Palyatif Bakım Hastaları ve Hemşirelerinin Gözünden İtibarlı Bakım

Year 2020, Volume: 1 Issue: 1, 1 - 18, 29.07.2020

Yasemin Eskigülek , Sultan Kav

Abstract

Amaç: İnsan onurunun korunması, sağlık hizmetinin gerekliliklerinden biridir. Bu çalışma palyatif bakım hastalarının ve bu alanda çalışan hemşirelerin itibarlı bakım hakkındaki görüşlerinin belirlenmesi amacıyla yürütülmüştür.
Gereç ve Yöntem: Nitel tipteki bu çalışma Haziran-Temmuz 2018 tarihleri arasında, Ankara’da iki üniversite hastanesinde palyatif bakım alan 10 hasta ve bu kliniklerde çalışan 10 hemşireyle gerçekleştirilmiştir. Veriler hasta ve hemşireler için farklı hazırlanmış demografik veri formu ve yarı yapılandırılmış görüşme formu ile toplanmıştır. Görüşmeler yüz yüze yapılmış ve ses kayıt cihazına kaydedilmiştir. Veriler deşifre edildikten sonra tema analizi yapılmıştır.
Bulgular: Hemşirelerle yapılan görüşmelerin analizinde saygınlığın sürdürülmesi, engeller ve çözüm önerileri, bakımın yararları; hasta görüşmelerinin analizinde ise saygınlık, bakım uygulamaları ve yararlılık olmak üzere 3 tema elde edilmiştir.
Sonuç: İtibarlı bakımın hastanın saygınlığını koruyan, kendini değerli ve güvende hissetmesine, bütüncül ve bireyselleştirilmiş bakım almasına olanak sağlayan bir süreç olduğu; itibarlı bakımı yaygınlaştırmak için bireysel eğitimin yanı sıra kurumsal politikalar oluşturulmasının önemli olduğu sonucuna ulaşılmıştır. 

Keywords

hemşirelik, itibar, itibarlı bakım, palyatif bakım, tema analizi

Supporting Institution

Başkent Üniverstesi

Project Number

KA17/280

Thanks

Nitel araştırma yöntemleri konusundaki eğitim desteğinden dolayı Prof. Dr. Veysel Sönmez’e, nitel veri analizindeki desteklerinden dolayı Doç. Dr. Ebru Akgün Çıtak’a, çalışmaya katılan hasta ve hemşirelere, çalışmanın yapılması için gerekli izinleri veren kurum yöneticilerine teşekkürlerimizi sunarız.

Looking at Dignified Care With The Eye of Palliative Care Patients And Nurses

Abstract

Aim: Preserving human dignity is one of the necessities of health care. This study was carried out to explore views of palliative care patients and nurses working in this field about dignified care.
Material and Methods: This qualitative study was conducted between June-July 2018 with ten patients receiving palliative care and ten nurses caring those patients in inpatient clinics of two university hospitals in Ankara. The data was collected with demographic form and semi-structured interview form prepared separately for patients and nurses. The interviews were conducted through face-to-face in-depth interviews and taped on the audio recorder. Thereafter the data was transcribed verbatim, thematic analysis was performed.
Results: Three themes were derived for each group. Themes derived from data of nurses were maintaining respectability, barriers and facilitators, benefits of care for nurses. Themes derived from patients were respectability, caring practices, and usefulness.
Conclusion: The results of the study showed that dignified care is a process preserving patient's dignity, allows one to feel valued and safe, and receive holistic and individualized care. It has been concluded that it is important to establish institutional policies as well as individual education to promote dignified care. 

