PALYATİF BAKIM HASTALARI, YAKINLARI VE HEMŞİRELERİNİN İYİ ÖLÜME İLİŞKİN GÖRÜŞLERİ

Öz

Amaç: Bu araştırmanın amacı; palyatif bakım hastaları, hasta yakınları ve hemşirelerinin iyi ölüme ilişkin görüşlerini belirlemektir.
Yöntem: Araştırma, 01.07.2019-29.09.2019 tarihleri arasında Malatya il ve ilçe merkezlerinde bulunan Palyatif Bakım Kliniklerinde yapılmıştır. Araştırmanın örneklemini, çalışmaya katılmaya gönüllü olan 90 hasta, 90 hasta yakını ve 90 hemşire oluşturmuştur. Araştırmada veriler, literatürden yararlanılarak oluşturulan Hasta, Hasta Yakını, Hemşire Kişisel Bilgi Formu ve İyi Ölüm Ölçeği kullanılarak yüz yüze görüşme yöntemi ile toplanmıştır. İnönü Üniversitesi Sağlık Bilimleri Girişimsel Olmayan Klinik Araştırmalar ve Yayın Etik Kurulundan, Malatya il ve ilçe hastanelerinden, hastalar, hasta yakınları ve hemşirelerden yazılı izin alınmıştır.
Bulgular: Hemşirelerin %65.6’sının 29-35 yaş grubunda, %85.6’sının kadın, %55.6’sının bekâr, %56.6’sının lisans mezunu, %64.4’ünün ilde yaşadığı saptanmıştır. Hastaların %55.6’sının 29-35 yaş grubunda, %61.1’inin kadın, %71.1’inin evli, %76.7’sinin lise/ön lisans mezunu, %60.0’ının ilde yaşadığı belirlenmiştir. Hasta yakınlarının %53.3’ünün 22-28 yaş grubunda, %84.4’ünün kadın, %60.0’ının evli, %62.2’sinin lisans mezunu, %68.9’un ilde yaşadığı belirlenmiştir. Araştırmaya katılanların iyi ölüm tanımlarına bakıldığında; hastaların %46.7’sinin “ağrı ve stres olmadan hayatın sonlanması”, hasta yakınlarının %61.1’inin “aile bireyleriyle birlikte süreci paylaşmak”, hemşirelerin ise % 57.8’inin “acı çekmeden süreci yaşamak” olarak tanımladıkları saptanmıştır. İyi Ölüm Ölçeği puan ortalamalarına bakıldığında; hastaların puan ortalamasının (58.77±6.50), hasta yakınlarının puan ortalamasının (58.04±6.71) ve hemşirelerin puan ortalamasının (55.80±7.94) olduğu saptanmıştır.
Sonuç: Hastaların İyi Ölüm Ölçeği toplam puan ortalamasının hemşire ve hasta yakınından daha yüksek olduğu saptanmıştır.

Anahtar Kelimeler

• Bakıcılar
• Hastalar
• Hemşireler
• Ölüm
• Palyatif bakım

OPINIONS OF PALLIATIVE CARE PATIENTS, RELATIVES AND NURSES ON GOOD DEATH

Öz

Aim: The aim of this research; to state the opinions of palliative care patients, patient relatives and nurses on good death.
Methods: Research was carried out between 01.07.2019-29.09.2019 at Palliative Care Clinics in Malatya provincial and district centres. The sample of the research occurred 90 patients, 90 relatives and 90 nurses who volunteered to attend in the research. Data were gathered by face-to-face interviews using the Personal Information Form and Good Death Scale. Written permission was attained from Inonu University Health Sciences Non-Interventional Clinical Research and Publication Ethics Committee, Malatya provincial and district hospitals, patients, patient relatives and nurses.
Results: It was found that 65.6% of the nurses were in the 29-35 age groups, 85.6% were female, 55.6% were single, 56.6% were undergraduate graduates and 64.4% lived in the province. It was stated that 55.6% of the patients were in the 29-35 age group, 61.1% were women, 71.1% were married, 76.7% were high school / associate degree graduates and 60.0% lived in the province. It was stated that 53.3% of the patients' relatives were in the 22-28 age group, 84.4% were women, 60.0% were married, 62.2% were undergraduate graduates and 68.9% lived in the province. Looking at the definitions of good death of the participants; it was discovered that 46.7% of the patients defined “ending life without pain and stress”, 61.1% of the patients' relatives “shared the process with their family members”, and 57.8% of the nurses defined “experiencing the process without suffering”. When the mean point of Good Death Scale; the mean point of the patients (58.77 ± 6.50), the mean point of patients' relatives (58.04 ± 6.71) and the mean point of nurses (55.80 ± 7.94) was found to be.
Conclusion: It was stated that the mean total point of the good death scale of the patients was higher than the nurse and the patient's relatives.

