NICU护士安宁疗护核心能力要素的质性研究

doi:10.3761/j.issn.2096-7446.2025.10.007

摘要/Abstract

摘要：

目的探讨并分析新生儿重症监护室（neonatal intensive care unit，NICU）护士安宁疗护核心能力要素，为护理管理者对其开展安宁疗护教育和培训提供有价值的参考。方法采用质性研究的方法，于2024年2月—5月，对来自浙江省、江苏省、湖南省3所三级甲等儿童医院的15名医护人员、社工及志愿者进行半结构式访谈，采用Colaizzi七步分析法对访谈内容进行整理并分析。结果 NICU护士安宁疗护核心能力归纳为7个主题：综合评估能力、症状管理能力、心理-精神支持能力、社会支持能力、沟通与合作能力、自我调节与自主学习能力、恪守道德与伦理。结论 NICU护士在提供安宁疗护时应该具备多方面的能力，其综合评估能力是实施安宁疗护的前提，症状管理能力是提高临终新生儿生存质量的核心，心理-精神支持能力和社会支持能力是给予家属哀伤辅导的关键，沟通与合作能力是解决临终新生儿及家属问题的方法，自我调节与自主学习能力是保持自身情绪稳定的根本，恪守道德与伦理是处理冲突的依据。

关键词: 重症监护病房, 新生儿, 护士, 安宁疗护, 核心能力, 质性研究

Abstract:

Objective To explore and analyze the core competence elements of palliative care among nurses in neonatal intensive care unit（NICU），aiming to provide a valuable reference for nursing administrators to conduct education and training in palliative care. Methods A qualitative research method was adopted，involving semi-structured interviews with a total of 15 medical staff，social workers，and volunteers from three tertiary class A children’s hospitals in Zhejiang，Jiangsu，and Hunan provinces from February to May 2024. The interview contents were sorted out and analyzed by using Colaizzi’s method. Results The core competence of NICU nurses in palliative care could be summarized into 7 themes：comprehensive assessment ability，symptom management ability，psycho-spiritual support ability，social support ability，communication and cooperation ability，self-regulation and self-learning ability，and moral and ethical adherence. Conclusion NICU nurses should have various abilities when providing palliative care. Comprehensive assessment ability is the prerequisite for implementing palliative care，symptom management ability is the core of improving the quality of life for terminally ill newborns，psycho-spiritual support ability and social support ability are crucial for offering bereavement support to bereaved families，communication and cooperation ability is the method to solve the problems for terminally ill newborns and their families，self-regulation and self-learning ability is fundamental to maintaining self emotional stability，and moral and ethical adherence is the basis for handling conflicts.

Key words: Intensive Care Units, Neonatal, Nurses, Palliative Care, Core Competence, Qualitative Research

许亚杰, 罗飞翔, 陈晓飞, 程晓英, 孟思佳, 陈朔晖. NICU护士安宁疗护核心能力要素的质性研究[J]. 中华急危重症护理杂志, 2025, 6(10): 1195-1200.

XU Yajie, LUO Feixiang, CHEN Xiaofei, CHENG Xiaoying, MENG Sijia, CHEN Shuohui. The core competence elements of palliative care among nurses in neonatal intensive care unit：a qualitative study[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(10): 1195-1200.

