Batley Nicholas J, Bakhti Rinad, Chami Ali, Jabbour Elsy, Bachir Rana, El Khuri Christopher, Mufarrij Afif J
Department of Emergency Medicine, American University of Beirut Medical Center, P.O.Box - 11-0236 Riad El Solh, Beirut, 1107 2020, Lebanon.
BMC Med Educ. 2017 Jul 10;17(1):110. doi: 10.1186/s12909-017-0945-9.
The emotional consequences of patient deaths on physicians have been studied in a variety of medical settings. Reactions to patient death include distress, guilt, and grief. Comparatively, there are few studies on the effects of patient death on physicians and residents in the Emergency Department (ED). The ED setting is considered unique for having more sudden deaths that likely include the young and previously healthy and expectations for the clinician to return to a dynamic work environment. To date, no studies have looked at the effects of patient deaths on the more vulnerable population of medical students in the ED. This study examined aspects of patient deaths in the ED that most strongly influence students' reactions while comparing it to those of an inpatient setting.
Semi-structured qualitative interviews were carried out with a total of 16 medical students from the American University of Beirut, Medical Center in Lebanon who had recently encountered a patient death in the ED. Questions included their reaction to the death, interaction with patients and their family members, the response of the medical team, and coping mechanisms adopted.
The analysis revealed the following as determinant factors of student reaction to patient death: context of death; including age of patient, expectation of death, first death experience, relating patient death to personal deaths, and extent of interaction with patient and family members. Importantly, deaths in an inpatient setting were judged as more impactful than ED deaths. ED deaths, however, were especially powerful when a trauma case was deemed physically disturbing and cases in which family reactions were emotionally moving.
The study demonstrates that students' emotional reactions differ as a function of the setting (surprise and shock in the ED versus sadness and grief in an inpatient setting). Debriefing and counseling sessions on ED deaths may benefit from this distinction.
在各种医疗环境中，都对患者死亡给医生带来的情感影响进行过研究。对患者死亡的反应包括痛苦、内疚和悲伤。相比之下，关于患者死亡对急诊科医生和住院医生影响的研究较少。急诊科环境被认为具有独特性，因为这里有更多的突然死亡病例，其中可能包括年轻人和此前健康的人，而且要求临床医生迅速回到充满活力的工作环境中。迄今为止，尚无研究探讨患者死亡对急诊科中较为脆弱的医学生群体的影响。本研究调查了急诊科患者死亡中对学生反应影响最为强烈的方面，并将其与住院部环境进行比较。
对黎巴嫩贝鲁特美国大学医学中心的16名医学生进行了半结构化定性访谈，这些学生最近在急诊科经历过患者死亡。问题包括他们对死亡的反应、与患者及其家属的互动、医疗团队的反应以及所采用的应对机制。
分析显示，以下因素是学生对患者死亡反应的决定性因素：死亡背景，包括患者年龄、对死亡的预期、首次死亡经历、将患者死亡与个人死亡联系起来的情况，以及与患者和家属的互动程度。重要的是，住院部的死亡被认为比急诊科的死亡影响更大。然而，当创伤病例被认为在身体上令人不安以及家属反应在情感上令人动容时，急诊科的死亡尤其具有冲击力。
该研究表明，学生的情感反应因环境而异（急诊科的惊讶和震惊与住院部的悲伤和悲痛）。关于急诊科死亡的汇报和咨询会议可能会受益于这种差异。
