Beta Eta, Assistant Professor, University of Wisconsin-Madison, School of Nursing, Madison, WI, USA.
J Nurs Scholarsh. 2019 Mar;51(2):129-137. doi: 10.1111/jnu.12459. Epub 2019 Jan 30.
To explore nurse-family communication during and after family meetings.
A cross-sectional study in which 36 family meetings were audio-recorded in two intensive care units in an urban, community hospital.
Data were analyzed using conversation analysis, a qualitative method.
Nurses spoke during 10 (28%) of the family meetings. During the family meetings, nurses mostly self-selected to take a turn by interrupting a physician or family member, finishing their sentences, responding to questions, and, in one instance, asking a question. Nurses were mostly selected as the next speaker to address logistical issues, but were also asked questions. Most of nurses' turns were short and simple, and aimed to provide clarification, reassurance, and information regarding the patient's status. Immediately after the family meetings, nurses offered to provide family members clarification or gestures of empathy, but these offers were met with resistance from family members.
Despite calls for nurses to take a more active role in surrogate decision making, nurses minimally participated during family meetings. Empowering nurses to share their expertise is one solution for nurses to contribute during family meetings. Further research is needed to explore nurse-family bedside interactions to improve our understanding of the nurse's role in the surrogate decision-making process.
Findings from this exploration of nurse communication during and after family meetings can inform how nurses may best assist families during surrogate decision making in the intensive care unit.
探讨家庭会议期间和之后护士与家属的沟通方式。
在一家城市社区医院的两个重症监护病房中，对 36 次家庭会议进行了横断面研究，对这些会议进行了录音。
使用会话分析（一种定性方法）对数据进行分析。
在 36 次家庭会议中，护士仅在 10 次（28%）会议中发言。在家庭会议中，护士主要通过打断医生或家属、完成他们的句子、回答问题等方式自行选择发言机会，在一个例子中，还提出了一个问题。护士大多被选为下一个发言者，以解决后勤问题，但也会被问到问题。护士的大部分发言简短而简单，旨在提供有关患者状况的澄清、保证和信息。家庭会议结束后，护士主动提出为家属提供澄清或表示同情，但这些提议遭到了家属的抵制。
尽管呼吁护士在替代决策中发挥更积极的作用，但护士在家庭会议中仅参与很少。赋予护士分享专业知识的权力是护士在家庭会议中做出贡献的一种解决方案。需要进一步研究护士与家属在床边的互动，以增进我们对护士在替代决策过程中角色的理解。
这项对家庭会议期间和之后护士沟通的探索性研究结果，可以为护士在重症监护病房中协助家属进行替代决策提供信息。
