Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ON, Canada; School of Nursing, Polytechnic University, Hong Kong, SAR, China.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ON, Canada.
Nurs Crit Care. 2017 Jul;22(4):229-237. doi: 10.1111/nicc.12154. Epub 2015 Feb 18.
chronic critical illness (CCI) is a complex syndrome with a high risk of dying in hospital. Intensive care unit nurses are well-positioned to lead conversations integrating palliative and end-of-life care, yet have reported limited involvement.
To generate further understanding of nurses' experiences of patients with CCI and their families.
This qualitative study followed Thorne's interpretive description methods. In 2012, 16 intensive care unit nurses from one academic hospital participated in interviews.
Our primary theme was that of internal tension generated through participants' knowledge of patients' anticipated and protracted dying, while wanting to shield families from suffering. This internal tension resulted from responsibilities to preserve hope for patients and families, while at the same time wanting to provide them prognostic information. Participants experienced challenges of: (i) preserving family trust, (ii) determining when and how to engage families in discussions and (iii) providing possibilities of a 'good' death. A secondary theme described constraints to acting on their insights because of interprofessional team dynamics or limited communication, within the team and with the family.
Internal tension, as experienced by participants reflects the challenges of transition from acute to palliation and end-of-life care, made more complex in CCI, because of its poorly defined terminal stage. Nurses' ability to manage the complex process of supporting hope while gradually providing information to build family understanding of CCI highlights their central role in facilitating what and how prognostic information is given, while managing the emotional implications and family response. To better support nurses do this, we advocate for formal structures enabling nurses to participate in decision-making regarding timing of transitions using palliation and end-of-life care.
慢性危重病（CCI）是一种复杂的综合征，患者在医院死亡的风险很高。重症监护病房的护士最适合领导姑息治疗和临终关怀的对话，但据报道，他们的参与度有限。
进一步了解护士对患有 CCI 的患者及其家属的体验。
本定性研究遵循 Thorne 的解释性描述方法。2012 年，来自一家学术医院的 16 名重症监护病房护士参与了访谈。
我们的主要主题是参与者对患者预期和延长死亡的了解所产生的内在紧张，同时希望保护家属免受痛苦。这种内在紧张源于对患者和家属保持希望的责任，同时又希望为他们提供预后信息。参与者面临以下挑战：（i）保护家庭信任，（ii）确定何时以及如何让家属参与讨论，以及（iii）提供“美好”死亡的可能性。次要主题描述了由于团队内的跨专业动态或团队内部和与家属之间的有限沟通，对基于他们的见解采取行动的限制。
参与者所经历的内在紧张反映了从急性到姑息治疗和临终关怀的过渡所带来的挑战，在 CCI 中由于其定义不明确的终末期而变得更加复杂。护士在支持希望的同时逐渐提供信息以建立家属对 CCI 的理解的能力，突显了他们在促进提供预后信息的内容和方式，同时管理情感影响和家属反应方面的核心作用。为了更好地支持护士做到这一点，我们主张建立正式的结构，使护士能够参与关于姑息治疗和临终关怀时机的决策制定。
