Coombs Maureen, Fulbrook Paul, Donovan Sarah, Tester Rachel, deVries Kay
Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
School of Nursing, Midwifery, and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
Aust Crit Care. 2015 May;28(2):82-6. doi: 10.1016/j.aucc.2015.03.002. Epub 2015 Mar 29.
With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing.
To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care.
Sequential mixed methods study using cross sectional survey with follow-on focus groups.
NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted in each of the sites to explore specific aspects of the survey findings.
203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over half of nurses surveyed (55%, n=111) disagreed that withholding and withdrawing life support treatment were ethically the same. 78% (n=159) of nurses stated that withholding treatment was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that demonstrated one of the highest levels of uncertainty (21%, n=41). Just under a quarter of respondents were also uncertain about the use of continued nutritional support, continued passive limb exercises and use of deep sedation during EOL. The 18 nurses who participated in follow-on focus groups detailed the supportive, culturally sensitive, collaborative environment that EOL was conducted in. However diverse opinions and understandings were held on the use of passive limb and use of fluids at EOL.
Whilst results from this NZ study broadly align with European studies, uncertainty about specific areas of EOL practices highlight that further guidance for nurses is required.
临终关怀是重症监护护理工作的核心，但很少有研究在新西兰重症监护护理的背景下探讨临终关怀。
调查新西兰重症监护护士对临终关怀的经历和态度。
采用横断面调查和后续焦点小组的顺序混合方法研究。
联系了新西兰四个大型三级重症监护病房（ICU）的465名重症监护护士，让他们完成一项包含43个项目的网络调查。在每个地点进行了后续焦点小组讨论，以探讨调查结果的具体方面。
四个ICU共返回了203份完整填写的调查问卷（回复率44%）。超过一半接受调查的护士（55%，n = 111）不同意在伦理上 withholding 和 withdrawing 生命支持治疗是相同的。78%（n = 159）的护士表示，在伦理上 withholding 治疗比 withdrawing 治疗更可接受。虽然护士们普遍支持在临终时为使用呼吸机的患者将吸入氧气降至空气水平（71%，n = 139），但这也是不确定性最高的领域之一（21%，n = 41）。不到四分之一的受访者对临终时持续营养支持、持续被动肢体运动和深度镇静的使用也不确定。参与后续焦点小组讨论的18名护士详细描述了进行临终关怀的支持性、文化敏感、协作性环境。然而，对于临终时被动肢体运动和液体使用存在不同意见和理解。
虽然这项新西兰研究的结果与欧洲研究大致一致，但临终关怀实践特定领域的不确定性凸显了需要为护士提供进一步的指导。
