Tavabie Simon, Pearson Stephen, Balabanovic Janet, Batho Anna, Juj Manoj, Kastande Priscilla, Bennetts Joanne, Collis Emily, Bonnici Tim
Department of Palliative Medicine, Barts Health NHS Trust, London, UK.
Department of Critical Care, University College Hospitals NHS Foundation Trust, London, UK.
Am J Hosp Palliat Care. 2025 Nov;42(11):1144-1150. doi: 10.1177/10499091251316492. Epub 2025 Jan 22.
Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. Three multidisciplinary focus groups of critical care staff at a large central London hospitals trust were facilitated with a semi structured format and digitally transcribed. Inductive thematic analysis was conducted to extract themes. N = 34 (18 nursing, 7 allied health professionals, 6 medical, 3 clerical/administrative). The five themes were structured as priority statements: "We need to recognise" included the subthemes of being "sick enough to die" and potential rapid deteriorations in this setting; "We need to understand" with subthemes of perspectives on dying and prioritising time for conversations; "We need to connect" with subthemes of therapeutic relationship and physical presence; "We need to collaborate" with subthemes of critical care working and empowerment, and cross teams working; "We need support" with themes of experiencing support and making time to support others. We present an approach to identifying critical care departmental priorities for an end-of-life care improvement programme. The themes extracted will be used to evaluate systems for dying in critical care, aiming to empower staff to provide excellent care every time they look after a dying person. This service evaluation identifies key priorities among critical care staff regarding end-of-life care. The insights can guide service improvements, such as tailored training and enhanced support for staff, to ensure better communication, collaboration, and quality care for patients at the end of life.
重症监护室是一个死亡频发的地方，高达四分之一的入院患者会在住院期间死亡。照顾濒死患者在实际操作、专业层面和个人方面都带来了诸多挑战。本研究的目的是更好地了解重症监护室中照顾濒死患者的工作人员的观点，并确定他们认为需要改进的优先事项。在伦敦市中心一家大型医院信托机构，对三个多学科的重症监护室工作人员焦点小组进行了半结构化形式的访谈，并进行了数字转录。采用归纳主题分析法提取主题。N = 34（18名护士、7名专职医疗人员、6名医生、3名文书/行政人员）。五个主题被构建为优先事项陈述：“我们需要认识到”包括“病重到濒死”以及在这种情况下可能迅速恶化的子主题；“我们需要理解”包括对死亡的看法以及为对话安排优先时间的子主题；“我们需要建立联系”包括治疗关系和身体陪伴的子主题；“我们需要协作”包括重症监护工作与赋权以及跨团队协作的子主题；“我们需要支持”包括获得支持的体验以及抽出时间支持他人的主题。我们提出了一种确定重症监护科室临终关怀改善计划优先事项的方法。提取的主题将用于评估重症监护室的临终关怀系统，旨在使工作人员在每次照顾濒死患者时都能提供优质护理。这项服务评估确定了重症监护室工作人员在临终关怀方面的关键优先事项。这些见解可以指导服务改进，例如为工作人员提供量身定制的培训和加强支持，以确保在患者生命末期实现更好的沟通、协作和优质护理。
