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

家庭对促进临终决策策略的看法

• 批准号: 8397210
• 负责人: Judith A. Adams
• 金额: $ 3.21万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8397210
• 关键词: Adult; Affect; Anxiety; Area; Beds; Caring; Cessation of life; Communication; Complex; Critical Illness; Data; Decision Making; Discipline of Nursing; Emotional; Environment; Face; Family; Family member; Feeling; Foundations; Fright; Future; Goals; Grief reaction; Guilt; Health; Health Professional; Hospitals; Instinct; Intensive Care Units; Intervention; Interview; Intuition; Knowledge; Learning; Left; Life; Literature; Medical; Mental Depression; Methods; Nature; Nurse' s Role; Nurses; Outcome; Participant; Patients; Perception; Physicians; Pilot Projects; Play; Positioning Attribute; Post-Traumatic Stress Disorders; Process; Recruitment Activity; Regrets; Research; Review Literature; Risk; Running; Self Care; Severities; Stress; Symptoms; System; Techniques; Time; Training; Trust; University Hospitals; Use Effectiveness; Work; base; coping; decision-making capacity; end of life; experience; improved; loved ones; meetings; member; nursing standards; prospective; response; skills; tertiary care; therapy development; tube feeding

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.

描述（由申请人提供）：意义：ICU临终患者的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必不可少的。护士凭借在病床边的时间和对病人和家庭需求的了解，在支持家庭成员方面处于独特的地位。文献提供了大量关于护士如何感知他们参与EOL决策的研究，以及一些研究描述了家庭成员一般认为他们需要从医疗保健专业人员那里得到什么。缺乏的是描述家庭成员对具体策略的看法的文献

项目成果

Studying the clinical encounter with the Adaptive Leadership framework.

• DOI: 10.2147/jhl.s32686
• 发表时间: 2012-08
• 期刊: Journal of healthcare leadership
• 影响因子: 4.4
• 作者: Bailey DE Jr;Docherty SL;Adams JA;Carthron DL;Corazzini K;Day JR;Neglia E;Thygeson M;Anderson RA
• 通讯作者: Anderson RA

Nursing strategies to support family members of ICU patients at high risk of dying.

• DOI: 10.1016/j.hrtlng.2014.02.001
• 发表时间: 2014-09
• 期刊: HEART & LUNG
• 影响因子: 2.8
• 作者: Adams, Judith A.;Anderson, Ruth A.;Docherty, Sharron L.;Tulsky, James A.;Steinhauser, Karen E.;Bailey, Donald E., Jr.
• 通讯作者: Bailey, Donald E., Jr.