Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW, 2751, Australia.
Aust Crit Care. 2020 Jul;33(4):311-316. doi: 10.1016/j.aucc.2019.08.004. Epub 2019 Oct 31.
End-of-life (EOL) decision-making in the intensive care unit (ICU) can be emotionally challenging for both doctors and nurses, who are sometimes placed in difficult positions where they are required to make decisions on behalf of patients. With an ageing population and advances in medical technology, there is an increase in such decisions being made in ICUs.
The objective of this study was to explore the perspectives of doctors and nurses involved in the EOL decision-making process in an ICU.
This study used a qualitative methodology based on naturalistic inquiry. Intensive care nurses and doctors from a large Sydney metropolitan public hospital were purposively selected, and data saturation was reached after a total of eight nurses and four doctors were interviewed. Data were collected through semistructured interviews, either face-to-face or over the telephone. Interviews were then transcribed verbatim, and themes were identified and coded through a line-by-line analysis of each transcript (manual thematic analysis).
The findings revealed two main themes: 'Doctors' and nurses' roles in decision-making' and 'Managing family expectations'. These themes highlighted key differences in decision-making processes, in that doctors tended to aim to meet the family's needs, while the nurses tended to advocate on behalf of the patient and what they interpreted as the patient's best interests. Furthermore, nurses tended to feel undervalued in decision-making during family conferences, when in reality, the doctors were making decisions based on all information obtained, primarily from nursing staff.
EOL decision-making is complex and affects doctors and nurses involved in different ways. More emphasis on interprofessional education and collaboration between the two disciplines may enhance future decision-making processes.
在重症监护病房（ICU）进行临终（EOL）决策对医生和护士来说都是情感上的挑战，他们有时处于需要代表患者做出决策的困境中。随着人口老龄化和医疗技术的进步，ICU 中做出此类决策的情况有所增加。
本研究旨在探讨参与 ICU 临终决策过程的医生和护士的观点。
本研究采用基于自然主义探究的定性方法。从一家大悉尼都会区公立医院有目的地选择了重症监护护士和医生，在总共采访了 8 名护士和 4 名医生后达到了数据饱和。通过半结构化访谈收集数据，无论是面对面还是通过电话进行。访谈随后逐字转录，通过对每个转录本（手动主题分析）进行逐行分析来确定和编码主题。
研究结果揭示了两个主要主题：“医生和护士在决策中的角色”和“管理家庭期望”。这些主题突出了决策过程中的关键差异，即医生倾向于满足家庭的需求，而护士则倾向于代表患者及其认为的患者最佳利益进行倡导。此外，护士在家庭会议上参与决策时往往感到被低估，而实际上，医生是根据从护理人员那里获得的所有信息做出决策的。
EOL 决策复杂，对参与其中的医生和护士产生不同的影响。更多地强调专业间教育和两个学科之间的协作可能会增强未来的决策过程。
