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麻醉恢复室护士在推进直接麻醉后期间预立医疗指示的经历:现象学研究
Author(s) -
McKin Majella,
Donnelly Frank,
Perry Josephine
Publication year - 2020
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.14357
Subject(s) - confusion , paternalism , interpretative phenomenological analysis , psychology , nursing , distress , phenomenology (philosophy) , medicine , qualitative research , psychotherapist , social science , philosophy , epistemology , sociology , political science , psychoanalysis , law
Aims The aims of this study were to develop an understanding of the lived experience of the Post Anaesthetic Unit Recovery Nurse facilitating Advanced Directives and implications for patient‐centred care. Design Interpretive phenomenological analysis. Methods Homogenized purposive sampling of six Registered Nurses using in‐depth semi‐structured interviews. Interviews were conducted between June–July 2018. Analysis was performed using interpretive phenomenology analysis. Results Post Anaesthetic Recovery Nurses experienced a ‘Grey Zone’ when facilitating Advanced Directives postanaesthetic. The ‘Grey Zone’ is defined through four themes; The ‘Trigger’ of the anaesthetic characterized by physiological instability; ‘Confusion and Frustration’ featuring balancing of roles as a clinician and advocate during patient decline; ‘Consistent Paternalism’ by medical staff in the consideration of Advanced Directives; and ‘Disempowerment’ where nurses faced issues of advocacy, personal distress, a lack of literature or protocols, and handover of information. Conclusion The lived experience of nurses facilitating Advanced Directives postanaesthetic may be distressing. Further research is required to understand the implications of Advanced Directives following an anaesthetic. Education and development of protocols are recommended to optimize patient‐centred care. Impact Post Anaesthetic Unit Recovery Nurses experienced a ‘Grey Zone’ when facilitating Advanced Directives, defined through four themes. Advanced Directives may appear to be clear, however, the anaesthetic may trigger physiological instability leading to confusion and frustration in interpretation and application of Advanced Directives. Confusion and Frustration were experienced while the attitudes of Consistent Paternalism were encountered when advocating for patient wishes, resulting in Disempowerment. Post Anaesthetic Unit Recovery Nurses may become empowered through acknowledging and describing the ‘Grey Zone’.