Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions
Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions
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DOI：
10.1164/rccm.200207-752oc
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发表时间：
2003-05-15
影响因子：
24.7
通讯作者：
Duvaldestin, P
中科院分区：
文献类型：
--
作者：
Ferrand, E;Lemaire, FO;Duvaldestin, P
几项研究指出，在停止或停止生命支持治疗的决策过程中存在伦理缺陷。我们进行了一项研究，以评估重症监护病房中所有参与这一过程的照顾者的看法。来自133个法国重症监护病房的3156名护理人员和521名医生完成了封闭式问卷调查(参与率为42%)。73%的医生和33%的护理人员认为决策过程令人满意。超过90%的护理人员认为决策应该是协作的，但50%的医生和只有27%的护理人员认为护理人员实际上参与其中(p<；0.001)。害怕诉讼是医生修改提供给有能力的患者、家属和护理人员的信息的一个原因。护理人员的感知可能是医疗决策过程质量的可靠指标，并可能成为评估日常实践的简单而有效的工具。建议和立法可能有助于在决策过程的每一步在照顾者之间建立共识和避免冲突。
Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decisionmaking should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.