Keywords

dignified care, dignity, nursing, palliative care, theme analysis

Project Number

KA17/280

References

• 1. World Health Organization [Internet]. Definition of palliative care, 2002. [Alıntılanma: 06 Haziran 2020] Erişim adresi: https://www.who.int/cancer/palliative/definition/en/
• 2. Clark D. From margins to centre: a review of the history of palliative care in cancer. The Lancet Oncology. 2007; 8(5):430-438.
• 3. Saunders C. The evolution of palliative care. Patient Education and Counseling. 2000; 41(1)7-13.
• 4. Kabalak AA, Öztürk H, Çağıl H. Yaşam sonu bakım organizasyonu: palyatif bakım. Yoğun bakım dergisi, 2013;11(2):56-70.
• 5. Connor SR, Sepulveda Bermedo MC (eds). Global atlas of palliative care at the end of life. Worldwide Palliative Care Alliance, 2014. [Alıntılanma: 06 Haziran 2020] Erişim adresi: http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf
• 6. Palliative care fact sheets. World Health Organization. [Internet] 2018. [Alıntılanma: 05 Haziran 2020] Erişim adresi: https://www.who.int/news-room/fact-sheets/detail/palliative-care
• 7. Çevik B, Kav S, Karaaslan Eşer A, Uğurlu Z, Erten B. Stigma perception among women with ovarian cancer: a qualitative study. Supportive Care in Cancer. 2019;27 (Suppl1):199-200.
• 8. Albert RH. End of life care: managing common symptoms. American Family Physician Journal. 2017;95(6):356-361.
• 9. Uysal N, Şenel G, Karaca Ş, Kadıoğulları N, Koçak N, Oğuz G. Palyatif bakım kliniğinde yatan hastalarda görülen semptomlar ve palyatif bakımın semptom kontrolüne etkisi. Ağrı. 2015;27(2):104-110.
• 10. Onyeka TC. Psychosocial issues in palliative care: a review of five cases. Indian J Palliat Care. 2010;16(3):123-128.
• 11. Steinberg MS. Cultural and religious aspects of palliative care. Int J Crit Illn Inj Sci. 2011;2(1):154-156.
• 12. Ek K, Sahlberg-Blom E, Andershed B. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease. Journal of advanced nursing. 2011;67(7):1480-1490.
• 13. McCaffrey N, Bradley S, Ratcliffe C, Currow, D. What aspects of quality of life are ımportant from palliative care patients’ perspectives? a systematic review of qualitative research. J Pain Symptom Manage. 2016;52(2):318-328.
• 14. van Gennip I, Pasman H, Oosterveld-Vlug M, Willems D, Onwuteaka-Philpsen B. How dementia affects personal dignity: a qualitative study on the perspective of ındividuals with mild to moderate dementia. The Journals of Gerontology Series B. 2016; 71(3):491-501.
• 15. Madan, T. Dying with dignity. Soc Sci Med. 1992;35(4):425-432.
• 16. Chochinov HM. Dignity-Conserving Care—A new model for palliative care: helping the patient feel valued. JAMA, 2002;287(17):2253-2260.
• 17. della Mirandola G. Oration of dignity of man, 1492 [Alıntılanma: 02 Temmuz 2018] Erişim adresi: https://ebooks.adelaide.edu.au/p/pico_della_mirandola/giovanni/dignity/
• 18. Rachels, J. Kantian theory: the idea of human dignity. the elements of moral philosophy. Random House Inc, 1986
• 19. Meyer M. Kant's concept of dignity and modern political thought. History of European Ideas. 1987;8(3):319-332.
• 20. Kadivar M, Mardani-Hamooleh M, Kouhnavard M. Concept analysis of human dignity in patient care: Rodgers' evolutionary approach. J Med Ethics Hist Med, 2018;11(4).
• 21. Coventry M. Care with dignity: a concept analysis. JGerontol Nurse, 2006;32(5):42-48.
• 22. Kinnear D, Williams V, Victor C. The meaning of dignified care: an exploration of health and social care professionals’ perspectives working with older people. BMC research notes, 2014;7(854).
• 23. Chochinov H. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007;335(7612):184-187.
• 24. Murata H. Spiritual pain and its care in patients with terminal cancer: construction of a conceptual framework by philosophical approach. Palliat Support Care, 2003;1(1):15-21.
• 25. Burhans L, Alliegood M. Quality nursing care in the words of nurses. Journal of advanced nursing, 2010;66(8):1689-1697.
• 26. International Council of Nurses. The ICN code of ethics for nurses, Geneva, 2012. ISBN: 978-92-95094-95-6.
• 27. World Health Organization. A declaration on the promotion of patients' rights in Europe. 1994 [Alıntılanma: 05Haziran2020] Erişim adresi: https://www.who.int/genomics/public/eu_declaration1994.pdf
• 28. Healthcare Denmark. New Danish initiative to strengthen elderly care. [Internet] 2017 [Alıntılanma: 05 Haziran 2020.] Erişim adresi: https://www.healthcaredenmark.dk/news/new-danish-initiative-to-strengthen-elderly-care.aspx
• 29. National Dignity Council. Dignity in care. [Internet] 2006 [Alıntılanma: 05 Haziran 2020] Erişim adresi: https://www.dignityincare.org.uk/About/National_Dignity_Council/
• 30. Health Council of Canada. Empathy, dignity, and respect: creating cultural safety for Aboriginal people in urban healthcare. 2012[Alıntılanma: 05 Haziran 2020] Erişim adresi: https://healthcouncilcanada.ca/files/Aboriginal_Report_EN_web_final.pdf
• 31. South Australia Health. Government of South Australia: Dignity in care. [Internet] 2011. [Alıntılanma:05Haziran2020] Erişim adresi: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/safety+and+wellbeing/dignity+in+care/dignity+in+care
• 32. National Dignity Council. dignityincare. [Internet] 2010. [Alıntılanma: 05 Haziran 2020.] Erişim tarihi: https://www.dignityincare.org.uk/Dignity-Champions/
• 33. Baillie L. Patient dignity in an acute hospital setting: a case study. International Journal of Nursing Studies, 2009;46(1):23-26.
• 34. Walsh K, Kowanko L. Nurses’ and patients’ perceptions of dignity. International Journal of Nursing Practice, 2002;8(3):143-151.
• 35. Henderson A, Van Eps M, Pearson K, James C, Henderson P, Osborne Y. Maintainance of patients' dignity during hospitalization: comparison of staff–patient observations and patient feedback through interviews. International Journal of Nursing Practice, 2009;15(4):227-230.
• 36. Matiti M, Trorey G. Patients’ expectations of the maintenance of their dignity. Journal of Clinical Nursing, 2008;17(20):2709-2717.
• 37. Chochinov HM. Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer JClin, 2006;56(2):84-103.
• 38. Türnüklü A. Eğitimbilim araştırmalarında etkin olarak kullanılabilecek nitel bir araştırma tekniği: görüşme. Kuram ve Uygulamada Eğitim Yönetimi, 2000;6(4):543-559.
• 39. Anderson F, Downing G, Hill J. Palliative performance scale (PPS): a new tool. J Palliat Care, 1996;12(1):5-11.
• 40. SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago.
• 41. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology, 2006;3(2):77-101.
• 42. Berglund M, Westin L, Svanström R, Sundler, A. Suffering caused by care—Patients’ experiences from hospital settings. Int J Qual Stud Health Well-being, 2012;7:1-9.
• 43. Tallo D. Patients are people with names, not a bed number or an ailment. Nurs Stand, 2015;29(41):33.
• 44. Kinnear D, Victor C,Williams V. What facilitates the delivery of dignified care to older people? A survey of health care professionals. BMC Res Notes, 2015;8(826).
• 45. Enes SPD. An exploration of dignity in palliative care. Palliative Medicine, 2003;17(3):263-269.
• 46. Williams V, Kinnear D, Victor C. 'It's the little things that count': healthcare professionals' views on delivering dignified care: a qualitative study. J Adv Nurs, 2016;72(4);782-790.
• 47. Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. International Journal of Nursing Studies. 2020;108.
• 48. Chochinov H, Hack T, McClement S, Kristjanson L, Harlos M. Dignity in the terminally ill: a developing empirical model. Social Science & Medicine, 2002;54(3):433-443.
• 49. Östlund U, Blomberg K, Söderman A, Werkander Harstäde C. How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliat Care, 2019;18(10).
• 50. Bylund-Grenklo T, Werkander-Harstäde C, Sandgren A, Benzein E, Östlund U. Dignity in life and care: the perspectives of Swedish patients in a palliative care context. International Journal of Palliative Nursing, 2019;25(4):193-201.
• 51. Johnston B, Larkin P, Connoly M, Barry C, Narayanasamy M, Östlund U, McIlfatrick S. Dignity-conserving care in palliative care settings: An integrative review. J Clin Nurs, 2015;24(13-14):1743-1772.
• 52. Aydın Er R, İncedere A, Öztürk S. Respectful care of human dignity: how is it perceived by patients and nurses? J Med Ethics. 2018;44(10):675‐680. doi:10.1136/medethics-2017-104666