Bloomer Melissa J, Endacott Ruth, Ranse Kristen, Coombs Maureen A
School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.
Centre for Quality and Patient Safety Research, Deakin University, Geelong, Vic., Australia.
J Clin Nurs. 2017 Mar;26(5-6):690-697. doi: 10.1111/jocn.13585. Epub 2016 Nov 28.
To explore how nurses navigate communication with families during withdrawal of life-sustaining treatment in intensive care.
Death in the intensive care unit is seldom unexpected and often happens following the withdrawal of life-sustaining treatment. A family-centred approach to care relies on the development of a therapeutic relationship and understanding of what is happening to the patient. Whilst previous research has focused on the transition from cure to palliation and the nurse's role in supporting families, less is known about how nurses navigate communication with families during treatment withdrawal.
A qualitative descriptive approach was used. Semi-structured focus groups were conducted with adult critical care nurses from four intensive care units, two in Australia and two in New Zealand.
Twenty-one nurses participated in the study. Inductive content analysis revealed five key themes relating to how nurses navigate family communication: (1) establishing the WHO; (2) working out HOW; (3) judging WHEN; (4) assessing the WHAT; and (5) WHERE these skills were learnt.
Navigating an approach to family communication during treatment withdrawal is a complex and multifaceted nursing activity that is known to contribute to family satisfaction with care. There is need for support and ongoing education opportunities that develop the art of communication in this frequently encountered aspect of end-of-life care.
How nurses navigate communication with families during treatment withdrawal is just as important as what is communicated. Nurses need access to supports and education opportunities in order to be able to perform this vital role.
探讨重症监护病房中，护士在撤除维持生命治疗期间如何与家属进行沟通。
重症监护病房内的死亡很少是意外情况，通常发生在撤除维持生命治疗之后。以家庭为中心的护理方法依赖于建立治疗性的关系以及对患者情况的了解。虽然先前的研究集中在从治疗到姑息治疗的转变以及护士在支持家属方面的作用，但对于护士在治疗撤除期间如何与家属进行沟通了解较少。
采用定性描述性方法。对来自四个重症监护病房（澳大利亚两个，新西兰两个）的成年重症监护护士进行了半结构化焦点小组访谈。
21名护士参与了该研究。归纳性内容分析揭示了与护士如何进行家庭沟通相关的五个关键主题：（1）确定沟通对象；（2）想出沟通方式；（3）判断沟通时机；（4）评估沟通内容；（5）这些沟通技巧的学习途径。
在治疗撤除期间采用一种家庭沟通方法是一项复杂且多方面的护理活动，已知这有助于提高家属对护理的满意度。需要提供支持和持续的教育机会，以培养在临终护理这一常见方面的沟通技巧。
护士在治疗撤除期间与家属沟通的方式与沟通内容同样重要。护士需要获得支持和教育机会，以便能够履行这一重要职责。
