Frampton M W, Mayewski R J
Myers Community Hospital, Sodus, New York.
J Gen Intern Med. 1987 Nov-Dec;2(6):394-9. doi: 10.1007/BF02596364.
Physician and nurse attitudes regarding aggressiveness of patient care were prospectively surveyed by questionnaire in a small rural community hospital. All patient admissions during one year, excluding routine obstetrical cases, were surveyed. Physicians and nurses used a simple continuous scale to indicate care level (1 = comfort care to 5 = full care). Nurses were more willing than physicians to limit care efforts for patients (mean scores of 4.35 vs 4.79, respectively). Both physicians and nurses indicated nearly identical factors important in making decisions to limit full resuscitative efforts: quality of life, nature of underlying illness, and age. A significant communication gap existed between nurses and physicians regarding aggressiveness of care: physicians indicated communication with nursing staff in 564 cases; nurses acknowledged this in only 56 of these same cases. These data suggest that current policies regarding do not resuscitate (DNR) orders should be broadened to include guidelines for less than full aggressive patient care. These policies should ensure adequate, documented communication between professional staff, patients, and others significantly involved with patient care decisions.
在一家小型乡村社区医院，通过问卷调查对医生和护士关于积极治疗患者的态度进行了前瞻性研究。对一年期间所有入院患者（不包括常规产科病例）进行了调查。医生和护士使用一个简单的连续量表来表示护理水平（1 = 舒适护理至5 = 全面护理）。护士比医生更愿意限制对患者的护理力度（平均得分分别为4.35和4.79）。医生和护士都指出，在决定限制全力复苏努力时，几乎相同的因素很重要：生活质量、基础疾病的性质和年龄。在护理的积极性方面，护士和医生之间存在显著的沟通差距：医生表示在564例病例中与护理人员进行了沟通；护士仅在其中56例相同病例中承认了这一点。这些数据表明，当前关于“不要复苏”（DNR）医嘱的政策应予以扩大，以纳入关于不完全积极治疗患者的指导方针。这些政策应确保专业人员、患者以及其他与患者护理决策密切相关的人员之间进行充分的、有记录的沟通。
