Latour Jos M, Fulbrook Paul, Albarran John W
Clinical Researcher, Paediatric Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Nurs Crit Care. 2009 May-Jun;14(3):110-21. doi: 10.1111/j.1478-5153.2008.00328.x.
Available literature suggests that critical care nurses have varied experiences in relation to end-of-life (EOL) care. Few studies have examined the involvement of European intensive care nurses' involvement in EOL care decisions and the extent to which their nursing practice is based on shared beliefs, experiences and attitudes.
To investigate experiences and attitudes of European intensive care nurses regarding EOL care.
Using a survey method, delegates (n = 419) attending an international critical care nursing conference were invited to complete a self-administered questionnaire about their involvement with EOL care practices. The questionnaire composed of 45 items and was available in three European languages.
A total of 164 questionnaires were completed, yielding a response rate of 39%. The majority of respondents (91.8%) indicated direct involvement in EOL patient care, while 73.4% reported active involvement in decision-making process. 78.6% of respondents expressed commitment to family involvement in EOL decisions, however only 59.3% of the participants said that this was routinely undertaken (p < 0.0005, Z = -4.778). In decisions to withdraw or withhold therapy, 65% would decrease the flow of inspired oxygen, 98.8% provide continuous pain relief and 91.3% endorse open visiting. The majority (78%) disagreed that dying patients should be transferred to a single room. A division of views was observed in relation to 44% agreeing that patients should be kept deeply sedated and equal numbers contesting the continuation of nutritional support (41.6% versus 42.3%).
The involvement of European intensive care nurses in EOL care discussions and decisions is reasonably consistent with many engaged in initiating dialogue with coworkers. In general, views and experiences of EOL care were similar, with the exception of the provision of nutrition and use of sedation.
Use of formal guidelines and education may increase nurses' involvement and confidence with EOL decisions.
现有文献表明，重症护理护士在临终关怀方面有着不同的经历。很少有研究探讨欧洲重症监护护士参与临终关怀决策的情况，以及他们的护理实践在多大程度上基于共同的信念、经验和态度。
调查欧洲重症监护护士对临终关怀的经历和态度。
采用调查方法，邀请参加国际重症护理会议的代表（n = 419）填写一份关于他们参与临终关怀实践的自填式问卷。该问卷由45个项目组成，有三种欧洲语言版本。
共完成164份问卷，回复率为39%。大多数受访者（91.8%）表示直接参与临终患者护理，而73.4%报告积极参与决策过程。78.6%的受访者表示支持家属参与临终决策，然而只有59.3%的参与者表示这是常规进行的（p < 0.0005，Z = -4.778）。在撤掉或停止治疗的决策中，65%会减少吸氧流量，98.8%会提供持续的疼痛缓解，91.3%支持开放探视。大多数人（78%）不同意将临终患者转移到单人病房。在44%的人同意应让患者深度镇静以及相同比例的人反对继续提供营养支持（41.6%对42.3%）方面存在意见分歧。
欧洲重症监护护士参与临终关怀讨论和决策的情况与许多参与与同事展开对话的人相当一致。总体而言，除了营养提供和镇静使用外，临终关怀的观点和经历相似。
使用正式指南和教育可能会增加护士参与临终决策的程度和信心。
