Vázquez-García Daniel, De-la-Rica-Escuín Marisa, Germán-Bes Concepción, Caballero-Navarro Ana-Luisa
Departamento de Fisiatría y Enfermería. Universidad de Zaragoza. Zaragoza. España.
Rev Esp Salud Publica. 2019 Aug 1;93:e201908051.
Emergency services are specialized in population's severe illness care. However, the increasing trend of chronic patients which in some cases require of palliative care, has lead to a higher influx of this type of patients in emergency services, thus growing the rate of deaths consequently. How is this fact perceived by the health professionals and which strategies they count on to face patients' death? The aim of this work was to deeply review the perception and the strategies to face patients' death in the end-of-life (EOL) at emergency services.
Systematic review of qualitative studies was made according to PRISMA statements. Research was performed in the following bibliographic databases: Pubmed, Web of Science, Scopus, EMBASE, CINAHL, VHL Regional portal, Cuiden, COCHRANE LIBRARY and JBI. Inclusion criteria were as follows: Physicians and Nurses with at least one year of working experience as health professionals, Pediatric care excluded. Methodological quality, data extraction and its inclusion process was made in agreement with the tools described in JBI.
The extracted findings were structured and added in 4 thematic categories: 1) Priority of professional attention according to the causes and origin of patient's death; 2) Environmental barriers in the department hindering attention at the EOL; 3) professionals' emotions dealing with patients' death; 4) Professional strategies dealing with patient' death.
Health care professionals (Physicians and nurses) face more efficiently patients' death when is caused by a critic disease than when is caused by chronic/palliative diseases. Environment and the lack of training have been identified as factors that difficult end-of-life attention in emergency services.
急救服务专门负责对重症患者的护理。然而，慢性病患者数量呈上升趋势，在某些情况下需要姑息治疗，这导致这类患者大量涌入急救服务部门，进而导致死亡率上升。医护人员如何看待这一事实，以及他们依靠哪些策略来面对患者的死亡？这项工作的目的是深入审视急救服务部门在临终关怀（EOL）中对患者死亡的认知和应对策略。
根据PRISMA声明对定性研究进行系统综述。在以下文献数据库中进行研究：PubMed、科学网、Scopus、EMBASE、CINAHL、VHL区域门户、Cuiden、Cochrane图书馆和JBI。纳入标准如下：具有至少一年医护工作经验的医生和护士，不包括儿科护理。方法学质量、数据提取及其纳入过程按照JBI中描述的工具进行。
提取的研究结果被整理并归纳为4个主题类别：1）根据患者死亡原因和起源确定的专业关注重点；2）部门内阻碍临终关怀的环境障碍；3）医护人员面对患者死亡时的情绪；4）应对患者死亡的专业策略。
与由慢性/姑息性疾病导致的患者死亡相比，医护人员（医生和护士）在面对由危重病导致的患者死亡时效率更高。环境和缺乏培训被认为是阻碍急救服务部门进行临终关怀的因素。
