Duke University School of Nursing (DUSON), Durham, NC, United States.
Intensive Crit Care Nurs. 2013 Dec;29(6):329-36. doi: 10.1016/j.iccn.2013.05.004. Epub 2013 Jul 21.
Using the Adaptive Leadership framework, we describe behaviours that providers used while interacting with family members facing the challenges of recognising that their loved one was dying in the ICU.
In this prospective pilot case study, we selected one ICU patient with end-stage illness who lacked decision-making capacity. Participants included four family members, one nurse and two physicians. The principle investigator observed and recorded three family conferences and conducted one in-depth interview with the family. Three members of the research team independently coded the transcripts using a priori codes to describe the Adaptive Leadership behaviours that providers used to facilitate the family's adaptive work, met to compare and discuss the codes and resolved all discrepancies.
We identified behaviours used by nurses and physicians that facilitated the family's ability to adapt to the impending death of a loved one. Examples of these behaviours include defining the adaptive challenges for families and foreshadowing a poor prognosis.
Nurse and physician Adaptive Leadership behaviours can facilitate the transition from curative to palliative care by helping family members do the adaptive work of letting go. Further research is warranted to create knowledge for providers to help family members adapt.
利用适应领导框架，我们描述了护理人员在与面临识别 ICU 中亲人即将死亡这一挑战的家属互动时所采用的行为。
在这项前瞻性试点案例研究中，我们选择了一位患有终末期疾病且缺乏决策能力的 ICU 患者。参与者包括四名家属、一名护士和两名医生。首席研究员观察并记录了三次家庭会议，并对家属进行了一次深入访谈。研究团队的三名成员使用事先确定的编码独立对转录本进行编码，以描述护理人员用于促进家庭适应工作的适应领导行为，然后开会比较和讨论这些编码，并解决所有差异。
我们确定了护士和医生用来促进家属适应亲人即将死亡的行为。这些行为的例子包括为家属定义适应挑战和预示预后不良。
护士和医生的适应领导行为可以通过帮助家属完成放手的适应工作，促进从治疗到姑息治疗的转变。需要进一步研究为护理人员提供知识，以帮助家属适应。
