Hemşirelik Öğrencileri Terminal Dönemindeki Çocuk Hastanın Bakımı Hakkında Ne Düşünüyor? Odak Grup Çalışması

Öz

Amaç: Hemşirelik öğrencileri terminal dönemde bakım ihtiyacı olan birçok hasta ile karşılaşmaktadır. Bu araştırma, intörn hemşirelerin terminal dönemde olan çocuğa verilen palyatif bakım ile ilgili görüşlerinin belirlenmesi amacıyla yapılmıştır. Yöntem: Çalışma nitel araştırma yöntemlerinden odak grup görüşmesi yapılarak 2017 yılında gerçekleştirilmiştir. Araştırmanın evreninin Türkiye’de bir üniversitesinin Hemşirelik Fakültesinde eğitim gören intörn hemşireler oluşturmaktadır. Araştırmada niteliksel araştırmalarda kullanılan örneklem seçme yöntemlerinden biri olan amaçlı örneklem kullanılmıştır. Hemşirelik öğrencisinin en az bir hastaya palyatif bakım vermesi ya da bir hastanın ölümüne tanıklık etmesi dahil edilme kriterini oluşturmaktadır. Odak grup görüşmesi, belirlenen kriterlere uygun bulunan on iki katılımcı ile Hemşirelik Fakültesinin toplantı odasında, katılımcıların uygun olduğu gün ve saatte bir moderatör ve moderatör yardımcısı, iki raportör olmak üzere dört araştırmacıyla yapılmıştır. İntörn hemşirelere sorulmak üzere araştırmacıların deneyimleri ve akademik bilgilerinden faydalanılarak yarı yapılandırılmış soru formu hazırlanmıştır. Bu sorular doğrultusunda görüşmeler ses kayıt cihazı ile kaydedilmiş ayrıca görüşme sırasında rapor tutulmuştur. Verilerin içerik analizi yapılmıştır. Bulgular: Ölüme hazırlık, öz bakım, çocuk ve ailesinin bakım gereksinimlerinin karşılanması olmak üzere üç ana tema belirlenmiştir. Çalışmada hemşirelik öğrencilerinin, çocuk hastanın ve ailesinin terminal dönemde hastalık ve tedavi süreci ile ilgili bilgilendirilmesi gerektiği, semptom yönetimi ve öz bakım ihtiyaçlarının en iyi şekilde sağlanması, emosyonel destek verilmesi gerektiğini düşündükleri belirlenmiştir. Hemşirelik öğrencilerinin terminal dönemdeki çocuk hastanın bakım ortamı hakkında farklı düşüncelere sahip olduğu, çocuğun istediği ortamın ev veya hastane ortamı olabileceğini düşündükleri belirlenmiştir. Terminal dönemde olan çocuk hastaya bakım veren hemşirelik öğrencilerinin korku, tedirginlik, çaresizlik, şok, duygusal yıpranma, hissizlik, inkâr ve üzüntü gibi birçok duyguyu yaşadıkları ve bu duygularla nasıl başa çıkmaları gerektiğini bilmedikleri belirlenmiştir. Sonuç ve Öneriler: Hemşirelik eğitim öğretim sürecine terminal dönemdeki çocuğa bakım ve ölüme hazırlık ile ilgili eğitim programları eklenmelidir. Terminal dönemdeki çocuğa bakım veren hemşirelik öğrencilerinin duygularını ifade etmelerine olanak sağlamak için bireysel görüşmeler veya grup toplantıları düzenlenmelidir.

Anahtar Kelimeler

• Terminal dönem
• Palyatif bakım
• Hemşirelik öğrencisi
• Klinik uygulama
• Odak grup görüşmesi

WHAT DO UNDERGRADUATE STUDENT NURSES THINK ABOUT THE CHILD PATIENT IN THE TERMINAL PERIOD? FOCUS GROUP STUDY

Öz

Aim: Nursing students face many patients who require palliative care in the terminal period. This study aims to determine the student nurses' experiences with the palliative care provided to children in the terminal period. Method: The study was conducted using focus group interviews, which are qualitative research methods. The sample was constituted of 12 intern student nurses who were working in the pediatric hospital of the university in 2017 in Turkey. The research inclusion criteria for students were that they must have provided palliative care or seen death. The focus group interview was held in the meeting room at the Nursing School on the day and hour when the nurses were available with four researchers. Data were analyzed together by using conventional content analysis. Results: Three main themes were determined (Preparing for death, self-care, and meeting the demands of the child and the family). It was found that nursing students providing care to pediatric patients in the terminal period experience many feelings including fear, nervousness, helplessness, shock, emotional deterioration, etc. and they do not know how to deal with these emotions. These students believe that symptom management and self-care requirements should be managed in the best way and that emotional support should be provided. The students pointed out the families' information needs and emotional support needs. They also emphasized the emotional effects associated with themself. Conclusions and Suggestions: Educational programs related to care for the child in the terminal period and preparation for death should be added to the nursing education and training process. Organize individual and group meetings to provide nursing students opportunities to express their feelings regarding the care and death of the child in the terminal period.

