Oerlemans Anke J M, van Sluisveld Nelleke, van Leeuwen Eric S J, Wollersheim Hub, Dekkers Wim J M, Zegers Marieke
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
Department of Intensive Care Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
BMC Med Ethics. 2015 Feb 26;16:9. doi: 10.1186/s12910-015-0001-4.
There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.
This was an explorative, descriptive study using qualitative methods (individual and focus group interviews). We conducted 19 individual interviews and 4 focus group interviews with nurses and physicians working in the ICU or the general ward of 10 Dutch hospitals.
The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. The gap between the high level of care the ICU can provide and the lower care level in the general ward sometimes leads to mutual misunderstandings. Our results indicate that when professionals of different wards feel there is a collective responsibility and effort to solve a problem, this helps to prevent or alleviate moral distress. ICU patients' wishes are often unknown, causing healthcare professionals to err on the side of more treatment. Additionally, the highly technological nature of intensive care appears to encourage over-treatment.
It is important for ICUs and general wards to communicate and cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients. Early discussion of a patient's wishes with regard to treatment options is important in preventing over-treatment.
关于在决定重症监护病房（ICU）患者的收治和出院时，哪些非医疗因素会影响医生和护士，实证研究较少。了解医护人员对这一过程的态度，有助于改善重症监护资源分配的决策。为深入了解影响ICU收治和出院过程的伦理问题，我们旨在识别和探讨医护人员面临的伦理困境。
这是一项采用定性方法（个人访谈和焦点小组访谈）的探索性描述性研究。我们对荷兰10家医院的ICU或普通病房的护士和医生进行了19次个人访谈和4次焦点小组访谈。
ICU收治和出院背景下的伦理问题可分为与床位满员相关的问题和与治疗决策相关的问题。ICU所能提供的高水平护理与普通病房较低的护理水平之间的差距有时会导致相互误解。我们的结果表明，当不同病房的专业人员感到有共同的责任和努力来解决问题时，这有助于预防或减轻道德困扰。ICU患者的意愿往往不为人知，导致医护人员倾向于进行更多治疗。此外，重症监护的高科技性质似乎助长了过度治疗。
ICU和普通病房之间良好的沟通与合作很重要，因为不同科室之间为实现最佳患者流动存在相互依存关系。改善这些病房之间理解与合作的干预措施可能有助于缓解伦理问题。ICU环境的性质使得医护人员意识到过度治疗的风险、反思自己行为的原因以及注意过度治疗对患者可能产生的负面影响非常重要。尽早讨论患者对治疗方案的意愿对于预防过度治疗很重要。
