Ivany Elena, Aitken Leanne
Intensive Care, Chelsea and Westminster Hospital NHS Foundation Trust, London, England.
City University of London, London, England.
Nurs Stand. 2019 May 24;34(6):44-50. doi: 10.7748/ns.2019.e11248.
Caring for patients who are at the end of their lives is an essential aspect of practice in intensive care units (ICUs). While intensive care is one of the fastest-growing healthcare specialties as a result of technological and scientific advances, a significant proportion of patients admitted to an ICU in the UK will not survive their ICU stay. Therefore, it is important to examine ways to enhance practice in this area and the factors that might affect the care provided to patients and their families.
To identify the challenges and facilitators that members of the ICU multidisciplinary team encounter in the delivery of end of life care to dying patients in ICUs.
A scoping literature review was undertaken. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with full text, MEDLINE Complete and the EBSCOhost E-Journals Database were searched electronically to identify literature from April 2007 to April 2017, alongside hand-searching. Critical appraisal tools were used and thematic analysis was undertaken to analyse the data and identify themes.
Ten articles were included in the literature review, which identified various challenges and facilitators in providing effective end of life care in ICUs. The main themes identified were: communication, family involvement, personal factors and the ICU environment.
All of the studies included in the literature review identified several important challenges related to communication, such as time constraints, disagreements among healthcare professionals, and a lack of knowledge among healthcare professionals about how to conduct challenging conversations with patients and families. Future developments in practice should consider the role of effective multidisciplinary team-working in end of life care.
照顾临终患者是重症监护病房（ICU）实践的一个重要方面。由于技术和科学进步，重症监护是发展最快的医疗专业之一，但在英国，入住ICU的患者中有很大一部分无法在ICU期间存活下来。因此，研究如何改进这一领域的实践以及可能影响为患者及其家属提供护理的因素非常重要。
确定ICU多学科团队成员在为ICU中临终患者提供临终护理时遇到的挑战和促进因素。
进行了一项范围综述。通过电子检索护理及相关健康文献累积索引（CINAHL）全文数据库、医学期刊全文数据库（MEDLINE Complete）和EBSCOhost电子期刊数据库，以识别2007年4月至2017年4月期间的文献，并进行手工检索。使用了批判性评价工具，并进行了主题分析以分析数据并确定主题。
文献综述纳入了10篇文章，这些文章确定了在ICU中提供有效的临终护理方面的各种挑战和促进因素。确定的主要主题包括：沟通、家属参与、个人因素和ICU环境。
文献综述中纳入的所有研究都确定了与沟通相关的几个重要挑战，例如时间限制、医疗专业人员之间的分歧以及医疗专业人员缺乏如何与患者及其家属进行具有挑战性对话的知识。实践中的未来发展应考虑有效的多学科团队合作在临终护理中的作用。
