PDF(Pubmed)
Abstract：
BACKGROUND: Advance care planning is a way of facilitating conversations with patients about future health care, values, and preferences at end of life. Nursing home physicians have the medical responsibility and the main obligation to facilitate planned meetings with patients. Although there has been a great deal of focus on establishing advance care planning in Norwegian nursing homes, it has yet to be widely implemented. Stated reasons are that the work routines in a nursing home do not include such meetings or that implementation seems complex due to frail patients. The aim of this study is thus to explore how physicians understand and experience advance care planning and follow-up of care plans in Norwegian nursing homes.
METHODS: The study has a qualitative research design with a phenomenological-hermeneutic approach based on interviews of twelve nursing home physicians working in community care. Interviews were conducted in February 2023 to May 2023, using a semi-structured interview guide. All interviews were recorded on audio files, transcribed, and analyzed using structural text analysis.
RESULTS: The findings are presented based on the following themes: (1) advance care planning is a dialog and a process, (2) advance care planning implies clarifying mutual expectations, and (3) advance care planning that brings relief and hope to patients is a medical art.
CONCLUSIONS: Advance care planning is a complex and dynamic process that implies medical treatment, decisions on treatment level, pain relief, and formulation of care plans where the patient\'s self-determination and personal values are respected. It implies an ongoing dialogue between physicians, patients, and their relatives about values such as dignity, self-understanding, social relations, and existential questions at end of life. Advance care planning requires a holistic approach that meets patients\' psychological and existential needs such as comfort, trust, hope, and respect as well as their preferences and concerns.
METHODS: The study has a qualitative research design with a phenomenological-hermeneutic approach based on interviews of twelve nursing home physicians working in community care. Interviews were conducted in February 2023 to May 2023, using a semi-structured interview guide. All interviews were recorded on audio files, transcribed, and analyzed using structural text analysis.
RESULTS: The findings are presented based on the following themes: (1) advance care planning is a dialog and a process, (2) advance care planning implies clarifying mutual expectations, and (3) advance care planning that brings relief and hope to patients is a medical art.
CONCLUSIONS: Advance care planning is a complex and dynamic process that implies medical treatment, decisions on treatment level, pain relief, and formulation of care plans where the patient\'s self-determination and personal values are respected. It implies an ongoing dialogue between physicians, patients, and their relatives about values such as dignity, self-understanding, social relations, and existential questions at end of life. Advance care planning requires a holistic approach that meets patients\' psychological and existential needs such as comfort, trust, hope, and respect as well as their preferences and concerns.
摘要：
背景：提前护理计划是促进与患者就未来医疗保健进行对话的一种方式，值,和生命结束时的偏好。疗养院医生有医疗责任和主要义务，以促进与患者的计划会议。尽管在挪威的疗养院中已经非常注重建立预先护理计划，它尚未得到广泛实施。陈述的原因是疗养院的工作例程不包括此类会议，或者由于患者虚弱，实施似乎很复杂。因此，这项研究的目的是探索医生如何理解和体验挪威疗养院的预先护理计划和后续护理计划。
方法：该研究采用现象学诠释学方法进行了定性研究设计，该方法基于对12位在社区护理中工作的疗养院医生的访谈。面试于2023年2月至2023年5月进行，使用半结构化面试指南。所有采访都记录在音频文件上，转录，并使用结构文本分析进行分析。
结果：研究结果基于以下主题提出：（1）预先护理计划是一个对话和过程，(2)提前护理计划意味着澄清双方的期望，（3）为患者带来救济和希望的预先护理计划是一种医学艺术。
结论：提前护理计划是一个复杂而动态的过程，意味着医疗，关于治疗水平的决定，疼痛缓解,并制定患者的自决和个人价值观得到尊重的护理计划。这意味着医生之间正在进行的对话，病人,和他们的亲戚关于尊严等价值观，自我理解,社会关系,和生命终结时的存在问题。提前护理计划需要一个整体的方法，以满足患者的心理和生存需求，如舒适，信任,希望,和尊重以及他们的喜好和关注。
方法：该研究采用现象学诠释学方法进行了定性研究设计，该方法基于对12位在社区护理中工作的疗养院医生的访谈。面试于2023年2月至2023年5月进行，使用半结构化面试指南。所有采访都记录在音频文件上，转录，并使用结构文本分析进行分析。
结果：研究结果基于以下主题提出：（1）预先护理计划是一个对话和过程，(2)提前护理计划意味着澄清双方的期望，（3）为患者带来救济和希望的预先护理计划是一种医学艺术。
结论：提前护理计划是一个复杂而动态的过程，意味着医疗，关于治疗水平的决定，疼痛缓解,并制定患者的自决和个人价值观得到尊重的护理计划。这意味着医生之间正在进行的对话，病人,和他们的亲戚关于尊严等价值观，自我理解,社会关系,和生命终结时的存在问题。提前护理计划需要一个整体的方法，以满足患者的心理和生存需求，如舒适，信任,希望,和尊重以及他们的喜好和关注。
