护理SCI晨读：医护人员在姑息治疗阶段维护移民患者及其家人的尊严的策略：定性研究
确定注册护士和护理助手在移民患者及其家人生命的最后阶段维护尊严的困难和策略。
医护人员在姑息治疗阶段维护移民患者及其家人的尊严的策略：定性研究
摘要
目的
确定注册护士和护理助手在移民患者及其家人生命的最后阶段维护尊严的困难和策略。
背景
在姑息治疗阶段保持患者的尊严需要关注患者的独特性。移民患者通常有特殊的需求和愿望，并且护理人员感到难以解决或满足，因此患者的尊严可能会受到威胁。
方法
我们与护理人员进行了五次焦点小组讨论，另外还与荷兰具有不同种族背景的关键人物进行了讨论（2018–2020年）。使用主题分析进行文本处理。
结果
护理人员通过关注有关贴身身体护理的个人需求并提供非言语关注，创造性地维护了患者在日常护理中的尊严。当患者家属参与患者的选择或要求时，护理人员难以维护尊严。据护理人员说，在最后几天，家庭的干扰阻碍了患者的生活质量或威胁了患者的尊严，或者家庭成员的选择（貌似）胜过了患者的意愿。护理人员通过在生命的最后阶段适应文化或宗教习俗并在决策过程中运用文化知识来维护尊严。关键人物强调与患者和家人共同做出决定，并更仔细地倾听患者的意思。
结论
为了维护患者的尊严，除了患者的个人需求之外，还需要关注尊严与家庭需求之间的关系。
影响
应支持护理人员采用策略，例如承认移民家庭的价值观，为患者提供良好的照顾以及宗教习俗对尊严的重要性，来促进患者家庭的参与。
Abstract
Aims
To determine registered nurses' and care assistants' difficulties and strategies for preserving dignity of migrant patients in the last phase of life and their families.
Background
Preserving dignity of patients in a palliative phase entails paying attention to the uniqueness of patients. Migrant patients often have particular needs and wishes that care staff find difficult to address, or meet, and hence the patient's dignity might be at stake.
Methods
We performed five focus group discussions with care staff and one with key figures with diverse ethnic backgrounds in the Netherlands (2018–2020). Thematic analysis was used.
Results
Care staff creatively safeguarded the patient's dignity in daily care by attending to personal needs concerning intimate body care and providing non-verbal attention. Care staff had difficulties to preserve dignity, when the patient's family engaged themselves in the patient's choices or requests. According to care staff, the interference of family impeded the patient's quality of life or threatened the patient's dignity in the last days, or family member's choices (seemingly) prevailed over the patient's wishes. Care staff safeguarded dignity by catering to cultural or religious practices at the end of life and employing cultural knowledge during decision making. Key figures emphasized to make decisions with patient and family together and to listen more carefully to what patients mean. Bypassing family was experienced as harmful, and repetitively informing family, about, for example, the patient's disease or procedures in the nursing home, was experienced as ineffective.
Conclusion
To preserve the patient's dignity, attention is needed for relational aspects of dignity and needs of family, next to patients' individual needs.
Impact
Care staff should be supported to employ strategies to engage family of migrant patients, by, for example, acknowledging families' values, such as giving good care to the patient and the importance of religious practices for dignity.
原文链接：
https://onlinelibrary.wiley.com/doi/10.1111/jan.14829
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