آموزش و اخلاق در پرستاری
Education and Ethics In Nursing ISSN: 2322-5300

چالش های توسعه نقش مشاوره ای پرستاران در مراقبت تسکینی: یک مطالعه کیفی

https://doi.org/10.22034/ethic.2025.2055920.1163
دوره 14، شماره 2
مهر 1404
صفحه 1-11
آموزش و اخلاق در پرستاری

نوع مقاله : مقاله پژوهشی اصیل

نویسندگان

علیرضا ایرج پور 1
مریم السادات هاشمی 2

1 استاد، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، گروه پرستاری مراقبت ویژه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

2 استادیار، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، گروه پرستاری مراقبت ویژه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده
مقدمه: تفاوت بسترهای فرهنگی، سیاسی، اجتماعی، اقتصادی و بهداشتی ایران با کشورهای پیشرو در توسعۀ نقش­ های تخصصی پرستاران، لزوم شناسایی ابعاد مختلف گسترش نقش ­های تخصصی پرستاران و موانع رشد این نقش ­ها را اجتناب ناپذیر می­ کند؛ بنابراین پژوهش حاضر، با هدف شناسایی چالش­ های توسعۀ نقش مشاوره ­ای پرستاران، در مراقبت تسکینی انجام شد.
روش کار: پژوهش حاضر، بخشی از مطالعۀ اقدام پژوهی است که به ‌صورت کیفی، با رویکرد تحلیل محتوای مرسوم، به روش گرانهایم و لوندمن (15 مرداد 1403 تا 14 آبان 1403) انجام یافت. مشارکت‌کنندگان، 20 نفر از اعضای هیئت علمی پرستاری بودند که به ‌صورت نمونه‌گیری هدفمند، وارد مطالعه شدند. داده‌ها، از طریق مصاحبۀ نیمه ­ساختارمند حضوری  و به صورت فردی، مورد جمع ­آوری قرار گرفتند. تمام داده‌ها، پس از ضبط و پیاده‌سازی از طریق تحلیل محتوای کیفی و با استفاده از نرم‌افزار مکس کیودا نسخۀ 2020، مورد تجزیه‌ و تحلیل قرار گرفتند. به‌ منظور اطمینان از صحت یافته‌های پژوهش، چهار معیار اعتبار یا مقبولیت، قابلیت اعتماد یا همسان بودن، قابلیت انتقال و تأییدپذیری که توسط گوبا و لینکلن، برای استحکام تحقیقات کیفی پیشنهاد شده، استفاده گردید.
یافته‌ها: در راستای «تبیین چالش ­های توسعۀ نقش­ه ای مشاوره­ ای پرستاران، در مراقبت تسکینی» با تجزیه و تحلیل داده‌ها، 500 کد اولیه، 26 زیرطبقه، 8 طبقۀ فرعی و 3 طبقۀ اصلی چالش ­های فردی، سازمانی و بافتاری توسعۀ نقش‌های تخصصی پرستاران، پدیدار شد. طبقات اصلی عبارت ­اند از: چالش ­های فردی؛ 2 طبقۀ فرعی (چالش­ های مربوط به ویژگی­ های شخصیتی و توانمندی)، چالش ­های سازمانی؛ 2 طبقۀ فرعی (چالش ­های مربوط به جذب، تأمین و آموزش نیروی انسانی و چالش ­های مربوط برنامه ­ریزی و سیاست گذاری مدیران سازمانی) و چالش­ های بافتاری؛ از 4 طبقۀ فرعی (چالش­ های فرهنگی، اقتصادی، سیاستگذاری و تعیین قانون و مقررات توسعۀ نقش ­های تخصصی پرستاران و بالأخره چالش همکاری­ های بین حرفه ­ای) تشکیل شدند.
نتیجه‌گیری: با سیاستگذاری و تعیین قانون و مقررات توسعۀ نقش، برقراری پروانۀ صلاحیت تخصصی، تعرفه گذاری خدمات مشاورۀ پرستاری، پوشش بیمه ­ای خدمات مشاوره، تدوین برنامه­ های آموزشی و توسعۀ همکاری­ های بین حرفه ­ای، به عنوان استراتژی پیشران مراقبت ­های حمایتی - تسکینی می ­توان، به توسعۀ نقش­ های تخصصی پرستاران پرداخت.

