Daly Barbara J, Douglas Sara L, Lipson Amy R
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
Int J Nurs Res. 2018;4(4):281-287.
The aim of this study was to describe similarities and differences over time in expectations held by family members of long-term critically ill patients and the nurses caring for those patients.
In addition to demographic data, outcome expectations of family decision makers and ICU nurses were obtained by asking each participant to indicate expectations for the patient, 6 months in the future, for survival, cognition, and functional status. Families also were asked what kind of information was most important in understanding the patient's condition and what was most important in making decisions.
This was a descriptive correlational analysis. Nurses and family members were surveyed on the 3-5 day of the patient's stay, and every 5 days until discharge or death. Correlations between nurse and family predictions were examined using Pearson R. Repeated measures analysis of variance (RMANOVA) was used to explore the relationship between the family member's rating of what was most important in the care of the patient (survival vs. quality of life) and that individual's prediction of the likelihood of survival, over time.
Family members consistently predicted better outcomes than nurses, with >80% of families predicting a high likelihood of survival, while <50% of nurses thought survival probability was high. There were similar differences in expectations for functional status and cognition. Between 14% and 23% of families indicated it was talking with the nurses that were most important.
Results suggest a need for design and tests of nurse interventions aimed at improving family understanding of patient prognosis and future outcomes.
本研究旨在描述长期重症患者家属与护理这些患者的护士在不同时间对患者期望的异同。
除人口统计学数据外，通过要求每位参与者指出对患者未来6个月生存、认知和功能状态的期望，获取家庭决策者和重症监护室护士的结果期望。还询问家属在了解患者病情时哪种信息最重要，以及在做决策时什么最重要。
这是一项描述性相关性分析。在患者住院的第3至5天对护士和家属进行调查，此后每5天调查一次，直至出院或死亡。使用Pearson R检验护士与家属预测之间的相关性。采用重复测量方差分析（RMANOVA）来探讨家属对患者护理中最重要因素（生存与生活质量）的评分与该个体对生存可能性的预测随时间的关系。
家属始终比护士预测的结果更好，超过80%的家属预测患者生存可能性高，而不到50%的护士认为生存概率高。在功能状态和认知期望方面也存在类似差异。14%至23%的家属表示与护士交谈是最重要的。
结果表明需要设计和测试旨在提高家属对患者预后和未来结果理解的护士干预措施。
