【文献阅读】医务人员对告知坏消息的体验：批判性的解释性meta分析

医疗保健从业者对突发坏消息的体验：批判性的解释性元综合

目的： 概述医疗保健从业者对突发坏消息的体验。

方法： 通过系统检索确定的 14 篇定性论文的解释性元综合。通过相互转化分析提取数据并引出构建体。

结果： 研究结果包括四个相互关联的主题：（1）不适，特别是对突发坏消息的困难情绪和身体反应;（2）关系困扰，与对患者的依恋和认同有关;（3）临床医生不足，表明对出错的可能性的恐惧和反刍以及随后的自责;（4）只有人类，突出了一种刀枪不入的文化，在这种文化中，从业者的自我保健被取消了优先级。

结论： 突发坏消息会给从业者带来极大的痛苦，尤其是当他们对患者有强烈的依恋或认同感时。突发的坏消息被理解为一种孤立的经历，工作人员不透露困难似乎维持了一种不鼓励承认痛苦的无懈可击的文化。

实践启示： 鉴于从业者倦怠的不利影响和潜在影响，组织应承认后果，并为员工提供时间来处理坏消息的传递，促进集体关怀文化，并为反思实践提供空间。

关键字： 突发坏消息;具有挑战性的无懈可击;隔离;培训模式;未被承认的员工苦恼。

Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis

Abstract

Objective: To provide an overview of healthcare practitioners' experiences of breaking bad news.

Method: Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis.

Results: Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised.

Conclusions: Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged.

Practice implications: Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.

Keywords: Breaking bad news; Challenging invulnerability; Isolation; Models of training; Unacknowledged staff distress.