Kato Akane, Tanaka Yuta, Kizawa Yoshiyuki, Yamase Hiroaki, Tado Asami, Tatsuno Junko, Miyashita Mitsunori
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Adult and Geriatric Nursing, Faculty of Health Sciences, Shinshu University Medical School of Medicine, Matsumoto Nagano, Japan.
Am J Hosp Palliat Care. 2025 Nov;42(11):1151-1160. doi: 10.1177/10499091241303675. Epub 2024 Dec 5.
To investigate the current state of primary palliative care practice in Japanese critical care settings, identify care perceived as equivalent to primary palliative care, and explore the barriers. We employed a quantitative descriptive questionnaire survey with a nationwide cross-sectional design involving 740 critical care specialist nurses. Questionnaires were received from 384 nurses, yielding a response rate of 51.9%. Nurses recognized typical palliative care provided to cancer patients, such as "relieving suffering at end-of-life" (95.3%), "pain management" (88.8%), and "caring for patients' psychological suffering" (88.3%), as primary palliative care in the critical care setting. They also recognized "monitoring and management of delirium" (68.5%), "caring for patients' social suffering" (63.5%), and "preventing post-intensive care syndromes" (61.7%) less frequently as aspects of primary palliative care in critical care settings. Additionally, the recognition was lower among emergency department nurses than intensive care unit nurses. The nurses recognized inadequate overall palliative care practices, especially regarding patients' social (72.1%) and spiritual (76.8%) suffering. They recognized "insufficient knowledge and skills among critical care medical staff" (70.6%) and "unable to confirm the patients' preferences to treatment goals" (54.4%) as barriers to providing primary palliative care. The barriers that nurses recognized less often were "uncertainty about palliative care in critical care settings" (6.8%) and "disagreements among nursing teams regarding providing palliative care" (8.3%). Specialist nurses understood palliative care but felt unprepared in primary palliative care due to limited knowledge. Improved education in primary palliative care and patient-family communication is needed in Japan's critical care settings.
为调查日本重症监护环境中初级姑息治疗实践的现状，确定被视为等同于初级姑息治疗的护理内容，并探索障碍因素。我们采用了一项具有全国横断面设计的定量描述性问卷调查，涉及740名重症监护专科护士。共收到384名护士的问卷，回复率为51.9%。护士们将为癌症患者提供的典型姑息治疗，如“缓解临终痛苦”（95.3%）、“疼痛管理”（88.8%）和“照顾患者的心理痛苦”（88.3%），视为重症监护环境中的初级姑息治疗。他们也较少将“谵妄的监测与管理”（68.5%）、“照顾患者的社会痛苦”（63.5%）和“预防重症监护后综合征”（61.7%）视为重症监护环境中初级姑息治疗的方面。此外，急诊科护士的认知低于重症监护病房护士。护士们认识到总体姑息治疗实践不足，尤其是在患者的社会（72.1%）和精神（76.8%）痛苦方面。他们认为“重症监护医务人员知识和技能不足”（70.6%）和“无法确认患者对治疗目标的偏好”（54.4%）是提供初级姑息治疗的障碍。护士们较少认识到的障碍是“重症监护环境中姑息治疗的不确定性”（6.8%）和“护理团队在提供姑息治疗方面的分歧”（8.3%）。专科护士理解姑息治疗，但由于知识有限，在初级姑息治疗方面感到准备不足。日本的重症监护环境需要加强初级姑息治疗教育和患者与家属的沟通。
