[医院实践中的预先医疗指示：每个医疗专业人员和消费者都应关注的问题]
[Advance directives in hospital practice: A matter of concern for every healthcare professional and consumer].
作者信息
de Courson T, Sfeir C, de Guillebon G, Sanson H, Yannoutsos A, Priollet P
机构信息
Service de médecine interne, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France.
Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014 Paris, France.
出版信息
Rev Med Interne. 2019 Mar;40(3):145-150. doi: 10.1016/j.revmed.2018.04.019. Epub 2018 May 24.
INTRODUCTION
In France, Leonetti and Claeys-Leonetti laws relating to patients' rights and end-of-life practice have introduced the advance healthcare directives (ADs). Although family doctor's role is important in initiating discussions regarding AD, hospital healthcare professionals should also be concerned by the health care planning laws.
METHODS
A descriptive, quantitative and qualitative study was conducted in Paris Saint-Joseph hospital to evaluate the knowledge of nursing personnel regarding ADs. Among healthcare professionals present on 02/06/2016 and agreeing to participate, 50 non-medical caregivers and 50 doctors were randomly selected and took part in this survey. Three trainee lawyers conducted interviews, recorded and anonymized them. The Nvivo software analyzed the qualitative part of the results.
RESULTS
Only 10% of healthcare professionals knew these legal and ethical issues in health care. Most caregivers were not in favor of informing all patients admitted to a hospital (hospitalized patients or patients received consultations). For 44%, only hospitalized end-of-life patients should be informed about ADs. For 76% of the people questioned, family doctor has a unique position to guide the patient on the preparation and registration of living wills. In hospital stay, the nurse was proposed by 52% of the staff as the preferred caregiver for AD communication, as part of an interdisciplinary healthcare team approach. Finally, the clear majority of caregivers (85%), called for discussions and documentation about ADs, and end-of-life training.
CONCLUSION
Advance directives remain poorly known in the hospital, 12 years after the first Leonetti law. The attitude of professionals about ADs is not homogenous but interest for the subject is obvious in the vast majority of caregivers. The results of this survey highlighted that discussions and documentation about ADs as well as training on end-of-life patient care are essential.
引言
在法国，与患者权利及临终医疗实践相关的莱奥内蒂法和克莱伊斯 - 莱奥内蒂法引入了预先医疗指示（ADs）。尽管家庭医生在启动有关预先医疗指示的讨论中作用重要，但医院医护人员也应关注医疗保健规划法律。
方法
在巴黎圣约瑟夫医院进行了一项描述性、定量和定性研究，以评估护理人员对预先医疗指示的了解情况。在2016年6月2日在场且同意参与的医护人员中，随机挑选了50名非医疗护理人员和50名医生参与此次调查。三名实习律师进行访谈，并对访谈内容进行记录和匿名处理。Nvivo软件对结果的定性部分进行了分析。
结果
只有10%的医护人员了解这些医疗保健方面的法律和伦理问题。大多数护理人员不赞成告知所有住院患者（住院病人或接受会诊的患者）。44%的人认为，只应告知临终住院患者有关预先医疗指示的信息。76%的受访者认为，家庭医生在指导患者制定和登记生前遗嘱方面具有独特地位。在住院期间，52%的工作人员提议护士作为跨学科医疗团队中传达预先医疗指示的首选护理人员。最后，绝大多数护理人员（85%）呼吁就预先医疗指示进行讨论和记录，并开展临终培训。
结论
自第一部莱奥内蒂法颁布12年后，预先医疗指示在医院中仍鲜为人知。专业人员对预先医疗指示的态度并不一致，但绝大多数护理人员对该主题表现出明显兴趣。本次调查结果凸显了就预先医疗指示进行讨论和记录以及开展临终患者护理培训的重要性。
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