کلیدواژه‌ها

گسترش نقش
مراقبت تسکینی
پرستار
تحلیل محتوا
ایران
موضوعات

عنوان مقاله English

The challenges of developing the consultative role of nurses in palliative care: a qualitative study

نویسندگان English

Alireza Irajpour 1
Maryam Hashemi 2
1 Professor of Nursing Department of Department of critical care, School of Nursing and Midwifery Nursing and Midwifery Care Research Center Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Nursing & Midwifery Care Research Center, Department of critical care, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده English

Introduction: The difference between Iran's cultural, political, social, economic and health contexts and the leading countries in the development of the specialized roles of nurses makes it inevitable to identify the various aspects of the expansion of the specialized roles of nurses and the obstacles to the development of these roles; Therefore, the present study was conducted with the aim of identifying the challenges of developing the consultative role of nurses in palliative care.
Method & Materails: The current research is a part of the action research study that was conducted qualitatively, with the conventional content analysis approach, by the Granheim and Lundman method (August 15, 2024 to November 14, 2024). The participants were 20 nursing faculty members who were included in the study through purposive sampling. Data were collected through face-to-face and individual semi-structured interviews. All the data were analyzed after recording and implementation through qualitative content analysis using Max Kyoda software version 2020. In order to ensure the validity of the research findings, four criteria of validity or acceptability, reliability or similarity, transferability and verifiability suggested by Goba and Lincoln for the strength of qualitative research were used.
Results: In line with "explaining the challenges of developing the consultative roles of nurses in palliative care" by analyzing the data, 500 primary codes, 26 subcategories, 8 subcategories and 3 main categories of individual, organizational and contextual challenges in the development of nurses' specialized roles emerged. The main classes are: individual challenges; 2 sub-classes (challenges related to personality traits and capabilities), organizational challenges; 2 sub-classes (challenges related to recruitment, supply and training of human resources and challenges related to planning and policy making of organizational managers) and textural challenges; They were formed from 4 sub-classes (cultural and economic challenges, policy-making and determining the law and regulations for the development of the specialized roles of nurses and finally the challenge of interprofessional cooperation).
Conclusion: By politicizing and determining role development laws and regulations, establishing specialized qualification licenses, pricing nursing consulting services, insurance coverage for consulting services, developing training programs and developing interprofessional collaborations, as a strategy for driving support and palliative care, it is possible to develop the specialized roles of nurses.
 

