目的 以护士能力提升需求为导向,了解我国安宁疗护护士培训体系现状并提进改进建议。方法 采用质性研究方法,选取2019年4月至5月在北京市4所三级甲等医院安宁疗护病房工作的13名护士为研究对象,进行半结构式访谈,采用主题分析法对资料进行分析。结果 我国安宁疗护护士培训现有体系存在着培训体系层次性欠佳、培训内容专业性不足及培训内容与临床需求结合度不紧密等问题。能够满足安宁疗护护士进一步能力提升需求的培训内容包括公众死亡教育、患者和家属心理社会支持和灵性关怀、临终话题沟通、家属支持、护士自我压力管理和情绪调节。护士推荐线上线下结合的混合式培训的教学组织形式和以学习者为中心的教学方法。结论 我国安宁疗护护士培训体系存在诸多不足,培训内容上需要加强护士死亡教育能力、人文关怀技巧和自我调节等方面的培训,形成线上线下教学优势互补的培训模式,并更多采用以学习者为中心的教学方法。
Objective To explore the current situation of hospice nurse training system and propose recommendations for improvement for nurses' capacity improvement. Methods This is a descriptive qualitative study. Face to face semi-structured interviews were performed with 13 hospice nurses working on hospice care ward from four teaching hospitals in Beijing, China. Data were analyzed using thematic analysis. Results Three weaknesses in the existing training system were identified: lack of hierarchy in training system, lack of specialty in training content, and disconnection between training contents and clinical needs. Future training was suggested to focus on death education for the public, psycho-social-spiritual care for patients and their families, conversation on death and dying, family support, and stress management and self-care among nurses. The recommended instructional methods included online and offline training, learner-centered methods such as simulation, experiential teaching, case analysis and group discussion. Conclusions It is necessary to strengthen the skill training of death education, humanistic and self-regulation. The training mode should be strengthened by online and offline teaching, adopt more learner-centered teaching methods such as scenario simulation.
[1] 中华人民共和国国家卫生健康委员会. 对十二届全国人大五次会议第1536号建议的答复[EB/OL]. (2017-12-21)[2020-12-21]. http://www.nhc.gov.cn/zwgk/jianyi/201712/48a673a15451472eb879c09a9f54b78f.shtml.
[2] 医政医管局. 国家卫生计生委办公厅关于印发安宁疗护实践指南(试行)的通知[EB/OL]. (2017-02-09)[2020-07-12].http://www.nhc.gov.cn/yzygj/s3593/201702/83797c0261a94781b158dbd76666b717.shtml.
[3] 医政医管局. 国家卫生计生委关于印发全国护理事业发展规划(2016-2020年)的通知[EB/OL]. (2016-11-24)[2020-10-09].http://www.nhc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[4] 龙园园, 周宇彤. 安宁疗护护士工作特色及困难体验的质性研究[J].中华现代护理杂志,2019,25(22):2833-2838.DOI:10.3760/cma.j.issn.1674-2907.2019.22.014.
[5] 许湘华,李旭英,沈波涌,等.安宁疗护专科护士培训的实践[J].中国护理管理,2019,19(10):1513-1517.DOI: 10.3969/j.issn.1672-1756.2019.10.017.
[6] 刘德兰,闫荣,尚美美, 等.基于岗位胜任力的肿瘤安宁疗护专科护士培训方案的构建[J].护理研究,2021,35(4):596-601.DOI:10.12102/j.issn.1009-6493.2021.04.005.
[7] BraunV, Clarke V. Using thematic analysis in psychology[J]. Qualitative Research in Psychology, 2008, 3(2): 77-101. DOI: 10.1191/1478088706qp063oa.
[8] 谌永毅, 成琴琴, 刘翔宇, 等. 护士在安宁疗护中的角色和地位[J]. 中国护理管理, 2018, 18(3): 311-315. DOI: 10.3969/j.issn.1672-1756.2018.03.006.
[9] 纪敬敏, 邸淑珍, 冯莉莉, 等. 开设安宁疗护课程在医学院校教育中的意义[J]. 医学研究与教育, 2020, 37(1):71-75. DOI: 10.3969/j.issn.1674-490X.2020.01.013.
[10] 邸淑珍, 张学茹, 司秋菊, 等. 安宁疗护视角下护理人文关怀的探索[J]. 中国护理管理, 2018, 18(3): 302-305. DOI: 10.3969/j.issn.1672- 1756.2018.03.004.
[11] 赵艺媛, 陆宇晗, 王云, 等. 专业型护理研究生安宁疗护核心理论课程的构建[J]. 中华现代护理杂志, 2020, 26(19): 2631-2635. DOI: 10.3760/cma.j.cn115682-20200407-02428.
[12] Grunfeld E, Coyle D, Whelan T, et al. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principalcaregivers [J]. CMAJ, 2004,170(12):1795-1801. DOI: 10.1503/cmaj.1031205.
[13] Evans L, Taubert M. State of the science: the doll is dead: simulation in palliative care education[J]. BMJ Support Palliat Care, 2019,9(2):117-119. DOI: 10.1136/bmjspcare-2018-001595.
