Bilsen Johan J R, Vander Stichele Robert H, Mortier Freddy, Deliens Luc
End-of-Life Care Research Group, Medical Sociology and Health Sciences (MESO), Vrije Universiteit Brussel, Brussels, Belgium.
J Adv Nurs. 2004 Sep;47(6):583-91. doi: 10.1111/j.1365-2648.2004.02982.x.
Death in modern societies is often preceded by medical end-of-life decisions. Empirical research on these end-of-life decisions focuses predominantly on the physicians' role. Little is known about the role of other health care workers, especially that of nurses.
This paper reports the findings of a study that investigated how often nurses are consulted by physicians in the decision-making process preceding end-of-life decisions and how often nurses participate in administering lethal drugs in end-of-life decisions.
Data were collected within a nationwide cross-sectional retrospective death certificate study in Flanders, the Dutch-speaking part of Belgium. We selected 3999 deaths, a 20% random sample of all those occurring during the first 4 months of 1998. Anonymous questionnaires were mailed to the physicians who signed the death certificates. Several questions concerned the involvement of nurses in end-of-life decisions.
We received 1925 valid questionnaires. For all reported end-of-life decisions (39.3% of all deaths in Flanders), physicians provided information about the involvement of nurses. Physicians consulted at least one nurse in 52% of end-of-life decisions cases occurring in institutions, compared with 21.4% of such cases at home. Nurses administered lethal drugs in 58.8% of euthanasia cases occurring in institutions and in 17.2% at home. For cases in which life was ended without the patient's explicit request because, predominantly, they were too ill to do so, these percentages were respectively 82.7% and 25.2%. In institutions, nurses mostly administered drugs without the attendance of a physician who had prescribed the drugs.
Nurses in Belgium are largely involved in administering lethal drugs in end-of-life decisions, while their participation in the decision-making process is rather limited. To guarantee prudent practice in end-of-life decisions, we need clear guidelines, professionally supported and legally controlled, for the assignment of duties between physicians and nurses regarding the administration of lethal drugs to reflect current working practice. In addition, we need appropriate binding standards governing mutual communication about all end-of-life decisions.
在现代社会，死亡往往伴随着医疗临终决策。关于这些临终决策的实证研究主要集中在医生的角色上。对于其他医护人员的角色，尤其是护士的角色，我们了解甚少。
本文报告了一项研究的结果，该研究调查了在临终决策前的决策过程中医生咨询护士的频率，以及护士在临终决策中参与使用致命药物的频率。
数据收集于比利时弗拉芒地区（比利时讲荷兰语的部分）一项全国性的横断面回顾性死亡证明研究。我们选取了3999例死亡病例，占1998年头4个月所有死亡病例的20%随机样本。匿名问卷被邮寄给签署死亡证明的医生。几个问题涉及护士在临终决策中的参与情况。
我们收到了1925份有效问卷。对于所有报告的临终决策（占弗拉芒地区所有死亡病例的39.3%），医生提供了关于护士参与情况的信息。在机构发生的临终决策病例中，52%的医生至少咨询了一名护士，而在家中发生的此类病例中这一比例为21.4%。在机构发生的安乐死病例中，58.8%的护士参与使用致命药物，在家中这一比例为17.2%。对于那些主要因患者病情过重而未经患者明确请求就结束生命的病例，这些比例分别为82.7%和25.2%。在机构中，护士大多在没有开处方医生在场的情况下给药。
比利时的护士在很大程度上参与了临终决策中使用致命药物的工作，而她们在决策过程中的参与相当有限。为了确保临终决策中的审慎做法，我们需要明确的指导方针，这些方针要有专业支持并受到法律控制，以规定医生和护士在使用致命药物方面的职责分配，从而反映当前的工作实践。此外，我们需要适当的具有约束力的标准来规范关于所有临终决策的相互沟通。
