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

描述(由申请人提供)：意义：在ICU中死亡的患者的家属面临着痛苦的两难境地，其后果可能会困扰他们一生。向这些家庭成员提供有意义的支持和信息势在必行。护士凭借在病床边度过的时间以及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。这些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，以及几项描述家庭成员总体上认为他们需要从卫生保健专业人员那里获得什么的研究。所缺乏的是描述家庭成员对特定策略的感知的文献 护士用来支持她们的决策以及家庭成员如何对这些策略做出反应。因为护士可能会根据本能行事，她们使用的策略可能对家人有帮助，也可能没有帮助。拟议的研究将建立在先前工作的基础上，更深入地探讨家庭成员感知护士使用的具体策略，以及家庭成员如何应对这些策略。目的：本研究旨在探讨家庭成员如何回应护理策略以支持EOL决策，包括家庭成员对护士使用的策略的认知，这些策略在决策过程中如何改变，以及这些策略如何影响他们做出与患者目标一致的决策的能力以及他们应对做出EOL决策的压力的能力。方法：在这项前瞻性、纵向、定性的描述性研究中，我将确定ICU患者可能需要复杂的决策，并使用叙述式访谈技术来探索家属对护士使用的策略的感知以及这些策略的有效性。参与者将从杜克医院的16个床位的成人医疗ICU招募，杜克医院是一个三级护理大学医院系统。摘要：这项研究的知识将为推广专家护理实践铺平道路，通过导致针对家庭成员确定的重要区域的干预，这些区域最有可能改善他们的福祉，并在ICU环境中可行。有了这些知识，护士将能够基于经验数据而不是直觉与家属互动，并帮助家属做出与患者目标一致的决定，并应对EOL决策的负担。 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置喂养管。为了促进这些家庭成员的情绪健康，重要的是要确定 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.