护理人员对预立医疗照护计划认知与感受的Meta整合

doi:10.3761/j.issn.0254-1769.2022.22.015

摘要/Abstract

摘要：

目的整合护理人员对预立医疗照护计划（advance care planning，ACP）的认知与感受，为国内ACP的开展提供借鉴。方法检索涉及护理人员对ACP认知与感受的质性研究，数据库包括PubMed、Web of Science、The Cochrane Library、Embase、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献服务系统，检索时限为建库至2022年7月。文献质量评价采用澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）质性研究质量评价标准，采用汇集性Meta整合方法对文献进行归纳。结果共纳入9篇文献，提取32个主题，归纳为8个类别，得到3个整合结果：护理人员对ACP的认知、护理人员对实施ACP的益处感知、护理人员视角下实施ACP面临的现实困境。结论 ACP的实施受患者、疾病、社会支持等多方面的影响，多学科共同协作、加强护理人员ACP的培训、缓解ACP的现实困境是顺利实施ACP的保障。

关键词: 预立医疗照护计划, 护理人员, 质性研究, Meta整合

Abstract:

Objective To conduct a meta-synthesis of the perception and feeling of nursing staff in advance care planning（ACP） from the perspective of nursing staff，and provide guidance for the development and implementation of ACP in China. Methods We searched databases including PubMed，Web of Science，the Cochrane Library，Embase，CINAHL，CNKI，Wan Fang，VIP and CBM. The above databases were included to retrieve the literature on the perception and feeling of nursing staff in advance care planning from inception until July 2022. JBI Critical Appraisal Tool for qualitative studies in Australia was used to evaluate the quality of included studies，and meta-synthesis was used to summarize and integrate results. Results A total of 9 studies were included;32 themes were extracted;8 categories were summarized and 3 synthesis results were obtained，namely the perception of nursing staff in ACP，the perceived benefits of nursing staff in ACP，and realistic dilemmas of ACP from the perspective of nursing staff. Conclusion The implementation of ACP is affected by patients，diseases，social support and other aspects. Multidisciplinary cooperation is needed to promote the implementation of ACP.

Key words: Advance Care Planning, Nursing Staff, Qualitative Research, Meta-Synthesis

魏利荣, 刘云, 边继萍, 王雅男, 王申. 护理人员对预立医疗照护计划认知与感受的Meta整合[J]. 中华护理杂志, 2022, 57(22): 2784-2790.

WEI Lirong, LIU Yun, BIAN Jiping, WANG Yanan, WANG Shen. The perception and feeling of nursing staff in advance care planning：a Meta-synthesis of qualitative research[J]. Chinese Journal of Nursing, 2022, 57(22): 2784-2790.

