School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Intensive Care Unit, Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.
Int J Qual Health Care. 2019 Dec 31;31(10):741-747. doi: 10.1093/intqhc/mzz003.
To compare perceptions of various aspects of palliative care for doctors and nurses; and examine factors contributing to perceived quality palliative care in intensive care units (ICUs).
A cross-sectional survey study conducted from November to December 2013. Questionnaires used were Knowledge, Attitudinal and Experiential Survey on Advance Directives (ADs), Clarke's Quality of Palliative Care and Nurses' Participation in the end-of-life (EOL) decision-making process.
Seven adult medical and surgical ICUs at a medical center in Northern Taiwan.
In total, 172 doctors and nurses who worked in adult ICU for more than 3 months.
Nurses' and doctors' perception of quality palliative care.
Nurses provided better care than doctors in symptom management, comfort care and spiritual care; their participation in EOL decision-making was the sole modifiable contributor to perceived quality palliative care in ICUs (β = 0.24, P < 0.01). Both doctors and nurses had positive attitudes towards ADs (mean = 4.05/10; standard deviation [SD] = 1.38) while their knowledge of ADs was poor (mean = 29.72/40; SD = 3.00). More than half of nurses currently participated in EOL decision-making and over 80% of doctors and nurses agreed both parties should engage in EOL decision-making process. Majority of doctors (83.9%) reckoned nurses agreed with their EOL decisions while a significant percentage (40%) of nurses were uncertain about doctors' decisions (χ2 = 12.07, P < 0.01).
Nurses' participation in EOL decision-making and strengthening spiritual care are imperative to rendering quality palliative care in ICUs. Potential disagreements arose during EOL decision-making between doctors and nurses; and insufficient knowledge of ADs should be addressed.
比较医生和护士对姑息治疗各个方面的看法；并探讨影响重症监护病房（ICU）姑息治疗质量的因素。
2013 年 11 月至 12 月进行的横断面调查研究。使用的问卷是关于预立医疗指示（AD）的知识、态度和经验调查、Clarke 的姑息治疗质量和护士参与临终决策过程的问卷。
台湾北部一家医疗中心的 7 个成人内科和外科 ICU。
共有 172 名在成人 ICU 工作超过 3 个月的医生和护士。
护士和医生对姑息治疗质量的感知。
在症状管理、舒适护理和精神护理方面，护士提供的护理优于医生；他们参与临终决策是 ICU 中感知姑息治疗质量的唯一可改变的贡献因素（β=0.24，P<0.01）。医生和护士对 ADs 的态度都很积极（平均值=4.05/10；标准差[SD]=1.38），而他们对 ADs 的知识却很差（平均值=29.72/40；SD=3.00）。超过一半的护士目前参与临终决策，超过 80%的医生和护士同意双方都应参与临终决策过程。大多数医生（83.9%）认为护士同意他们的临终决定，而相当一部分护士（40%）对医生的决定不确定（χ2=12.07，P<0.01）。
护士参与临终决策和加强精神护理对于在 ICU 提供高质量的姑息治疗至关重要。在医生和护士之间的临终决策过程中可能会出现潜在的分歧；应解决 ADs 知识不足的问题。
