Levy M M
Brown University, Rhode Island Hospital, Providence, RI 02903, USA.
Crit Care Med. 2001 Feb;29(2 Suppl):N56-61. doi: 10.1097/00003246-200102001-00011.
Everywhere we turn these days, it seems that we are confronted with a new study that reports the dissatisfaction expressed by families with the quality of care received by their loved ones who have died while in the intensive care unit. It is difficult for caregivers to accept this information, which is now commonly reported both in published studies and in the lay press. As clinicians, most of us believe that we truly care about our patients and are trying, as best we can, to act in their best interest. No caregiver wants to hear that he or she does not do a good job when caring for dying patients and their families. It is ironic that clinicians recognize and accept the need for continuing education. Yet many clinicians resent the suggestion that the skills required for end-of-life care might be viewed in the same manner, as a lifelong learning process. It is unusual for physicians to identify end-of-life-care as an area of competency that can be improved or updated. Perhaps this is why end-of-life-care has been so difficult to teach to clinicians in training. Although many medical schools offer courses on the ethics of death and dying, formal training in end-of-life care skills is not routinely given in most postgraduate training programs. Learning these skills is a matter of on-the-job training for most caregivers. Not only have we been unable to measure any beneficial impact from education initiatives for end-of-life care, we have yet to identify clear indicators for end-of-life care. For caregivers, enhancing end-of-life skills may be a matter of improved listening skills, attention to the proper environment for end-of-life discussions, and a willingness to facilitate end-of-life decision-making. Encouraging caregivers to view end-of-life skills as a lifelong educational process, identifying core competencies in end-of-life care, and training clinicians in these skills are the challenges for the future. The quality of care our patients receive at the end of life will depend on our ability to answer these difficult questions.
如今，我们无论转向何处，似乎都会面临一项新的研究，该研究报告了家属对其在重症监护病房离世的亲人所接受护理质量的不满。护理人员很难接受这一信息，如今在已发表的研究以及大众媒体中都普遍报道了这一情况。作为临床医生，我们大多数人都相信自己真心关心患者，并尽最大努力为患者的最大利益行事。没有哪位护理人员愿意听到自己在照顾临终患者及其家属时做得不好。具有讽刺意味的是，临床医生认可并接受继续教育的必要性。然而，许多临床医生却反感将临终护理所需技能视为同样的终身学习过程这一建议。医生很少将临终护理视为一个可以改进或更新的能力领域。也许这就是为什么向实习临床医生传授临终护理如此困难的原因。尽管许多医学院校开设了关于死亡与临终伦理的课程，但大多数研究生培训项目并未常规性地提供临终护理技能的正式培训。对于大多数护理人员来说，学习这些技能是一个在职培训的问题。我们不仅无法衡量临终护理教育举措产生的任何有益影响，而且尚未确定临终护理的明确指标。对于护理人员而言，提高临终护理技能可能涉及提高倾听技巧、关注临终讨论的适宜环境以及愿意促进临终决策。鼓励护理人员将临终护理技能视为一个终身教育过程、确定临终护理的核心能力并对临床医生进行这些技能的培训，是未来面临的挑战。我们的患者在生命末期所接受护理的质量将取决于我们回答这些难题的能力。
