Kohlen Helen, McCarthy Joan, Szylit Buosso Regina, Gallagher Ann, Andrews Tom
1 Philosophisch-Theologische Hochschule Vallendar, Deutschland.
2 University Cork, Irland.
Pflege. 2015 Dec;28(6):329-38. doi: 10.1024/1012-5302/a000458.
Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses’ decision-making processes and nursing activities in different countries are scarcely studied.
Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described?
The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit.
Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis.
The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was ’negotiated reorienting’: The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses’ core practices are ’consensus seeking’ and ’emotional holding’ (sub-categories).
In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.
重症监护病房（ICU）传统上是为因疾病或事故而处于危急状况的患者提供高科技先进治疗的场所。关于撤除和 withholding（此处疑为“ withhold”，意为“ withholding”，即停止、 withholding 维持生命治疗以及终止维持生命治疗的问题与伦理困境相关。不同国家护士的决策过程和护理活动鲜有研究。
能识别和描述护士进行的哪些临终决策过程和活动？
目标是识别重症监护病房患者临终护理中决策和活动方面的护理领域。
在大学或医院场所对 51 名经验丰富的护士进行了半结构化访谈：巴西 10 名、英国 9 名、德国 10 名、爱尔兰 10 名以及巴勒斯坦 12 名护士。该研究采用扎根理论为数据收集和分析提供依据。
该研究的发现是识别出一个动态过程，其中重点在于治愈的活动转向重点在于临终护理的活动。出现的核心类别是“协商重新定位”：活动的转变意味着护士与医生、亲属以及自身之间的协商。此外，该过程的特点是由不断变化的患者数据和对整体情况的认识引发持续的重新定位。护士的核心实践是“寻求共识”和“情感支持”（子类别）。
在所有国家都能识别和描述临终护理活动的护理领域。然而，尚不清楚与患者亲属相关的护理活动是否占主导地位，以至于与临终患者的关系及其自主性的尊重被置于次要地位。一项实地研究可能会回答这个问题。
