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成人重症监护中无效的治疗性护理干预措施:一项描述性研究。

Futile therapeutic nursing interventions in adult intensive care: A descriptive study.

作者信息

Vieira João Vítor, Oliveira Henrique, Deodato Sérgio, Mendes Felismina

机构信息

Universidade Católica Portuguesa.

Instituto de Telecomunicações.

出版信息

Nurs Ethics. 2025 Aug;32(5):1458-1476. doi: 10.1177/09697330241277988. Epub 2024 Sep 28.

Abstract

Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same population, as perceived by adult intensive care nurses. Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. A simple random sample of nurses working in level II and level III intensive care units in Portugal. Research ethical approvals were obtained, and the participants provided informed consent. Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses' perception of their futility. There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions.

摘要

尽管近几十年来在成人重症监护中的无效治疗现象方面取得了进展,但在临床护理实践中识别它仍然是一个复杂且敏感的过程,在此过程中常常会出现一些难以找到具体答案的问题。分析在特定情况下入住成人重症监护病房的重症患者中实施无效护理干预的频率,以及成人重症监护护士所感知的在同一人群中自主和相互依赖的无效护理干预的实施频率。横断面、定量和描述性研究,采用专门为本研究构建的问卷来评估成人重症监护中护理治疗无效的认知。在对心理测量特性进行评估后,该问卷于2024年8月至10月以电子格式在EUSurvey平台上提供。使用统计软件包SPSS和R在2023年11月至2024年3月期间对数据进行分析。对葡萄牙二级和三级重症监护病房工作的护士进行简单随机抽样。获得了研究伦理批准,参与者提供了知情同意书。共获得414份有效问卷。结果能够识别出33个具有统计学意义的关联,推断出护理干预无效认知的均值和中位数的区间,置信区间为95%,并能根据护士对入住成人重症监护病房的重症患者实施的护理干预的无效认知进行分层。在所分析的特定情况下,护士对其干预无效性的认知存在平衡。有统计学意义的证据表明,与自主护理干预相比,相互依赖的护理干预总体上更常被视为无效。

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