Emotional Impact of End-of-Life Decisions on Professional Relationships in the ICU: An Obstacle to Collegiality?*
Emotional Impact of End-of-Life Decisions on Professional Relationships in the ICU: An Obstacle to Collegiality?*
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DOI：
10.1097/ccm.0000000000002710
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发表时间：
2017-12-01
影响因子：
8.8
通讯作者：
Hebert, Paul
中科院分区：
文献类型：
--
作者：
Laurent, Alexandra;Bonnet, Magalie;Hebert, Paul
目的：生命终结的决定不仅在ICU中很常见，而且经常引起卫生专业人员的强烈感受。即使我们寻求发展更多的合议跨专业的方法来护理和健康决策，有许多障碍，成功地管理复杂的决定。本研究的目的是更好地了解情绪如何影响临终决策过程中的专业人员在ICU工作。设计：定性研究与临床访谈。所有的采访逐字转录和分析专题使用解释性phenomenological analysis.Setting：两个独立的ICU在中心医院德L 'Universite蒙特利尔。主题：10名医生和10名护士。干预措施：无。测量和主要结果：在结束生命的决策过程中，家庭和患者重组的决策框架，通过引入一个强大的情感层面。这导致了新挑战的出现，与重症监护的即时性截然不同。为了应对决策框架的变化，医生依靠他们与患者家属的关系来协助高级护理决策。护士，但是，利用他们的关系和接近病人谴责治疗obstinations.Conclusions：我们的研究表明，在生命的最后决策过程中，护士对他们的病人和医生的感情对他们的病人的家庭影响他们的决定。虽然这些情感维度允许护士和医生以符合其职业道德的方式行事，但专业人员本身似乎对这些维度的理解很差，经常忽视它们，从而阻碍了合议决定。
Objectives: End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU.Design: Qualitative study with clinical interviews. All interviews were transcribed verbatim and analyzed thematically using interpretative phenomenological analysis.Setting: Two independent ICUs at the Centre Hospitalier de l'Universite de Montreal.Subjects: Ten physicians and 10 nurses.Interventions: None.Measurements and Main Results: During the end-of-life decision-making process, families and patients restructure the decision-making frame by introducing a strong emotional dimension. This results in the emergence of new challenges quite different from the immediacy often associated with intensive care. In response to changes in decision frames, physicians rely on their relationship with the patient's family to assist with advanced care decisions. Nurses, however, draw on their relationship and proximity to the patient to denounce therapeutic obstinacy.Conclusions: Our study suggests that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions.