Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
J Palliat Med. 2012 Aug;15(8):910-5. doi: 10.1089/jpm.2011.0481. Epub 2012 Jun 7.
Integration of palliative care for intensive care unit (ICU) patients is important but often challenging, especially in surgical ICUs (SICUs), in part because many surgeons equate palliative care with terminal care and failure of restorative care. SICU nurses, who are key front-line clinicians, can provide insights into barriers for delivery of optimal palliative care in their setting.
We developed a focus group guide to identify barriers to two key components of palliative care-optimal communication regarding prognosis and optimal end-of-life care-and used the tool to conduct focus groups of nurses providing bedside care in three SICUs at a tertiary care, academic, inner city hospital. Using content analysis technique, responses were organized into thematic domains that were validated by independent observers and a subset of participating nurses.
Four focus groups included a total of 32 SICU nurses. They identified 34 barriers to optimal communication regarding prognosis, which were summarized into four domains: logistics, clinician discomfort with discussing prognosis, inadequate skill and training, and fear of conflict. For optimal end-of-life care, the groups identified 24 barriers in four domains: logistics, inability to acknowledge an end-of-life situation, inadequate skill and training, and cultural differences relating to end-of-life care.
Nurses providing bedside care in SICUs identify barriers in several domains that may impede optimal discussions of prognoses and end-of-life care for patients with surgical critical illness. Consideration of these perceived barriers and the underlying SICU culture is relevant for designing interventions to improve palliative care in this setting.
将姑息治疗整合到重症监护病房（ICU）患者中非常重要，但往往具有挑战性，尤其是在外科 ICU（SICU）中，部分原因是许多外科医生将姑息治疗等同于临终关怀和恢复治疗的失败。SICU 护士是关键的一线临床医生，他们可以深入了解在他们的环境中提供最佳姑息治疗的障碍。
我们制定了一个焦点小组指南，以确定姑息治疗的两个关键组成部分的障碍-关于预后的最佳沟通和最佳临终关怀-并使用该工具在一家三级护理、学术、城市内医院的三个 SICU 中进行床边护理的护士的焦点小组。使用内容分析技术，将回应组织成主题领域，这些领域由独立观察员和一组参与护士进行验证。
四个焦点小组共包括 32 名 SICU 护士。他们确定了 34 个关于预后最佳沟通的障碍，这些障碍被总结为四个领域：物流、临床医生对讨论预后的不适、技能和培训不足、以及对冲突的恐惧。对于最佳临终关怀，这些小组在四个领域确定了 24 个障碍：物流、无法承认临终情况、技能和培训不足、以及与临终关怀相关的文化差异。
在 SICU 中提供床边护理的护士确定了几个可能阻碍对患有外科危重病患者进行预后和临终关怀最佳讨论的障碍。考虑到这些感知到的障碍和潜在的 SICU 文化，对于设计干预措施以改善该环境中的姑息治疗具有相关性。