Anahtar Kelimeler

• Caregivers
• Patients
• Nurses
• Death
• Palliative care

Kaynakça

1. 1. Wang L, Li C, Zhang Q, Li Y, Wang L. Clinical Nurses' Attitudes towards Death and Caring for Dying Patients in China. International Journal of Palliative Nursing 2018; 24(1): 33-9.
2. 2. Akyol DA. Son Dönem Böbrek Yetmezliği (SDBY) Olan Hastada Palyatif Bakım. Cumhuriyet Hemşirelik Dergisi 2013; 2(1):32-41.
3. 3. Gafaar TO, Pesambili M, Henke O, Vissoci JRN, Mmbaga BT, Staton C. Good Death: An Exploratory Study on Perceptions and Attitudes of Patients, Relatives, and Healthcare Providers, in Northern Tanzania. Plos One 2020; 15(7):6-9.
4. 4. Çevik B, Kav S. Attitudes and Experiences of Nurses towards Death and Caring for Dying Patients in Turkey. Cancer Nursing 2013; 36(6):58-65.
5. 5. Terkamo-Moisio A, Kvist T, Pietilä AM. Autonomy and Human Dignity Are Key Features of a Good Death in Finnish Nurses’ Conceptions. Journal of Hospice & Palliative Nursing 2016; 18(5):450-8.
6. 6. Leung KK, Tsai JS, Cheng SY, Liu WJ, Chiu TY, Wu CH, et al. Can a Good Death and Quality of Life Be Achieved for Patients With Terminal Cancer in a Palliative Care Unit? Journal of Palliative Medicine 2010; 13(12):1433–8.
7. 7. Bakanic V, Singleton M, Dickinson GE. Hospice Attitudes of Physicians and Nurses: A Pilot Study. American Journal of Hospice and Palliative Medicine 2016; 33(1):34-40.
8. 8. Braun M, Hasson-Ohayon I, Hales S, Zimmermann C, Rydall A, Peretz T, et al. Quality of Dying and Death with Cancer in Israel. Support Care Cancer 2014; 22 (7): 1973-80.