图/表 1

参考文献 25

[1]	Lu XL, Wu QL, Liu X, et al. Research progress on causes of neonatal death in China[J]. Minerva Pediatr, 2022, 74(3):380-382. doi: 10.23736/S2724-5276.22.06812-4 pmid: 35142458
[2]	国家统计局. 2023年《中国儿童发展纲要(2021—2030年)》统计监测报告[EB/OL]. (2025-01-24)[2025-02-18]. https://www.stats.gov.cn/sj/zxfb/202501/t20250124_1958440.html.
	National Bureau of Statistics. Statistical monitoring report on the “China children’s development program(2021-2030)” in 2023[EB/OL]. (2025-01-24)[2025-02-18]. https://www.stats.gov.cn/sj/zxfb/202501/t20250124_1958440.html.
[3]	刘颖, 赵敏慧. 对围产期丧失胎儿或新生儿家庭进行悲伤支持的研究进展[J]. 中华护理杂志, 2019, 54(1):125-130.
	Liu Y, Zhao MH. Research progress on grief support for families of perinatal fetus or newborn[J]. Chin J Nurs, 2019, 54(1):125-130.
[4]	赵咪, 王蒙蒙, 刘辉, 等. 安宁疗护护士胜任力要素的系统综述[J]. 医学与哲学, 2021, 42(1):34-39.
	Zhao M, Wang MM, Liu H, et al. The competencies of nurses in hospice care:a systematic review[J]. Med Philos, 2021, 42(1):34-39.
[5]	韩鸽鸽, 陈长英, 史岩, 等. 国外安宁疗护护士核心能力研究及培训现状对我国的启示[J]. 中国护理管理, 2019, 19(5):796-800.
	Han GG, Chen CY, Shi Y, et al. The enlightement of current research on the core competence and training of foreign hos-pice nurses to China[J]. Chin Nurs Manag, 2019, 19(5):796-800.
[6]	赵艺媛, 陆宇晗, 王云, 等. 安宁疗护高级实践护士核心能力指标体系的构建[J]. 中国护理管理, 2021, 21(2):268-273.
	Zhao YY, Lu YH, Wang Y, et al. The research in core competencies of Hospice Advanced Practice Nurse[J]. Chin Nurs Manag, 2021, 21(2):268-273.
[7]	Gorman LM. Hospice and palliative nursing competencies published[J]. Home Healthc Nurse, 2001, 19(9):585.
[8]	Colaizzi PF. Psychological research as the phenomenologist views it[M]. New York: Oxford University Press,1978:48-71.
[9]	江苏省新生儿科医疗质量控制中心. 新生儿重症监护病房医护人员对新生儿疼痛评估和镇痛管理的认知现状调查[J]. 中国当代儿科杂志, 2021, 23(12):1271-1275.
	Jiangsu Neonatology Medical Quality Control Center. An investigation on the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit[J]. Chin J Contemp Pediatr, 2021, 23(12):1271-1275. doi: 10.7499/j.issn.1008-8830.2107116 pmid: 34911612
[10]	韦双双, 游雪梅, 杨莉洁, 等. 临终患儿父母哀伤辅导的证据总结[J]. 中华护理杂志, 2024, 59(5):540-546. doi: 10.3761/j.issn.0254-1769.2024.05.004
	Wei SS, You XM, Yang LJ, et al. Summary of evidence on bereavement support for parents of terminally ill children[J]. Chin J Nurs, 2024, 59(5):540-546. doi: 10.3761/j.issn.0254-1769.2024.05.004
[11]	Haug S, Farooqi S, Wilson CG, et al. Survey on neonatal end-of-life comfort care guidelines across America[J]. J Pain Symptom Manage, 2018, 55(3):979-984.e2.
[12]	李梦婷, 陈朔晖, 陈晓飞, 等. 医护人员对新生儿安宁疗护感受和经验的质性研究[J]. 中华护理杂志, 2022, 57(8):908-913. doi: 10.3761/j.issn.0254-1769.2022.08.002
	Li MT, Chen SH, Chen XF, et al. Qualitative research on the feeling and experience of medical staff on neonatal hospice care[J]. Chin J Nurs, 2022, 57(8):908-913. doi: 10.3761/j.issn.0254-1769.2022.08.002
[13]	王慧艳, 杨家鸣, 李佳欣, 等. 新生儿科医护人员疼痛管理认知现状及差异研究[J]. 护理管理杂志, 2023, 23(2):105-108, 122.
