Dilemmas and Coping Methods for Nurses Providing Terminal Care to Cancer Patients Moved to a General Ward After the ‘Gear Change’

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  • ギアチェンジ後に一般病棟に転院したがん患者のターミナルケアを行う看護師のジレンマと対処方法
  • ギアチェンジ ゴ ニ イッパン ビョウトウ ニ テンイン シタ ガン カンジャ ノ ターミナルケア オ オコナウ カンゴシ ノ ジレンマ ト タイショ ホウホウ

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Abstract

<p>Abstract</p><p>The study objective was to determine dilemmas of nurses when providing terminal care to cancer patients who had been moved to a general ward after the so-called ‘gear change’（switch from positive treatment to mainly palliative care）and methods used for coping with such situations. We conducted semi-structured interviews with 11 nurses providing terminal care to cancer patients transferred to a general ward from university hospital after the gear change, and analyzed the results.</p><p>Six categories were extracted from dilemmas of the nurse. These categories included items such as “there are differences in the perception of the gear change between the medical staff and patients” and “we cannot tell the truth to some patients despite their ability to understand, because their families request that we not tell them.” Seven categories were extracted from the nurses’ methods for coping with these dilemmas. These categories included items such as “coping with their own feelings through consultation and interaction”, “coping with their own feelings by forgetting or giving up”, and “adjusting the situation so that care is given as a team”.</p><p>This study revealed that nurses providing terminal care to cancer patients who had been moved to a general ward after the gear change experienced dilemmas when there was a gap in perception of the gear change between medical staff and patients. We found that the dilemmas of these nurses arose because the patients, their families, and medical staff did not share a common goal during the terminal period. Psychological fluctuations of patients and their families due to insufficient perception of their present conditions may underlie this situation. We conclude that in order to cope with these dilemmas, nurses need to coordinate work to facilitate information sharing among patients, doctors and nurses, and support patients in making autonomous efforts to palliate symptoms.</p>

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