described. CLINICAL IMPLICATIONS: This study can provide insight for nurses into the needs of these families during a subsequent pregnancy and can help nurses to better support fathers during this critical time.     

住院孕产妇围生期护理服务需求调查研究

目的了解孕产妇围生期护理服务需求的现状,以便更好地满足孕产妇个体化需求：方法采用自行设计的问卷调查我院100例住院孕产妇护理服务需求情况。结果孕产妇对“分娩后告知新生儿的健康状况”的需求程度最高,为（384±044）分,且产前对“产科门诊预约挂号”、产时对“待产时分娩技巧指导”的需求程度最高,得分分别为（350±0．64）分、（3．66±0．52）分。结论应根据孕产妇对护理服务的需求情况,提供针对性的护理服务。     

Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study

Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short‐term home‐based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi‐structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk‐focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women’s needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.