Family Perceptions of Strategies to Facilitate End-of-Life Decisions

描述（由申请人提供）：意义：在ICU死亡的患者家属面临着痛苦的困境，其后果可能会困扰他们一生。为这些家庭成员提供有意义的支持和信息是当务之急。护士，凭借在床边度过的时间和病人和家庭需求的知识，在支持家庭成员的独特地位。文献提供了大量的研究，护士认为他们参与了EOL决策和几项研究描述了什么样的家庭成员认为，他们需要从医疗保健专业人员一般。缺乏的是描述家庭成员对具体战略的看法的文献， 护士用来支持他们的决策以及家庭成员如何应对这些策略。因为护士可能会本能地采取行动，他们使用的策略可能会或可能不会对家庭成员有帮助。拟议的研究将建立在以前的工作，更深入地探讨具体的战略，家庭成员认为护士使用和家庭成员如何应对这些战略。目的：本研究旨在探讨家庭成员如何应对护理策略，以支持EOL决策，包括家庭成员的看法，护士使用的策略，这些策略如何改变决策的轨迹，以及这些策略如何影响他们的能力，使决策符合患者的目标和他们的能力，以科普压力，使EOL决策。研究方法：在这项前瞻性、纵向、定性描述性研究中，我将确定可能需要复杂决策的ICU患者，并使用叙事式访谈技术来探讨家属对护士使用的策略以及这些策略的有效性的看法。参与者将从杜克医院（一个三级护理大学医院系统）的一个16床成人医学ICU招募。总结：这项研究的知识将为传播专家护理实践铺平道路，通过针对家庭成员确定的重要领域进行干预，最有可能改善他们的健康状况，并在ICU环境中可行。有了这些知识，护士将能够与家庭互动的基础上的经验数据，而不是本能，并帮助家庭成员作出决定，是符合病人的目标，并科普的负担，终末期决策。 公共卫生相关性：当ICU中的患者濒临死亡时，他们的家人可能面临艰难的选择，例如是否停止生命支持或放入喂食管。为了促进这些家庭成员的情绪健康， 对他们有帮助的护理行动，以便所有护士都能接受如何帮助家庭成员做出这些选择的培训。

DESCRIPTION (provided by applicant): Significance: Family members of patients dying in the ICU are faced with agonizing dilemmas, the consequences of which may haunt them for a lifetime. Providing these family members with meaningful support and information is imperative. Nurses, by virtue of the time spent at the bedside and knowledge of patient and family needs, are in a unique position to support family members. The literature provides ample studies of how nurses perceive they are involved in EOL decision-making and several studies describing what family members perceive that they need from health care professionals in general. What is lacking is literature that describes the family members perceptions of the specific strategies that nurses use to support their decision-making and how family members respond to these strategies. Because nurses may act on instinct, the strategies they use may or may not be helpful to family members. The proposed study will build on prior work by exploring in greater depth the specific strategies that family members perceive nurses using and how family members respond to these strategies. Purpose: This study aims to explore how family members respond to nursing strategies to support EOL decision-making, including family members perceptions of the strategies nurses use, how these strategies change over the trajectory of decision-making, and how these strategies affect their ability to make decisions consistent with the goals of the patient and their ability to cope with the stress of making EOL decisions. Methods: In this prospective, longitudinal, qualitative descriptive study, I will identify ICU patients who are likely to need complex decision-making and use narrative style interviewing techniques to explore the family members' perceptions of the strategies nurses use and the effectiveness of these strategies. Participants will be recruited from a 16 bed adult medical ICU at Duke Hospital, a tertiary care university hospital system. Summary: Knowledge from this study will pave the way for spreading expert nursing practices by leading to interventions targeting the areas identified as important by family members, most likely to improve their well being, and feasible in ICU environment. With this knowledge, nurses will be able to interact with families based on empirical data, rather than on instinct, and to help family members to make decisions that are consistent with the patient's goals and to cope with the burden of EOL decision-making. PUBLIC HEALTH RELEVANCE: When patients in the ICU are dying, their family members may be faced with hard choices, such as whether or not to stop life support or put in a feeding tube. In order to promote the emotional health of these family members, it is important to identify nursing actions that are helpful to them so that all nurses can be trained in how to help family members making these choices.