伦理考量与重症监护病房中家庭和危重症患者的虚拟探视：一项定性描述性研究。
Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study.
机构信息
Imperial College London, London, UK.
Guy's and St Thomas' NHS Foundation Trust, London, UK.
出版信息
BMC Med Ethics. 2024 Nov 9;25(1):126. doi: 10.1186/s12910-024-01130-z.
BACKGROUND
During the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting. This study aimed to explore the anticipated or unanticipated ethical issues raised by using virtual visiting in the ICU, such that healthcare professionals can be informed about how to carry out virtual visits ethically, safely and productively.
METHODS
We used a descriptive exploratory qualitative research approach recruiting a convenience sample of newly-graduated junior doctors facilitating ICU virtual visits in a tertiary academic centre. Eight newly graduated junior doctors, seven female and one male, aged 23-27, participated in semi-structured interviews. We analysed transcripts using an inductive coding approach.
RESULTS
Five overarching themes emerged. Two of the themes namely, 'fulfilling a moral instinct to connect families' and 'promoting autonomy', arose from participants' descriptions of how virtual visits aligned with healthcare standards and practices they considered ethical. Three further themes, 'preserving dignity and privacy', 'managing emotional distress', and 'providing equitable access' to virtual visiting technologies, highlight how virtual visits might exacerbate ethical issues related to family communications.
CONCLUSION
Virtual visiting may potentially both ameliorate and exacerbate aspects of ethical healthcare delivery for ICU patients and family members. ICU team members should consider unique ethical considerations related to using virtual visiting. We recommend virtual communications skills training for staff and advocate for the use of easily accessible educational resources for families who wish to visit critically unwell patients remotely.
背景
在 COVID-19 大流行期间，虚拟探视技术在英国和全球的重症监护病房（ICU）迅速得到整合。如今，这些技术为那些因地理位置、工作/照顾承诺或体弱而限制进入 ICU 的人提供了面对面探视的必要补充。然而，很少有实证研究探讨与虚拟探视相关的伦理问题。本研究旨在探讨在 ICU 使用虚拟探视所引发的预期或意外的伦理问题，以便医护人员能够了解如何在道德、安全和富有成效的情况下进行虚拟探视。
方法
我们采用描述性探索性定性研究方法，在一家三级学术中心招募了刚刚毕业的年轻医生，让他们协助 ICU 的虚拟探视。八名新毕业的年轻医生，七名女性，一名男性，年龄在 23-27 岁之间，参与了半结构式访谈。我们使用归纳编码方法对转录本进行分析。
结果
出现了五个总体主题。其中两个主题，即“满足与医疗标准和他们认为合乎道德的实践相一致的与家属联系的道德本能”和“促进自主权”，源自参与者对虚拟探视如何符合他们认为合乎道德的医疗标准和实践的描述。另外三个主题，即“维护尊严和隐私”、“管理情绪困扰”和“公平获得”虚拟探视技术，突显了虚拟探视如何加剧与家庭沟通相关的伦理问题。
结论
虚拟探视可能会改善和加剧 ICU 患者和家属的医疗保健服务的伦理方面。ICU 团队成员应考虑与使用虚拟探视相关的独特伦理考虑因素。我们建议对员工进行虚拟沟通技能培训，并倡导为希望远程探视重病患者的家属提供易于获取的教育资源。
Zotero 插件