Wiegand Debra L, Cheon Jooyoung, Netzer Giora
1 University of Maryland School of Nursing, Baltimore, MD, USA.
2 Department of Nursing Science, College of Nursing, Sungshin Women's University, Seoul, South Korea.
Am J Hosp Palliat Care. 2019 Jan;36(1):13-23. doi: 10.1177/1049909118801011. Epub 2018 Sep 24.
Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians' experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.
在生命末期撤除维持生命的治疗是一个复杂的现象。在做出这些艰难决策时，重症监护护士和医生面临着照顾患者并支持其家属的任务。本研究的目的是探索和描述参与撤除维持生命治疗过程的重症监护护士和医生的经历。采用诠释现象学方法指导这项定性研究。对来自两个医疗中心的重症监护护士和医生进行了访谈。运用归纳法进行数据分析，以了解护士和医生经历之间的相似之处。确立了方法的严谨性，并达到了数据饱和。从数据分析中归纳得出的主要类别包括从新手到专家、确保符合伦理的护理、从不确定到确定、推动该过程以及为家属做准备和提供支持。这些类别有助于理解护士和医生的经历，因为他们单独或共同努力陪伴患者及其家属度过整个疾病历程、撤除维持生命治疗的决策过程和死亡过程。了解参与撤除维持生命治疗过程的医疗服务提供者的观点，将有助于其他努力为临终患者及其家属提供优质护理的医疗服务提供者。
