COMMUNICATING WITH PATIENTS' FAMILIES AND PHYSICIANS ABOUT PROGNOSIS AND GOALS OF CARE
COMMUNICATING WITH PATIENTS' FAMILIES AND PHYSICIANS ABOUT PROGNOSIS AND GOALS OF CARE
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DOI：
10.4037/ajcc2015855
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发表时间：
2015-07-01
影响因子：
2.7
通讯作者：
Anderson, Wendy G.
中科院分区：
文献类型：
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作者：
Milic, Michelle M.;Puntillo, Kathleen;Anderson, Wendy G.
背景：将姑息治疗纳入重症监护需要床边护士积极参与患者预后和护理目标的讨论。目的通过有针对性的教育干预，提高重症监护护士与患者家属和医生讨论预后和护理目标的技能和信心。方法对重症监护护士进行为期8小时的培训。明确护士在预后和护理目标沟通中的关键角色和技能。参与者在辅助角色扮演中练习技能。反思环节涉及倦怠、痛苦和自我照顾。参与者在研讨会之前、之后和三个月后分别完成了调查，评估了他们在执行关键任务时的信心和技能。在调查中使用了参与者焦点小组和开放式回答项目，进一步阐明了讲习班的影响。结果2011年3月至2013年4月，共有82名重症护士完成了一次培训。与研讨会前相比，研讨会后，护士在14项调查项目（包括评估家庭对预后和护理目标的理解、解决家庭情感需求和参与家庭会议）上的技能和信心都有所提高（P < 0.001）。讲习班结束后3个月仍持续增加。结论明确角色，提供技能实践和反思的机会，可以增强护士参与预后和护理目标讨论的信心。
Background Integrating palliative care into intensive care requires active involvement of bedside nurses in discussions of patients' prognosis and goals of care.Objective To improve critical care nurses' skills and confidence to engage in discussions with patients' families and physicians about prognosis and goals of care by using a focused educational intervention.Methods An 8-hour-long workshop was developed for critical care nurses. Key roles and skills of nurses in communication about prognosis and goals of care were defined. Participants practiced skills during facilitated role-plays. A reflection session addressed burnout, distress, and self-care. Participants completed surveys before, immediately after, and 3 months after their workshop, rating their confidence and skill in performing key tasks. Use of a participant focus group and open-response items in the surveys further elucidated the impact of the workshop.Results Between March 2011 and April 2013, a total of 82 critical care nurses completed a workshop. Compared with before the workshop, after the workshop, nurses reported greater skill and confidence for 14 survey items (P < .001), including assessing families' understanding of prognosis and goals of care, addressing families' emotional needs, and contributing to family meetings. Increases were sustained 3 months after the workshop.Conclusion Defining roles and providing opportunities for skills practice and reflection can enhance nurses' confidence to engage in discussions about prognosis and goals of care.