Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: interactions between patients' families, healthcare providers, and the healthcare system.
Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: interactions between patients' families, healthcare providers, and the healthcare system.
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DOI：
10.4037/ajcc2006.15.2.178
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发表时间：
2006-03
期刊：
影响因子：
--
通讯作者：
D. Wiegand
中科院分区：
文献类型：
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作者：
D. Wiegand
背景技术重症监护病房中生命维持治疗的退出正在增加。患者家属密切参与这一过程，因为患者通常无法参与。在此过程中，人们对家庭成员与医疗保健提供者和医疗保健系统的互动知之甚少。目的 描述在突然、意外的疾病或受伤后停止生命维持治疗期间患者家属、医疗保健提供者和医疗保健系统之间的相互作用。方法 这项调查是一项更大规模的解释性现象学研究的一部分。对参与家庭成员生命维持治疗退出过程的19个家庭（56名家庭成员）进行访谈和观察。数据分析的归纳方法用于发现意义单元、聚类和类别。结果 家庭的经历涉及多个方面，包括与医疗保健提供者的问题（与护士和医生的关系和一致性、医生的存在、信息、护理协调、家庭会议、对时间的敏感性以及临终过程的准备）以及与医疗保健系统的问题（停车、寻找隐私的困难以及患者的转移）。结论 患者家属在参与生命维持治疗的退出过程时需要信息、指导和支持。这项研究的结果对临床实践和未来的研究具有重要意义。
BACKGROUND Withdrawal of life-sustaining therapy in intensive care units is increasing. Patients' families are intimately involved in this process because the patients are usually unable to participate. Little is known about family members' interactions with healthcare providers and the healthcare system during this process. OBJECTIVE To describe the interactions between patients' family members, healthcare providers, and the healthcare system during withdrawal of life-sustaining therapy after a sudden, unexpected illness or injury. METHODS The investigation was part of a larger interpretative phenomenological study. Nineteen families (56 family members) who participated in the process of withdrawal of life-sustaining therapy for a family member were interviewed and observed. An inductive approach to data analysis was used to discover units of meaning, clusters, and categories. RESULTS The families' experiences involved a variety of dimensions, including issues with healthcare providers (bonds and consistency with nurses and physicians, physicians' presence, information, coordination of care, family meetings, sensitivity to time, and preparation for the dying process) and issues with the healthcare system (parking, struggles with finding privacy, and transfers of patients). CONCLUSIONS Patients' families need information, guidance, and support as the families participate in the process of withdrawal of life-sustaining therapy. The results of this study have important implications for clinical practice and future research.