9. 9. Goris S, Tasci S, Ozkan B, Ceyhan O, Tekinsoy KP, Celiksoy A, et al. Effect of Terminal Patient Care Training on the Nurses’ Attitudes towards Death in an Oncology Hospital in Turkey. Journal of Cancer Education 2017; 32(1):65–71.
10. 10. Khader KA, Jarrah SS, Alasad J. Influence of Nurses' Characteristics and Education on Their Attitudes towards Death and Dying: A Review of Literature. International Journal of Nursing and Midwifery 2010; 2(1): 1-9.
11. 11. Schwartz CE, Mazor K, Rogers J, Yunsheng MA, Reed G. Validation of a New Measure of Concept of a Good Death. Journal of Palliative Medicine 2003; 6(4):575-84.
12. 12. Fadıloğlu Ç, Aksu T. İyi Ölüm Ölçeğinin Geçerlilik ve Güvenirliği. Ege Üniversitesi Hemşirelik Fakültesi Dergisi 2013;29(1): 1-15.
13. 13. Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In Search of a Good Death: Observations of Patients, Families, and Providers. Annals of Internal Medicine. 2000; 132(10): 825-32.
14. 14. Yun YH, Kim YN, Sim JA, Kan EK, Lee J, Choo J. Priorities of a ‘’Good Death’’ According to Cancer Patients, Their Family Caregivers, Physicians, and the General Population: A Nationwide Survey. Supportive Care in Cancer 2018; 26(10):3479-88.
15. 15. Rainsford S, Mac Leod RD, Glasgow NJ, Wilson DM, Phillips CB, Wiles RB. Rural End-of-Life Care from the Experiences and Perspectives of Patients and Family Caregivers: A Systematic Literature Review. Palliative Medicine 2017; 31(10):895-912.
16. 16. Davies A, Todd J, Bailey F, Gregory A, Waghorn M. Good Concordance between Patients and Their Non-Professional Carers about Factors Associated with a ‘Good Death’ and Other Important End-of-Life Decisions. BMJ Supportive & Palliative Care 2019; 9(3):340-5.
17. 17. Ceyhan O, Ozen B, Zincir H, Simsek N, Basaran M. How Intensive Care Nurses Perceive Good Death. Death Studies 2018; 42(10):667-72.
18. 18. Cipolletta S, Oprandi N. What Is a Good Death? Health Care Professionals’ Narrations on End-of-Life Care. Death Studies 2014; 38(1):20-7.
19. 19. Miyashita M, Kawakami S, Kato D, Yamashita H, Igaki H, Nakano K, et al. The Importance of Good Death Components among Cancer Patients, the General Population, Oncologists, and Oncology Nurses in Japan: Patients Prefer ‘’Fighting Against Cancer’’. Supportive Care in Cancer 2015; 23(1):103-10.
20. 20. Kastbom L, Milberg A, Karlsson M. A Good Death from the Perspective of Palliative Cancer Patients. Supportive Care in Cancer 2017; 25(3):933–9.
21. 21. Yıldızer ÖF, Oğur S. Sağlık Personellerin Palyatif Bakım Hakkındaki Bilgi ve Tutumları: Bitlis İli Örneği. Journal of Current Researches on Health Sector 2018; 8(2):411-38.
22. 22. Zheng R, Lee SF, Bloomer MJ. How New Graduate Nurses Experience Patient Death: A Systematic Review and Qualitative Metasynthesis. International Journal of Nursing Studies 2016; 53:320-30.
23. 23. Madenoğlu KM. Türkiye’de Palyatif Bakım Hizmetleri. Sağlık Bilimleri ve Meslekleri Dergisi 2017;4(2):132-5.
24. 24. İnci F, Öz F. Palyatif Bakım ve Ölüm Kaygısı. Psikiyatride Güncel Yaklaşımlar 2012; 4(2):178-87.
25. 25. Koku F, Ateş M. Terminal Dönem Hasta Bakımının Niteliğini Geliştirmede Hemşirelerin Ölüme İlişkin Deneyim ve Tutumları. Sağlık ve Hemşirelik Yönetimi Dergisi 2016; 3(2):99-104.
26. 26. Yao CA, Hu WY, Lai YF, Cheng SY, Chen CY, Chiu TY. Does Dying at Home Influence the Good Death of Terminal Cancer Patients? Journal of Pain and Symptom Management 2007; 34(5):497-504.
27. 27. Kinoshita H, Maeda I, Morita T, Miyashita M, Yamagishi A, Shirahige Y, et al. Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden. Journal of Clinical Oncology 2015; 33(4):357-63.
28. 28. Krikorian A, Maldonado C, Pastrana T. Patient's Perspectives on the Notion of a Good Death: A Systematic Review of the Literature. Journal of Pain and Symptom Management 2020; 59(1):152-64.
29. 29. Cavdar I. Care of the Cancer Patient in the Terminal Period. Turkish Journal of Oncology 2011; 26(3):142–7.
30. 30. Şahan UF, Terzioğlu F. Dünyada ve Türkiye’de Palyatif Bakım Eğitimi ve Örgütlenmesi. Cumhuriyet Hemşirelik Dergisi 2015; 4(2): 81-90.
31. 31. Sahin DS, Onal O, Inanc BB. Attitudes of Nurses Working Emergency and Intensive Care Units towards Good Death and Death Anxiety. Journal of Clinical and Analytical Medicine 2017; 8:75-9.
32. 32. Yılmaz E, Vermişli S. Yoğun Bakımda Çalışan Hemşirelerin Ölüme ve Ölmekte Olan Bireye Bakım Vermeye İlişkin Tutumları. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 2015;2(2):41- 6.
33. 33. Krishna LK, Alsuwaigh R, Miti PT, Wei SS, Ling KH, Manoharan D. The Influence of the Family in Conceptions of Person Hood in the Palliative Care Setting in Singapore and Its Influence upon Decision Making. American Journal of Hospice and Palliative Medicine 2014; 31(6):645–54.
34. 34. İlaslan E, Özer Z, Kol E. Kolorektal Kanserlerde Palyatif Bakım Hemşireliği. Hemşirelik Akademik Araştırma Dergisi, 2017;3(1):43-8.
35. 35. Scarre G. Can There Be a Good Death? Journal of Evaluation in Clinical Practice 2012; 18(5):1082-6.
36. 36. Cottrell L, Duggleby W. The ‘’Good Death’’: An Integrative Literature Review. Palliative & Supportive Care 2016; 14(6):686–712.
37. 37. Stajduhar KI, Funk L, Outcalt L. Family Caregiver Learning-How Family Caregivers Learn to Provide Care at the End of Life: A Qualitative Secondary Analysis of Four Datasets. Palliative Medicine 2013; 27(7):657–64.