	Wang HY, Yang JM, Li JX, et al. Research on cognition status and difference of pain management among medical staff in department of neonatology[J]. J Nurs Adm, 2023, 23(2):105-108,122.
[14]	Donovan LA, Wakefield CE, Russell V, et al. Hospital-based bereavement services following the death of a child:a mixed study review[J]. Palliat Med, 2015, 29(3):193-210. doi: 10.1177/0269216314556851 pmid: 25395578
[15]	李琳玉, 孙畅, 陈晓飞, 等. 新生儿重症监护室护士对死亡态度与安宁疗护教育需求的相关性分析[J]. 中华急危重症护理杂志, 2022, 3(5):431-436.
	Li LY, Sun C, Chen XF, et al. Correlation analysis between death attitude and hospice education needs of the nurses in neonatal intensive care unit[J]. Chin J Emerg Crit Care Nurs, 2022, 3(5):431-436.
[16]	Silva IN, Salim NR, Szylit R, et al. Knowing nursing team care practices in relation to newborns in end-of-life situations[J]. Escola Anna Nery, 2017, 21(4):46-56.
[17]	颜新凌, 马小琴, 黄瑞盈. 新生儿重症监护室护士参与新生儿安宁疗护看法和认知的Meta整合[J]. 军事护理, 2024, 41(7):101-104.
	Yan XL, Ma XQ, Huang RY. NICU nurses’ views and cognition of participating in neonatal palliative care:a qualitative meta-synthesis[J]. Mil Nurs, 2024, 41(7):101-104.
[18]	Imhof L, Kipfer S, Waldboth V. Nurse-led palliative care services facilitate an interdisciplinary network of care[J]. Int J Palliat Nurs, 2016, 22(8):404-410. doi: 10.12968/ijpn.2016.22.8.404 pmid: 27568780
[19]	Montgomery KE, Sawin KJ, Hendricks-Ferguson V. Communication during palliative care and end of life:perceptions of experienced pediatric oncology nurses[J]. Cancer Nurs, 2017, 40(2):E47-E57.
[20]	Peng NH, Chen CH, Huang LC, et al. The educational needs of neonatal nurses regarding neonatal palliative care[J]. Nurse Educ Today, 2013, 33(12):1506-1510.
[21]	Kitao M, Setou N, Yamamoto A, et al. Associated factors of psychological distress among Japanese NICU nurses in supporting bereaved families who have lost children[J]. Kobe J Med Sci, 2018, 64(1):E11-E19.
[22]	赵浩梅, 汪张毅, 闫伟, 等. NICU护士新生儿安宁疗护态度现状及影响因素分析[J]. 中国实用护理杂志, 2022, 38(18):1383-1389.
	Zhao HM, Wang ZY, Yan W, et al. A study on the status quo and influencing factors of neonatal palliative care attitude among NICU nurses[J]. Chin J Pract Nurs, 2022, 38(18):1383-1389.
[23]	朱佳楠, 张欣, 林敏, 等. 新生儿重症监护室护士经历道德困扰体验的现象学研究[J]. 护理学杂志, 2019, 34(15):14-17.
	Zhu JN, Zhang X, Lin M, et al. A phenomenological study on moral distress experience of nurses working in neonatal intensive care unit[J]. J Nurs Sci, 2019, 34(15):14-17.
[24]	施敏. 安宁疗护中医患双方认识误区的探讨[J]. 医学与哲学, 2022, 43(12):49-52.
	Shi M. Discussion on misunderstanding between doctors and patients in palliative care[J]. Med Philos, 2022, 43(12):49-52.
[25]	张婧一, 刘梅洁, 王雨, 等. 未成年人安宁疗护程序规范建议[J]. 中国医学伦理学, 2022, 35(10):1157-1170.
	Zhang JY, Liu MJ, Wang Y, et al. Suggestions on the standard of hospice care procedure for minors[J]. Chin Med Ethics, 2022, 35(10):1157-1170.