Is There Hope? Is She There? How Families and Clinicians Experience Severe Acute Brain Injury
Is There Hope? Is She There? How Families and Clinicians Experience Severe Acute Brain Injury
复制标题
DOI：
10.1089/jpm.2016.0286
复制
发表时间：
2017-02-01
影响因子：
2.8
通讯作者：
Creutzfeldt, Claire J.
中科院分区：
文献类型：
--
作者：
Schutz, Rachael E. C.;Coats, Heather L.;Creutzfeldt, Claire J.
背景：严重急性脑损伤（SABI）患者提出了重要的姑息治疗考虑与突然破坏性损伤和不确定的预后。目的：本研究的目的是探讨在神经科学重症监护病房（neuroicu）接受治疗的SABI患者的家庭成员、护士和医生如何体验姑息和支持性护理需求。设计：对半结构化访谈进行录音、转录，并使用主题分析进行分析。环境/对象：美国一家区域性综合卒中和一级创伤中心的30张床位神经icu。我们完成了对15名患者及其家属（n = 16）、护士（n = 15）和医生（n = 16）的47次访谈。结果：确定了两个主题：(1)希望和(2)人格。(1)家庭将预后的不确定性与希望的需要联系起来，并表示希望医生承认这种关系。希望的语言因参与者而异：临床医生将希望作为一种可以给予或带走的对象，通常在传达预后的过程中，而家庭则将希望作为一种支持应对其亲人的急性疾病及其预后不确定性的行动。(2)参与者描述了脑损伤导致的人格丧失，认识和治疗脑损伤患者的必要性，以及相关性和联系的重要性，包括临床医生对家庭的个人支持。结论：经SABI患者家属和临床医生确认，在神经icu中支持希望和保留人格挑战护理。具体的实际方法可以解决这些挑战，并改善姑息治疗提供给患者和家属在神经icu。
Background: Patients with severe acute brain injury (SABI) raise important palliative care considerations associated with sudden devastating injury and uncertain prognosis.Objective: The goal of this study was to explore how family members, nurses, and physicians experience the palliative and supportive care needs of patients with SABI receiving care in the neuroscience intensive care unit (neuro-ICU).Design: Semistructured interviews were audiotaped, transcribed, and analyzed using thematic analysis.Setting/Subjects: Thirty-bed neuro-ICU in a regional comprehensive stroke and level-one trauma center in the United States. We completed 47 interviews regarding 15 patients with family members (n = 16), nurses (n = 15), and physicians (n = 16).Results: Two themes were identified: (1) hope and (2) personhood. (1) Families linked prognostic uncertainty to a need for hope and expressed a desire for physicians to acknowledge this relationship. The language of hope varied depending on the participant: clinicians used hope as an object that can be given or taken away, generally in the process of conveying prognosis, while families expressed hope as an action that supported coping with their loved one's acute illness and its prognostic uncertainty. (2) Participants described the loss of personhood through brain injury, the need to recognize and treat the brain-injured patient as a person, and the importance of relatedness and connection, including personal support of families by clinicians.Conclusions: Support for hope and preservation of personhood challenge care in the neuro-ICU as identified by families and clinicians of patients with SABI. Specific practical approaches can address these challenges and improve the palliative care provided to patients and families in the neuro-ICU.