Dawson Katherine A
Center for Palliative Care, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Crit Care Nurs Q. 2008 Jan-Mar;31(1):19-23. doi: 10.1097/01.CNQ.0000306392.02154.07.
Overall, critical care nursing and medical teams are inadequately prepared to deliver palliative care for the critically ill geriatric patient. Conversations with nursing and medical providers caring for the frail elderly within an intensive care unit often reveal feelings of concern for overtreatment of patients when hope for improvement has diminished. Decline of critically ill elders regularly results in conflicts and disagreements surrounding care directives among patient, family, nursing, and specialty service teams. Uncertainty shrouds the care goals as the patient declines within a critical care setting. Nursing and medical providers caring for the critically ill elderly population often waver anxiously between aggressive verses palliative care measures and are troubled by ethical dilemmas of "doing more harm than good." Collaborative, interdisciplinary practice in the face of such dilemmas offers an interactive and practical approach that promotes clinical excellence and improves quality of care for the critically ill. This article defines palliative care, discusses the complexities of caring for the critically ill older adult, and suggests recommendations for nursing practice.
总体而言，重症护理和医疗团队在为危重症老年患者提供姑息治疗方面准备不足。与在重症监护病房照顾体弱老年人的护理人员和医疗人员交谈时，常常会发现，当患者病情改善的希望渺茫时，他们会担心对患者过度治疗。危重症老年人的病情恶化常常导致患者、家属、护理人员和专科服务团队在护理指令方面产生冲突和分歧。随着患者在重症监护环境中病情恶化，护理目标变得模糊不清。照顾危重症老年人群体的护理人员和医疗人员常常在积极治疗与姑息治疗措施之间焦虑地摇摆不定，并为“弊大于利”这样的伦理困境所困扰。面对此类困境时开展协作性的跨学科实践，能提供一种互动且实用的方法，促进临床卓越性，并改善危重症患者的护理质量。本文对姑息治疗进行了定义，讨论了照顾危重症老年人的复杂性，并提出了护理实践的建议。