图/表 4

图1 PubMed检索策略

Figure 1 PubMed search strategy

图2 文献筛选流程

Figure 2 Literature screening process

表1 纳入文献的基本特征（n=9）

Table 1 Information of included studies（n=9）

表2 纳入文献的方法学质量评价（n=9）

Table 2 Methodological quality evaluation of included studies（n=9）

参考文献 27

[1]	Sudore RL, Lum HD, You JJ, et al. Defining advance care planning for adults:a consensus definition from a multidisciplinary Delphi panel[J]. J Pain Symptom Manag, 2017, 53(5):821-832.e1. DOI URL
[2]	Lee YK, Fried TR, Costello DM, et al. Perceived dementia risk and advance care planning among older adults[J]. J Am Geriatr Soc, 2022, 70(5):1481-1486. DOI PMID
[3]	Deng RL, Zhang JH, Chen LL, et al. The effectiveness of a mo-dified advance care planning programme[J]. Nurs Ethics, 2020, 27(7):1569-1586. DOI URL
[4]	Lim MK, Lai PSM, Lim PS, et al. Knowledge,attitude and practice of community-dwelling adults regarding advance care plan-ning in Malaysia:a cross-sectional study[J]. BMJ Open, 2022, 12(2):e048314. DOI URL
[5]	McDermott CL, Engelberg RA, Sibley J, et al. The association between chronic conditions,end-of-life health care use,and documentation of advance care planning among patients with cancer[J]. J Palliat Med, 2020, 23(10):1335-1341. DOI PMID
[6]	张玲利, 刘东玲, 王子辰, 等. 痴呆患者及家属参与预立医疗照护计划体验的Meta整合[J]. 中华护理杂志, 2021, 56(12):1876-1882. DOI
	Zhang LL, Liu DL, Wang ZC, et al. The experience of dementia patients and their relatives in advance care planning:a meta-synthesis of qualitative research[J]. Chin J Nurs, 2021, 56(12):1876-1882.
[7]	The Joanna Briggs Institute. Criticl appraisal checklist for qua-litative research[EB/OL].[2022-04-07]. https://joannabriggs.org/ebp/critical_appraisal_tools.
[8]	绳宇, 王心茹. 医护人员对预立医疗照护计划认识与实践的质性研究[J]. 中国护理管理, 2022, 22(2):166-171.
	Sheng Y, Wang XR. The perspectives and practice status quo of Advance Care Planning among medical professionals[J]. Chin Nurs Manag, 2022, 22(2):166-171.
[9]	Seymour J, Almack K, Kennedy S. Implementing advance care planning:a qualitative study of community nurses’ views and experiences[J]. BMC Palliat Care, 2010, 9:4. DOI PMID
[10]	Glaudemans JJ, Jong AED, Onwuteaka Philipsen BD, et al. How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study[J]. Fam Pract, 2019, 36(2):219-224. DOI PMID
[11]	Khairuddin NNB, Lau ST, Ang WHD, et al. Implementing advance care planning:a qualitative exploration of nurses’ perceived benefits and challenges[J]. J Nurs Manag, 2020, 28(5):1080-1087. DOI URL
[12]	Ohr SO, Cleasby P, Jeong SY, et al. Nurse-led normalised advance care planning service in hospital and community health settings:a qualitative study[J]. BMC Palliat Care, 2021, 20(1):139. DOI PMID
[13]	Mitchell S, Dale J. Advance care planning in palliative care:a qualitative investigation into the perspective of paediatric intensive care unit staff[J]. Palliat Med, 2015, 29(4):371-379. DOI PMID
[14]	Son YJ, Choi J, Ahn JW. Nurses’ perspectives on advance directives before the establishment of the new well-dying law in Korea:a mixed methods study[J]. Appl Nurs Res, 2020, 51:151187. DOI URL
[15]	Boot M, Wilson C. Clinical nurse specialists perspectives on advance care planning conversations:a qualitative study[J]. Int J Palliat Nurs, 2014, 20(1):9-14. DOI URL
[16]	Llewellyn H, Neerkin J, Thorne L, et al. Social and structural conditions for the avoidance of advance care planning in neuro-oncology:a qualitative study[J]. BMJ Open, 2018, 8(1):e019057. DOI URL
[17]	李豪, 景孟娟, 徐榆林, 等. 预立医疗照护计划在血液透析患者中的应用研究[J]. 中华护理杂志, 2022, 57(6):645-650. DOI
	Li H, Jing MJ, Xu YL, et al. The application effect of advance care planning in hemodialysis patients[J]. Chin J Nurs, 2022, 57(6):645-650. DOI
[18]	Hafid A, Howard M, Guenter D, et al. Advance care planning conversations in primary care:a quality improvement project using the serious illness care program[J]. BMC Palliat Care, 2021, 20(1):122. DOI PMID
[19]	Harrison DK, Scates C, McGill G, et al. A training needs analysis of admiral nurses to facilitate advance care planning in dementia[J]. Palliat Care, 2019, 12:1178224219850183.
[20]	Chan CWH, Ng NHY, Chan HYL, et al. A systematic review of the effects of advance care planning facilitators training programs[J]. BMC Health Serv Res, 2019, 19(1):362. DOI PMID
[21]	Werner P, Schiffman IK. Nursing home staff members’ attitudes regarding advance care planning:relationships with different types of knowledge[J]. Aging Clin Exp Res, 2020, 32(10):2091-2098. DOI
[22]	Hsieh CC, Huang HP, Tung TH, et al. The exploration of the knowledge,attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses[J]. BMC Palliat Care, 2019, 18(1):99. DOI URL
[23]	Ng SY, Wong ELY. The role complexities in advance care planning for end-of-life care-nursing students’ perception of the nursing profession[J]. Int J Environ Res Public Health, 2021, 18(12):6574. DOI URL
[24]	Whitehead P, Frechman E, Johnstone-Petty M, et al. A scoping review of nurse-led advance care planning[J]. Nurs Outlook, 2022, 70(1):96-118. DOI URL
[25]	陈柳柳, 杨柳, 赵俊延, 等. 护理人员预立医疗照护计划的沟通培训[J]. 护理学杂志, 2020, 35(10):47-50.
	Chen LL, Yang L, Zhao JY, et al. Communication training on advance care planning for nurses[J]. J Nurs Sci, 2020, 35(10):47-50.
[26]	Sukockien ė E, Iancu Ferfoglia R, Boegli M, et al. Early advance care planning in amyotrophic lateral sclerosis patients:results of a systematic intervention by a palliative care team in a multidisciplinary management programme:a 4-year cohort study[J]. Swiss Med Wkly, 2021, 151:w20484.
[27]	O’Riordan J, Noble H, Kane PM, et al. Advance care plan barriers in older patients with end-stage renal disease:a qualitative nephrologist interview study[J]. BMJ Support Palliat Care, 2020, 10(4):e39. DOI URL