Robinson Frances, Cupples Margaret, Corrigan Mairead
Palliative Medicine, Sperrin Lakeland Trust, Tyrone County Hospital, Omagh, Co Tyrone, Northern Ireland.
Palliat Med. 2007 Jun;21(4):305-12. doi: 10.1177/0269216307077817.
To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital.
Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews.
Acute district hospital, Northern Ireland.
Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making.
Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in ;real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties.
The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings.
探讨急症医院中医生和护士对终末期疾病患者进行心肺复苏的态度和经验。
定性研究；对两个录音焦点小组和四次半结构式访谈进行主题分析。
北爱尔兰的急症区医院。
七名护士和九名医生；国籍、性别和专业经验各不相同；参与心肺复苏决策。
参与者对复苏政策以及“不进行心肺复苏”（DNAR）决定在患者实际护理中的含义有不同解读。在将政策转化为实践过程中的这种困惑，导致在启动、记录和实施心肺复苏决策时出现沟通困难。参与者意识到临床状况可能发生变化，并表示在确定终末期疾病方面存在不确定性；他们表达了对DNAR决定给患者护理带来潜在后果的担忧。与护士更以患者为中心的方法相比，医生在患者管理上更以疾病为中心的方法导致了团队内部的专业间冲突。医生确定了在“现实生活”中应用复苏政策和伦理原则方面的培训需求，护士则确定需要持续的专业支持，而初级医生获得这种支持的机会较少。工作人员与患者之间的个人关系、文化上不愿处理敏感问题以及当地社区对亲属参与决策的期望，都增加了政策实施的难度。
研究结果表明，在急症医院将复苏政策应用于终末期疾病患者的决策时，需要持续为工作人员提供支持和培训。这些结果支持了这样的建议，即应坦诚地审视当地的复苏政策和国家指南，明确在当地提供优质临终护理所涉及的目标、机会和困难。
