安宁疗护护士职业悲伤体验的质性研究

doi:10.3761/j.issn.0254-1769.2022.17.013

摘要/Abstract

摘要：

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。

关键词: 安宁疗护, 职业悲伤, 护士, 质性研究, 解释现象学

Abstract:

Objective To understand the inner feelings and grief experience of hospice nurses who experienced the death of patients. Methods Using the method of objective sampling combined with snowball sampling,15 hospice nurses from 4 community health service centers and 2 hospitals in Guangzhou were selected for semi-structured in-depth interviews from November 2020 to March 2021. The interview data were analyzed by interpretative phenomenological analysis to refine the themes. Results The grief experience of hospice nurses in patients’ death events can be summarized into 3 themes,namely characteristics of grief（disenfranchised grief,and grief is easily recalled）,coping style,long-term effect（job burnout,growth）. Conclusion Disenfranchised grief is common among hospice nurses,which is usually easy to be recalled. Grief has the characteristics of concealment,long-term and accumulation. Nurses have both negative and positive ways for adjustment of grief. The harvesters and the people who are job burnout both exist in the group. It is suggested that in the future formal education and support for professional grief should be provided to the hospice nurses,to guide their correct expression and promote their growth.

Key words: Hospice Care, Professional Grief, Nurses, Qualitative Research, Interpretative Phenomenology

左倩倩, 张正敏, 高钰琳. 安宁疗护护士职业悲伤体验的质性研究[J]. 中华护理杂志, 2022, 57(17): 2130-2136.

ZUO Qianqian, ZHANG Zhengmin, GAO Yulin. An interpretive phenomenological study on the professional grief experience of hospice nurses[J]. Chinese Journal of Nursing, 2022, 57(17): 2130-2136.

图/表 1

参考文献 24

[1]	Zisook S, Shear K. Grief and bereavement:what psychiatrists need to know[J]. World Psychiatry, 2009, 8(2):67-74. DOI URL
[2]	Chen CQ, Chow AYM, Tang SQ. Bereavement process of professional caregivers after deaths of their patients:a meta-ethnographic synthesis of qualitative studies and an integrated model[J]. Int J Nurs Stud, 2018, 88:104-113. DOI URL
[3]	Reid F. Grief and the experiences of nurses providing palliative care to children and young people at home[J]. Nurs Child Young People, 2013, 25(9):31-36.
[4]	de Castro de Oliveira F, Cleveland LM, Darilek U, et al. Bra-zilian neonatal nurses’ palliative care experiences[J]. J Perinat Neonatal Nurs, 2018, 32(4):E3-E10.
[5]	Tsui EK, Franzosa E, Cribbs KA, et al. Home care workers’ experiences of client death and disenfranchised grief[J]. Qual Health Res, 2019, 29(3):382-392. DOI URL
[6]	Laor-Maayany R, Goldzweig G, Hasson-Ohayon I, et al. Compassion fatigue among oncologists:the role of grief,sense of failure,and exposure to suffering and death[J]. Support Care Cancer, 2020, 28(4):2025-2031. DOI PMID
[7]	申乔乔, 张正敏, 梁韵仪, 等. 助产士对围产儿死亡产妇进行哀伤辅导体验的质性研究[J]. 中华护理杂志, 2021, 56(3):393-398. DOI
	Shen QQ, Zhang ZM, Liang YY, et al. Midwives’ experience of providing bereavement care for women after perinatal death:a qualitative study[J]. Chin J Nurs, 2021, 56(3):393-398.
[8]	Allie Z le Roux E, Mahlatsi K, et al. Bereavement overload and its effects on,and related coping mechanisms of health care providers and ward administrators at National District Hospital in Bloemfontein,Free State[J]. Afr J Prim Health Care Fam Med, 2018, 10(1):e1-e7.
[9]	张清慧, 谌永毅, 陈偶英, 等. 安宁疗护中专业健康照护者哀伤情绪的研究进展[J]. 中华护理杂志, 2019, 54(12):1805-1809. DOI
	Zhang QH, Chen YY, Chen OY, et al. Research progress on grief of professional caregivers in palliative care[J]. Chin J Nurs, 2019, 54(12):1805-1809.
[10]	李峥, 刘宇. 护理学研究方法[M]. 2版. 北京: 人民卫生出版社, 2018.
	Li Z, Liu Y. Nursing research method[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[11]	Smith JA. Beyond the divide between cognition and discourse:using interpretative phenomenological analysis in health psychology[J]. Psychol Heal, 1996, 11(2):261-271. DOI URL
[12]	Smith JA, Flowers P, Larkin M. Interpretative phenomenologi-cal analysis:theory,method and research[J]. Quali Res in Psychol, 2009, 6(4):346-347.
[13]	Sonnentag S, Bayer UV. Switching off mentally:predictors and consequences of psychological detachment from work during off-job time[J]. J Occup Health Psychol, 2005, 10(4):393-414. DOI URL
[14]	乌桑诺. 心理动力学心理治疗简明指南:短程、间断和长程心理动力学心理治疗的原则和技术[M]. 北京: 人民卫生出版社, 2010.
	Robert J. Ursano. Concise guide to psychodynamic psychotherapy:principles and techniques of brief,intermittent, and long-term psychodynamic psychotherapy[M]. Beijing: People’s Medical Publishing House, 2010.
[15]	Vallejo AA, Sarasola Sánchez-Serrano JL, Barerra Algarín E, et al. Disenfranchised grief,burnout and emotional distress among nursing home workers in Spain:a validation study[J]. Decis Trends Soc Syst, 2021:189-202.
[16]	Engler-Gross A, Goldzweig G, Hasson-Ohayon I, et al. Grief over patients,compassion fatigue,and the role of social acknowledgment among psycho-oncologists[J]. Psychooncology, 2020, 29 (3):493-499. DOI PMID
[17]	Deborah L. Disenfranchised grief and physician burnout[J]. The Annals of Family Med, 2017, 15(4):375-378. DOI URL
[18]	Peters E. Compassion fatigue in nursing:a concept analysis[J]. Nurs Forum, 2018, 53(4):466-480. DOI PMID
[19]	Wladkowski SP, Kusmaul N, Latimer A. Grief and loss during care transitions:experiences of direct care workers[J]. Omega (Westport), 2021:302228211038797.
[20]	Ghesquiere A, Bagaajav A. “we take care of people;what happens to us afterwards?”:home health aides and bereavement care in hospice[J]. Omega (Westport), 2020, 80(4):615-628. DOI URL
[21]	Sikstrom L, Saikaly R, Ferguson G, et al. Being there:a scoping review of grief support training in medical education[J]. PLoS One, 2019, 14(11):e0224325.
[22]	Darcie S, Napolitano N. Hidden grief and lasting emo-tions in emergency department nurses[J]. Creat Nurs, 2016, 22(4):249-253. DOI PMID
[23]	Marcella J, Kelley ML. “death is part of the job” in long-term care homes[J]. SAGE Open, 2015, 5(1):215824401557391.
[24]	吴际军, 林琴, 付梦雪, 等. 我国首批安宁疗护试点城市安宁疗护护士职业认同的现状调查[J]. 中华护理杂志, 2020, 55(8):1229-1233. DOI
	Wu JJ, Lin Q, Fu MX, et al. Investigation on professional identity of hospice nurses[J]. Chin J Nurs, 2020, 55(8):1229-1233.