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J Neurosci Nurs. 2014 Jun;46(3):162-70. doi: 10.1097/JNN.0000000000000049.
In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on "nondecisions" about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had "problems holding to the decision." The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was "communication barriers," a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
在瑞典，患有严重中风的患者在专门的中风病房接受治疗。在这些病房中，患者由多专业团队护理，重点关注中风急性期、康复期和姑息期的护理。照顾病情和症状差异如此大的患者可能对团队来说是一个额外的挑战。如今，团队在处理出现的困境和产生的后果方面缺乏相关知识。因此，本文的目的是研究在急性中风病房中从事临终护理的医护人员所面临的伦理困境、不同方法以及这些方法产生的后果。采访了 41 名在中风团队工作的医护人员，采访形式为焦点小组或个人访谈。数据逐字转录并使用内容分析法进行分析。出现的伦理困境取决于姑息治疗或停止治疗的“非决策”。由于缺乏共同的沟通工具，未做出决策使团队成员根据自己的个人技能采取行动。当做出决策时，医护人员“难以坚持决策”。制定和应用的计划可能会重新评估，这被描述为再次回到非决策的挫折。潜在的问题和主题是“沟通障碍”，这是缺乏共同技能和对价值体系的共识的后果。本研究强调了姑息治疗知识和技能的重要性，即使是患有严重中风的患者也需要这些知识和技能。做出决策并坚持下去是制定可信护理计划的前提。然而，实施基于姑息治疗、控制症状和提高生活质量的共同价值观可能会最大限度地减少可能出现的沟通障碍的风险，并提高创造有意义和有尊严的医疗保健的能力。
