基于生命价值观导向的叙事遗嘱概念分析

【摘要】目的 探索并澄清生命价值观导向的叙事遗嘱概念内涵,促进该理念在护理教育、管理和科研领域的理论发展和实践创新。 方法 在Web of Science、PubMed、EBSCOASU、中国知网、万方及维普等中外数据库中系统检索叙事遗嘱相关研究,检索时限为建库至2023年7月。应用改良版Rodgers演化概念分析法对筛选出的文献进行分析。结果 共纳入文献479篇。叙事遗嘱为基于生命价值观导向,以尊重个体意愿和需求为前提,通过叙事形式呈现个体独特的生命故事,传达其对经历事件的整体体验、意义解读及生命理解,并以符合个体期望的形式保存和传承,以超越空间和时间的人际互动方式促进人类对生命意义的寻求、反思和成长。包括生命价值观主导、承认个体独特性、尊重个体意愿和需求、叙事生命成长、生命价值传承、叙事遗嘱动态发展6个属性。其先决条件为个体需求和意愿的表达、多学科团队的支持、组织支持、制度完善及法律保障。产物为保障患者自主决策权、深化沟通内涵、辅助医疗决策、促进生命成长及社会文化传承。经过两轮德尔菲专家咨询,专家权威系数(Cr)分别为0.83和0.88。专家们对叙事遗嘱的概念意见一致。结论 叙事遗嘱是对生命价值意义的充分尊重和肯定,明确相关概念属性,有助于深化安宁疗护学科体系。

Conceptual Analysis of Narrative Wills Guided by Life Values

AbstractObjective: To explore and clarify the concept of a narrative will oriented by life values, and to promote the theoretical development and practical innovation of this concept in the fields of nursing education, management, and research.Methods: A systematic review was conducted on studies related to narrative wills from databases such as Web of Science, PubMed, EBSCOASU, CNKI, Wanfang, and VIP, from their inception to July 2023. The modified Rodgers'' evolutionary concept analysis method was applied to analyze the selected literature.Results: A total of 479 articles were included. A narrative will, guided by life values and respecting individual wishes and needs, presents an individual''s unique life story through a narrative form. It conveys the overall experience, meaning interpretation, and understanding of life events from the individual''s perspective, and preserves and transmits these in a manner consistent with the individual''s expectations. This promotes the pursuit, reflection, and growth of life''s meaning through interpersonal interactions that transcend space and time. The six attributes include life values orientation, recognition of individual uniqueness, respect for individual wishes and needs, narrative life growth, life value inheritance, and the dynamic development of narrative wills. The prerequisites are the expression of individual needs and wishes, multidisciplinary team support, organizational support, system improvement, and legal protection. The outcomes include ensuring patient autonomy in decision-making, deepening communication connotations, aiding medical decision-making, promoting life growth, and social and cultural inheritance. Through two rounds of Delphi expert consultation, the expert authority coefficients (Cr) were 0.83 and 0.88, respectively, indicating consensus among experts on the concept of a narrative will.Conclusion: A narrative will is a full respect and affirmation of the meaning of life values. Clarifying the related concept attributes helps to deepen the discipline system of palliative care.