End-of-Life Decision Making in the Intensive Care Unit: Physician and Nurse Perspectives
End-of-Life Decision Making in the Intensive Care Unit: Physician and Nurse Perspectives
复制标题
重症监护病房的临终决策：医生和护士的观点
DOI：
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发表时间：
2009
影响因子：
1.4
通讯作者：
S. A. McKee
中科院分区：
文献类型：
--
作者：
Dan M. Westphal;S. A. McKee
临终决定，包括预先指示和代码状态的考虑，在重症监护病房更频繁地发生。有必要确定护士和医生如何看待临终关怀，以便改善护士和医生的理解和沟通。共有96名医生和护士完成了一项关于他们对重症监护室临终关怀的一般信念和做法的调查。护士更倾向于询问病人是否有生前遗嘱，并阅读遗嘱内容。只有53%的医生会阅读生前遗嘱；然而，90%的医生在向家属提出建议时会考虑生前遗嘱中的意愿。只有当预后较差时，医生才更有可能讨论不复苏（DNR）命令。家庭动态和医疗/法律问题最常影响危重患者获得/撰写DNR命令的决定。建议的方法，以改善医生和护士合作的临终决策进行了讨论。
End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. Nurses were more likely to ask if there was a living will and to read it. Only 53% of physicians read living wills; however 90% of physicians consider the wishes in the living will when making recommendations to the family. Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and medical/legal concerns most often affect decisions to obtain/write a DNR order for a critically ill patient. Suggested approaches for improving physician and nurse collaboration about end-of-life decision making are discussed.