Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India
Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India
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DOI：
10.1155/2016/1897039
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发表时间：
2016-01-01
影响因子：
2.1
通讯作者：
Phatak, Ajay
中科院分区：
文献类型：
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作者：
Devpura, Bhanu;Bhadesia, Pranav;Phatak, Ajay
目标。通过对新生儿重症监护病房（NICU）新生儿家长/监护人的深度访谈，探讨新生儿不遵医嘱出院（DAMA）的原因。方法。在2014年4月至2015年3月入住NICU的456名婴儿中，116名婴儿为DAMA。在这116名婴儿中，随机选择50名居住在50公里范围内的婴儿的父母，在他们的家中进行了深入访谈。录音完成并手动转录，详细分析以探索导致DAMA的常见线索。从医院记录中检索新生儿的基本人口统计信息。结果。DAMA患病率为25.4%。在接触的50位家长中，完成了41位深度访谈。负担不起（38.6%）、无改善（14.6%）、预后差（12%）和医患关系办公室人员行为不当（10.6%）是导致DAMA发生的主要因素。6.6%的家长希望得到生存保障，5.3%的家长反映护士行为不佳。未观察到与DAMA相关的性别偏见。三分之一的新生儿（34.1%）在入院第一天进行DAMA。结论。DAMA问题需要引起注意。除了负担不起和婴儿的临床特点外，沟通（突发坏消息、咨询等）和缺乏足够的亲属基础设施成为导致DAMA的可改变因素。
Objective. We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods. Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results. The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions. The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.