Sorensen Roslyn, Iedema Rick
Centre for Health Services Management, Faculty of Nursing, Midwifery & Health, University of Technology, 11A The Terraces, Broadway, Sydney, NSW 2006, Australia.
Int J Nurs Stud. 2007 Nov;44(8):1343-53. doi: 10.1016/j.ijnurstu.2006.07.019. Epub 2006 Sep 15.
Clinicians worldwide are being called upon to reconcile accountability for patient outcomes with the resources they consume. In the case of intensive care, contradictory pressures can arise in decisions about continuing treatment where benefit is diminishing. As concern grows about the cost effectiveness of treatment at end-of-life, nursing expertise and advocacy become significant factors in decision making.
To explore the potential for a nursing advocacy role within a specific regime of nursing practice: end-of-life care; specifically to examine the concept of nursing advocacy from the literature, to consider its application in the workplace and to assess the capacity for nurses to advocate for people who die in institutions such as intensive care units.
Open-ended interviews with nurse managers and educators (4), palliative care specialists (2), chaplain (1), medical managers (2), intensives (7); focus groups with nurses (4 focus groups and 29 participants); patient case studies (13); observation of family conferences (6 conferences and 15 participants); observation of ward rounds (3 ward rounds and 11 participants). Total number of participants: 84.
A large ICU in a principal referral and teaching hospital in Sydney, Australia.
Clinical staff within, and clinical and non-clinical caregivers external to the unit.
Qualitative, ethnographic study.
Spurious economic imperatives, primacy given to medical intervention, conflict between medical and nursing clinicians about patient management and absence of nursing operational autonomy and organizational authority, impede the opportunity for nurses to define and enact an advocacy role.
If nurses are to be effective patient advocates at end-of-life, they will need to develop clear criteria within which nursing assessments of patient status can be framed, the specialized skills to manage the non-medical needs of dying people and the organizational and political skills to negotiate changing clinical practice and workplace relations.
全球临床医生都面临着既要对患者治疗结果负责，又要合理使用资源的挑战。在重症监护领域，当继续治疗的益处逐渐减少时，关于是否继续治疗的决策可能会产生相互矛盾的压力。随着人们对临终治疗成本效益的关注度不断提高，护理专业知识和支持在决策过程中变得至关重要。
探讨在特定护理实践模式——临终关怀中，护理支持角色的潜力；具体而言，从文献中审视护理支持的概念，思考其在工作场所的应用，并评估护士为在重症监护病房等机构中去世的患者提供支持的能力。
对护士经理和教育工作者（4名）、姑息治疗专家（2名）、牧师（1名）、医疗经理（2名）、重症监护医生（7名）进行开放式访谈；与护士进行焦点小组讨论（4个焦点小组，共29名参与者）；患者案例研究（13个）；观察家庭会议（6次会议，共15名参与者）；观察查房（3次查房，共11名参与者）。参与者总数：84名。
澳大利亚悉尼一家主要的转诊和教学医院的大型重症监护病房。
该病房内的临床工作人员以及病房外的临床和非临床护理人员。
定性的人种学研究。
虚假的经济需求、对医疗干预的过度重视、医疗和护理临床医生在患者管理方面的冲突以及护理操作自主权和组织权威的缺失，阻碍了护士界定并履行支持角色的机会。
如果护士要在临终时成为有效的患者支持者，他们需要制定明确的标准，据此对患者状况进行护理评估，掌握满足临终患者非医疗需求的专业技能，以及具备协商改变临床实践和工作场所关系的组织和政治技能。
