护士参与对卒中单元临终决策过程中实践的影响。

Influence of nurse's involvement on practices during end-of-life decisions within stroke units.

作者信息

Kerever Sébastien, Crozier Sophie, Mino Jean-Christophe, Gisquet Elsa, Resche-Rigon Matthieu

机构信息

Departments of Anesthesiology and Critical Care, Lariboisière University Hospital, AP-HP, Paris, France; ECSTRA Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre UMR 1153, Inserm, Paris, France; University of Paris VII Denis Diderot, Paris, France.

Stroke unit Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France.

出版信息

Clin Neurol Neurosurg. 2019 Sep;184:105410. doi: 10.1016/j.clineuro.2019.105410. Epub 2019 Jul 2.

DOI:10.1016/j.clineuro.2019.105410

PMID:31310921

Abstract

OBJECTIVES

Decision-making processes concerning end-of-life decisions are not well understood for patients admitted into stroke units with severe stroke. To assess the influence of nurses on the medical perspectives and approaches that lead to withholding and/or withdrawing treatments related to end-of-life (EOL) decisions.

PATIENTS AND METHODS

This secondary analysis nested within the TELOS French national survey was based on a physicians' self-report questionnaire and on a I-Score which was linked to nurses' involvement. Physician's responses were evaluated to assess the potential influence of nurse's involvement on physician's choices during an end-of-life decision.

RESULTS

Among the 120 questionnaires analyzed, end-of-life decisions were more often made during a round-table discussion (58% vs. 35%, p = 0.004) when physicians declare to involve nurses in the decision process. Neurologists involved with nurses in decision making were more likely to withhold a treatment (98% vs. 88%, p = 0.04), to withdraw artificial feeding and hydration (59% vs. 39%, p = 0.04), and more frequently prescribed analgesics and hypnotics at a potentially lethal dose (70% vs. 48%, p = 0.03).

CONCLUSION

The involvement of nurses during end-of-life decisions for patients with acute stroke in stroke units seemed to influence neurologists' intensivist practices and behaviors. Nurses supported the physicians' decisions related to forgoing life sustaining treatment for patients with acute stroke and may positively impact on the family's choice to participate in end-of-life decisions.

摘要

目的

对于入住重症卒中单元的患者，其临终决策的制定过程尚不清楚。评估护士对导致临终（EOL）决策中停止和/或撤销治疗的医学观点及方法的影响。

患者与方法

这项嵌套于法国TELOS全国性调查的二次分析基于一份医生自填问卷以及一个与护士参与度相关的I评分。对医生的回答进行评估，以评估护士参与在临终决策过程中对医生选择的潜在影响。

结果

在分析的120份问卷中，当医生宣称让护士参与决策过程时，临终决策更常在圆桌讨论期间做出（58%对35%，p = 0.004）。参与决策的神经科医生更有可能停止一项治疗（98%对88%，p = 0.04），撤销人工喂养和补液（59%对39%，p = 0.04），并且更频繁地开具可能致死剂量的镇痛药和催眠药（70%对48%，p = 0.03）。