Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Asian Nurs Res (Korean Soc Nurs Sci). 2023 Dec;17(5):235-244. doi: 10.1016/j.anr.2023.10.001. Epub 2023 Oct 13.
Although the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified.
This study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients' background information was also collected. Univariate and multivariate analyses were performed to model the data.
The mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates' negative affect on decisional conflict was fully mediated by decision self-efficacy.
Surrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.
尽管一些代理人在医疗决策过程中感到不知所措，但对于他们的经历却缺乏了解。本研究的目的是探讨在面临是否对计划拔管后呼吸衰竭的患者进行再次插管的决策时，重症监护病房（ICU）中的代理人的决策自我效能感和决策冲突。此外，还确定了影响这些决策过程的预测因素和中介因素。
本研究采用横断面设计，于 2021 年 8 月至 2022 年 2 月在一家医疗中心的内科 ICU 中，调查了 174 名面临是否对计划拔管后呼吸衰竭的患者进行再次插管决策的代理人的决策过程。通过结构化问卷收集代理人的背景信息、决策自我效能感、决策冲突、正负性情绪的相关数据。还收集了患者的背景信息。采用单变量和多变量分析对数据进行建模。
代理人的决策自我效能感平均得分为 82.41 分，20.7%的代理人的决策冲突得分超过 37.5 分，表明他们在决策过程中面临挑战。代理人的就业状况和负性情绪显著预测其决策自我效能感。此外，患者住院前的日常生活活动能力以及代理人的决策自我效能感显著预测代理人的决策冲突。代理人的负性情绪对决策冲突的影响完全被决策自我效能感所中介。
代理人的决策自我效能感中介了负性情绪与决策冲突之间的关系。提供注重增强代理人自我效能感和减轻负性情绪的临床护理干预措施，可以帮助减轻该人群的决策冲突。