کلیدواژه‌ها English

  • role expansion
  • palliative care
  • nurse
  • content analysis
  • Iran
1. Hacker K. The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2024;8(1):112-9.
2. Reis da Silva TH. Chronic kidney disease in older adults: nursing implications for community nurses. Journal of Kidney Care 2024 Jul 2; 9(4):174-9.
3. Unsworth J, Greene K, Ali P, Lillebø G, Mazilu DC. Advanced practice nurse roles in Europe: implementation challenges, progress and lessons learnt. International Nursing Review. 2024;71(2):299-308.
4. Zhu Y, Zhang H, Xi Y, Zhu H, Lu Y, Luo X, et al. The implication of diabetes-specialized nurses in Aiming for the Better Treatment and Management of Patients with Diabetes Mellitus: a brief narrative review. Diabetes Therapy 2024;15(5):917-27.
5. Bassah N, Vaughn L, Santos Salas A. Nurse‐led adult palliative care models in low‐and middle‐income countries: A scoping review. Journal of advanced nursing 2023;79(11):4112-26.
6. Htay M, Whitehead D. The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. International Journal of Nursing Studies Advances. 2021;3:100034.
7. Busca E, Savatteri A, Calafato TL, Mazzoleni B, Barisone M, Dal Molin A. Barriers and facilitators to the implementation of nurse’s role in primary care settings: an integrative review. BMC nursing 2021; 20:1-12.
8. Tabvuma T, Stanton R, Huang YL, Happell B. The Physical Health Nurse Consultant: Perceptions and Experiences of Those Who Care for People with Mental Illness. Issues in mental health nursing 2024 Sep 1;45(9):979-89.
 9. Lin L-S, Huang L-H, Chien S-P, Wang C-L, Lee L-C, Hu C-C, et al. Use and impact of a novel nurse-led consultation model in a palliative care consultation service for terminally ill cancer patients in Taiwan: an 11-year observational study. Supportive Care in Cancer 2023; 31(4):246.
10. Tam-Tham H, Persaud N, Arya A. Palliative care consultation teams in long-term care: a descriptive retrospective cohort study. BMC Palliative Care. 2025; 24(1):79.
11. Wilkin K, Fang ML, Sixsmith J. Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives. BMC geriatrics 2024;24(1):294.
12. Ma JE, Haverfield M, Lorenz KA, Bekelman DB, Brown-Johnson C, Lo N, et al. Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach. Palliative Medicine 2021;35(8):1542-52.
13. Basinska K, Wellens NI, Simon M, Zeller A, Kressig RW, Zúñiga F. Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method. Journal of advanced nursing 2021;77(2):742-54.
14. Kyngäs H, Kääriäinen M, Elo S. The trustworthiness of content analysis.  The application of content analysis in nursing science research: Springer; 2020. p. 41-8.
15. Shufutinsky A. Employing use of self for transparency, rigor, trustworthiness, and credibility in qualitative organizational research methods. OD Practitioner. 2020;52(1):50-8.
16. Johnson JL, Adkins D, Chauvin S. A review of the quality indicators of rigor in qualitative research. American journal of pharmaceutical education. 2020 Jan 1;84(1):7120.
17. Allen DH, Arthur EK, Blazey M, Brassil K, Cahill JE, Cooley ME, et al. A scoping review on the nurse scientist role within healthcare systems. Worldviews on Evidence‐Based Nursing 2023; 20(1):47-55.
18. Kilpatrick K, Savard I, Audet L-A, Costanzo G, Khan M, Atallah R, et al. A global perspective of advanced practice nursing research: a review of systematic reviews. Plos one 2024; 19(7):e0305008.
19. Giles M, Parker V, Mitchell R. Understanding Nurse Consultant role engagement in metropolitan and rural contexts. Collegian 2016; 23(4):329-40.
20. Nagarajan S. Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study. Aust J Prim Health 2022; 28: 151–7.
21. Faraz A. Novice nurse practitioner workforce transition and turnover intention in primary care. Journal of the American Association of Nurse Practitioners 2017; 29(1):26-34.
22. de Barbieri I, Strini V, Noble H, Amatori S, Sisti D. Nurse‐perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey. Journal of renal care 2022; 48(1):49-59.
23. Sangster-Gormley E. Interprofessional Collaboration: Co-workers' Perceptions of Adding Nurse Practitioners to Primary Care Teams. Quality in Primary Care 2015;23(3).
24. Torrens C, Campbell P, Hoskins G, Strachan H, Wells M, Cunningham M, et al. Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review. International journal of nursing studies 2020;104:103443.
25. Gregorowski A, Brennan E, Chapman S, Gibson F, Khair K, May L, et al. An action research study to explore the nature of the nurse consultant role in the care of children and young people. Journal of clinical nursing 2013; 22(1-2):201-10.
26. Seck F, Masot O, Carey N, Roca J, Botigué T, Paraíso Pueyo E, et al. Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group. Journal of advanced nursing 2024; 80(5):2106-20.
27. Clancy M. Irish Emergency Nurses’ Attitudes towards Role Expansion in, and Barriers to, Nurse Prescribing: Royal College of Surgeons in Ireland; 2011.
28. Mackavey C, Henderson C, van Leeuwen EdZ, Maas L, Ladd A. The advanced practice nurse role's development and identity: an international review. International Journal for Advancing Practice 2024; 2(1): 36-44.
29. Gillingham I, Neubeck L, Williams B, Dawkes S. Role expansion for nurses in the cardiac catheter laboratory: findings from a systematic scoping review. British Journal of Cardiac Nursing 2020;15(4):1-14.
30. Lockwood EB, Fealy GM. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists. Journal of Nursing management 2008;16(7):813-20.
31. Cameron M, Shaw V. Expanding the emergency nurse role to meet demand: nurse and physician perspectives. Emergency Nurse 2020;28: (6).
32. Suzuki M, Harada N, Honda K, Koda M, Araki T, Kudo T, et al. Facilitators and barriers in implementing the nurse practitioner role in Japan: A cross‐sectional descriptive study. International Nursing Review 2024;71(2):8-291.
 
 
 
 

صفحه اصلی

راهنمای نویسندگان

ارسال مقاله

تماس با ما