Anahtar Kelimeler

• end of life care
• nursin student
• practicum
• Focus group interview
• Terminal dönem
• Palyatif bakım
• Hemşirelik öğrencisi
• Klinik uygulama
• Odak grup görüşmesi

Kaynakça

1. Akdeniz, K. A., & Bektas, M. (2019) The effect of web-based pediatric palliative care education on the palliative care knowledge level and practices of nursing students. Perspectives in Psychiatric Care, 1-8. DOI: 10.1111/ppc.12463
2. Akgün, K. M., & Akan, M. (2011) Pediatric palliative care. Journal of Turk Oncology, 26(4): 182–92. (Orginal work published in Turkish). doi: 10.5505/tjoncol.2011.439
3. Araujo Sadala, M. L., & Machado da Silva, F. (2009) Taking care of terminal patients: nursing students’ perspective. Revista da Escola de Enfermagemda USP, 43(2): 287–94. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=19655667. https://doi.org/10.1590/S0080-62342009000200005
4. Ay, F., & Gençtürk, N. (2013) Midwifery Student’s Opinions Related to Death, Terminal Period and Palliative Care: Focus Group Study. Florence Nightingale Journal of Nursing, 164–71. Available from: http://dergipark.ulakbim.gov.tr/iufnhy/article/view/1023019789. (Orginal work published in Turkish).
5. Bassah, N., Seymour, J., & Cox, K. A. (2014) Modified systematic review of research evidence about education for pre-registration nurses in palliative care. BMC Palliative Care, 3(1): 56. Available from: http://bmcpalliatcare.biomedcentral.com/articles/10.1186/1472-684X-13-56.
6. Bassah, N., Cox, K., & Seymour, J. A., (2016) Qualitative evaluation of the impact of a palliative care course on preregistration nursing students’ practice in Cameroon. BMC Palliative Care, 15(1): 37. Available from: http://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-016-0106-7.
7. Birol, L. (2004) Patient Care in The Terminal Period; Internal Medicine Nursing Care. Eds. Akdemir N, Birol L (2th Ed), Sistem Ofset, Ankara. (Orginal work published in Turkish).
8. Cavaye, J., & Watts, J. H. (2014) An Integrated literature review of death education in pre-registration nursing curricula: key themes. International Journal of Palliative Care, 1–19. Available from: http://www.hindawi.com/journals/ijpc/2014/564619/.

