Beckstrand Renea L, Smith Michelle D, Heaston Sondra, Bond A Elaine
Brigham Young University, College of Nursing, 422 SWKT, PO Box 25432, Provo, UT 84602-5432, USA.
J Emerg Nurs. 2008 Aug;34(4):290-300. doi: 10.1016/j.jen.2007.09.004. Epub 2008 Jun 11.
Emergency nurses care for dying patients daily. The process of dying in an emergency department can be complicated. Research on specific obstacles that impede the delivery of end-of-life care in emergency departments and behaviors that support it is limited.
A 70-item questionnaire was mailed to randomly selected ENA members. Subjects were asked to rate items on the size, frequency, and magnitude of obstacles and supportive behaviors that relate to end-of-life care for ED patients.
The perceived obstacles with the greatest magnitude were as follows: (a) ED nurses' work loads being too high to allow adequate time for patient care, (b) poor design of emergency departments, and (c) family members not understanding what "life-saving measures" really mean. The three highest-scoring supportive behaviors were as follows: (a) allowing family members adequate time to be alone with the patient after he or she has died; (b) having good communication between the physician and RN; and (c) providing a peaceful, dignified bedside scene for family members once the patient has died.
It is hoped that the results of this study will help increase and facilitate the discussions regarding end-of-life care in emergency departments. Realistic initial implications include finding ways to decrease workloads of emergency nurses and increase direct patient care. Another important implication would be the improvement of ED designs. Further research in the area of end-of-life care in emergency settings is recommended.
急诊护士每天都要照顾濒死患者。在急诊科的死亡过程可能很复杂。关于阻碍急诊科临终关怀服务提供的具体障碍以及支持临终关怀的行为的研究有限。
向随机抽取的急诊护士协会成员邮寄一份包含70个条目的问卷。要求受试者对与急诊科患者临终关怀相关的障碍和支持行为的规模、频率和程度进行评分。
被认为影响最大的障碍如下：（a）急诊护士工作量过大，没有足够时间照顾患者；（b）急诊科设计不佳；（c）家庭成员不理解“救生措施”的真正含义。得分最高的三种支持行为如下：（a）在患者死亡后，给家庭成员足够时间与患者独处；（b）医生和注册护士之间进行良好沟通；（c）在患者死亡后，为家庭成员营造一个安静、有尊严的床边场景。
希望本研究结果将有助于增加并促进关于急诊科临终关怀的讨论。实际的初步影响包括找到减轻急诊护士工作量和增加直接患者护理的方法。另一个重要影响将是改善急诊科设计。建议在急诊环境下的临终关怀领域进行进一步研究。
