School of Nursing, Duquesne University, Pittsburgh, Pennsylvania, USA.
AJOB Empir Bioeth. 2021 Oct-Dec;12(4):239-252. doi: 10.1080/23294515.2021.1907477. Epub 2021 Apr 19.
Historically nurses have lacked significant input in end-of-life decision-making, despite being an integral part of care. Nurses experience negative feelings and moral conflict when forced to aggressively deliver care to patients at the EOL. As a result, nurses participate in slow codes, described as a limited resuscitation effort with no intended benefit of patient survival. The purpose of this study was to explore and understand the process nurses followed when making decisions about participation in limited resuscitation. Five core categories emerged that describe this theory: (1) recognition of patient and family values at the EOL; (2) stretching time and reluctance in decision-making; (3) harm and suffering caused by the physical components of CPR; (4) nurse's emotional and moral response to delivering aggressive care, and; (5) choosing limited resuscitation with or without a physician order. Several factors in end-of-life disputes contribute to negative feelings and moral distress driving some nurses to perform slow codes in order to preserve their own moral conflict, while other nurses refrain unless specifically ordered by physicians to provide limited care through tailored orders.
从历史上看，尽管护士是护理工作的重要组成部分，但他们在临终决策方面的参与程度并不高。护士在被迫积极为临终患者提供护理时，会感到负面情绪和道德冲突。因此，护士会参与“缓慢编码”，即一种有限的复苏努力，没有患者生存的预期获益。本研究旨在探讨和了解护士在参与有限复苏决策时所遵循的过程。五个核心类别描述了这一理论：（1）临终时识别患者和家属的价值观；（2）在决策中拖延时间和不情愿；（3）心肺复苏术的物理组件造成的伤害和痛苦；（4）护士对积极护理的情绪和道德反应；（5）在有或没有医生医嘱的情况下选择有限复苏。临终争议中的几个因素导致负面情绪和道德困境，促使一些护士进行缓慢编码，以保护自己的道德冲突，而其他护士则会拒绝提供有限的护理，除非医生特别下令通过定制医嘱来提供。