9. Cavaye, J., & Watts, J. H. (2014) Student nurses learning about death, dying, and loss: too little, too late? Illness, Cris & Loss, 22(4): 293–310. Available from: https://journals.sagepub.com/doi/pdf/10.2190/IL.22.4.cChesser-Smyth, P. A. (2005) The lived experiences of general student nurses on their first clinical placement: A phenomenological study. Nurse Education Practise, 5(6):320–7.
10. Cernigoy, E. (2014) Novice nurses’experiences providing palliative care for children and their families. MSc Thesis. Trinity Western University. https://www.twu.ca/sites/default/files/cernigoy_e_a.pdf
11. Charalambous, A., & Kaite, C. (2013) Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences. BMC Health Services Research, 13: 63.
12. Çelik, H., Baykal, N. B., & Memur, H. N. K. (2020). Qualitative data analysis and fundamental principles. Journal of Qualitative Research in Education, 8(1), 379-406.
13. Dahlin, C. (2015) Palliative care: delivering comprehensive oncology nursing care. Seminars Oncology Nursing, 31(4): 327–37. Available from: http://dx.doi.org/10.1016/j.soncn.2015.08.008.
14. Das, K., Khanna, T., Arora, A., & Agrawal, N. (2020) Parents’ acceptance and regret about end-of-life care for children who died due to malignancy. Supportive Care in Cancer, 28(1), 303-308.
15. Dickinson, G. E, Clark, D., & Sque, M. (2008) Palliative care and end of life issues in pre-registration , undergraduate nursing programm es. Nurse Education Today, 28(2): 163–70. DOI:10.1016/j.nedt.2007.03.008.
16. Edo-Gual, M., Tomás-Sábado, J., Bardallo-Porras, D.,& Monforte-Royo, C. (2014) The impact of death and dying on nursing students: An explanatory model. Journal of Clinical Nursing, 23(23–24): 3501–12.
17. Ek, K., Westin, L., Prahl, C., Österlind, J., Strang, S., Bergh, I., et al. (2014) Death and caring for dying patients: exploring first-year nursing students’ descriptive experiences. International Journal of Palliative Nursing, 20(10): 509–15. Available from: http://www.magonlinelibrary.com/doi/abs/10.12968/ijpn.2014.20.10.509.
18. Ferrell, B., Malloy, P., Mazanec, P., & Virani, R. (2016) Cares: AACN’s new competencies and recommendations for educating undergraduate nursing students to ımprove palliative care. Journal of Professional Nursing, 32(5): 327–33.
19. Foster, T. L., Lafond, D. A., Reggio, C., & Hinds, P. S. (2010) Pediatric palliative care in childhood cancer nursing: from diagnosis to cure or end of life. Seminars in Oncology Nursing, 26(4): 205–21.
20. Gallagher, O., Saunders, R., Tambree, K., Alliex, S., & Monterosso, L. (2014) Nursing student experiences of death and dying during a palliative care clinical placement: teaching and learning implications. Teaching and Learning Forum, 1–12. Available from: http://researchonline.nd.edu.au/nursing_conference%5Cnhttp://researchonline.nd.edu.au/nursing_conference/54.
21. Harputluoğlu, N., & Çelik, T. (2020) Pediatric palliative care. Journal of Dr. Behcet Uz Children's Hospital, 10(1).
22. Kent, B., Anderson, N. E., & Owens, R. G. (2012) Nurses’ early experiences with patient death: The results of an on-line survey of registered nurses in New Zealand. International Journal of Nursing Studies, 49(10): 1255–65. Available from: http://dx.doi.org/10.1016/j.ijnurstu.2012.04.005.
23. Kostak, M. A., & Akan. M. (2011) Palliative care for children in terminal period. Turkish Journal of Oncology, 26(4), 182-192.
24. Li, J., Smothers, A., Fang, W., & Borland, M. (2019) Undergraduate nursing students’ perception of end-of-life care education placement in the nursing curriculum. Journal of Hospice & Palliative Nursing, 21(5): 12-18.
25. Malloy, P., Ferrell, B., Virani, R., Wilson, K., & Uman, G. (2006) Palliative care education for pediatric nurses. Pediatric Nursing, 32(6): 555–61.
26. Mirlashari, J., Warnock, F., Jahanbani, J. (2017) The experiences of undergraduate nursing students and self-reflective accounts of first clinical rotation in pediatric oncology. Nurse Education in Practice, 25: 22-28.
27. Morelhão, P. K., de Oliveira Iglesias, S. B., Tufik, S., Andersen, M. L., & Andersen, M. L. (2019) The importance of palliative care for children with terminal disease and the need to consider the role of sleep disturbances within this contexto. Residencia Pediatrica, 3:35.
28. Nakazawa, Y., Kato, M., Miyashita, M., Morita, T., & Kizawa, Y. (2018) Changes in nurses' knowledge, difficulties, and self-reported prac-tices toward palliative care for cancer patients in Japan: An analy-sis of two nationwide representative surveys in 2008 and 2015. Journal of Pain & Symptom Management, 55: 402–412. https://doi.org/10.1016/j.jpainsymman.2017.08.034.
29. Parry, M. (2011) Student nurses’ experience of their first death in clinical practice. Int Journal of Palliative Nursing, 17(9): 446- 51.
30. Peykerli, G. (2003) Psychological approach to deadly diseases. Journal of Cumhuriyet University Medicine Faculty, 25(4): 62-65. (Original Work Published in Turkish). http://eskidergi.cumhuriyet.edu.tr/makale/492.pdf
31. Ranallo, L. (2017) Improving the quality of end-of-life care in pediatric oncology patients through the early implementation of palliative care. Journal of Pediatric Oncology Nursing, 34(6), 374-380.
32. Siden, H., Miller, M., Straatman, L., & Omesi, L. (2008) A report on location of death in paediatric palliative care between home, hospice and hospital. Palliative Medicine, 22: 831–834.
33. Stayer, D. (2012) Pediatric palliative care: a conceptual analysis for pediatric nursing practice. Journal of Pediatric Nursing, 27, 350–35.
34. Taplak, A. S., Gürol, A., & Polat, S. (2020) Nurses' perceptions of the palliative care needs of neonates with multiple congenital anomalies. Journal of Hospice & Palliative Nursing, 22(2), 137-144.
35. Thrane, S.E. (2020) Online palliative and end-of-life care education for undergraduate nurses. Journal of Professional Nursing, 36(1): 42-46.
36. Ünver, S., Kızılcık, Ö. Z, & Gi̇rgi̇n, B. N. (2021) The palliative care difficulty levels of the nursing students during clinical practices. Perspectives in Psychiatric Care, 57(3), 1466-1473.
37. Wang, Y. (2019) End-of-life simulation improve nursing undergraduates' self-efficacy in palliative care. In Proceedings of the 2019 3rd International Conference on Education and Multimedia Technology, 179-183. https://doi.org/10.1145/3345120.3345123
38. Wong, F. K. Y., & Lee, W. N. (2000) A phenomenological study of early nursing experiences in Hong Kong. Journal of Advanced Nursing, 31(6): 1509- 1517. Doi:10.1046/j.1365-2648.2000.01433.x.
39. Yılmaz, M., & Türkleş, S. (2018) Anger, Loneliness and Delirium Management in the Terminally Ill Children. Cimete G, editor. Palliative Care in Children; Approach to the Child and Family in the Terminal Period.1st edition. Ankara: Turkiye Klinikleri J, sp, 72-8.
40. Yorulmaz, D. S., & Karadeniz, H. (2020) Nursing care in terminal period and good death. Journal of Intensive Care Nursing, 24(2), 134-138. https://dergipark.org.tr/tr/download/article-file/1122372.