Brooks Laura Anne, Manias Elizabeth, Nicholson Patricia
Laura Anne Brooks is a lecturer in the School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia. Elizabeth Manias is a research professor, Faculty of Health, School of Nursing and Midwifery, Deakin University; adjunct professor of medicine, The Royal Melbourne Hospital, and honorary professor, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. Patricia Nicholson is an associate professor in the School of Nursing and Midwifery, Deakin University; and honorary senior lecturer, Nursing Department, School of Health Sciences, The University of Melbourne.
Am J Crit Care. 2017 Jul;26(4):336-341. doi: 10.4037/ajcc2017774.
Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care.
To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit.
The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis.
Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making.
Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians.
重症监护病房的临床医生常常面临涉及停止或撤销维持生命治疗的决策，这带来了诸多临床和伦理挑战。沟通与共同决策是从积极治疗过渡到临终关怀的关键方面。
探讨护士和医生在重症监护病房启动临终关怀时的经历和观点。
该研究在澳大利亚墨尔本一家拥有24张床位的重症监护病房进行。采用解释性定性研究方法，以焦点小组作为数据收集方式。招募重症监护护士和医生参与特定学科的焦点小组。焦点小组讨论进行录音、转录，并进行主题数据分析。
开展了5个焦点小组；17名护士和11名医生参与。讨论的关键方面包括沟通和共同决策。与沟通相关的主题包括临终关怀讨论的时机以及进行艰难对话。临终关怀计划的实施、多学科接受度以及涉及患者和家属的协作决策是与共同决策相关的主题。
在重症监护病房启动临终关怀时，有效的沟通和决策实践很重要。重症监护病房临终关怀计划的多学科实施和接受度有待提高。支持引入护士和医生临终关怀负责人的明确组织流程对于优化患者、家属和临床医生的结局至关重要。
