Kato Akane, Tanaka Yuta, Kizawa Yoshiyuki, Yamase Hiroaki, Tado Asami, Tatsuno Junko, Miyashita Mitsunori
Department of Adult and Geriatric Nursing, Faculty of Health Sciences, Shinshu University School of Medicine, Nagano, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
Acute Crit Care. 2025 May 20;40(2):339-48. doi: 10.4266/acc.003096.
Recognizing the importance of multidisciplinary collaboration during treatment family conferences is increasing in critical care settings. We aimed to elucidate how critical care specialist nurses engage in the family conference process in terms of the actual discussions held, the recommended topics, and their perspectives regarding transfer of critical care patients to general wards.
This self-administered nationwide survey was conducted between October and December 2020, targeting a random sample of 740 critical care specialist nurses. An anonymous questionnaire based on established guidelines and pilot tests was used to assess the level of engagement with the family conference process, content of discussions, considerations regarding withholding or withdrawing treatment, and perspectives concerning patient care location and discontinuation of life-sustaining treatments among the surveyed nurses.
Of the 396 returned questionnaires (response rate, 51.9%), 384 were analyzed. Less than 35% of the nurses consistently participated in family conferences and ensured that decisions regarding withholding or withdrawing life-sustaining treatments were re-evaluated following the conferences. Discussions focused predominantly on the patients' physical aspects, whereas the nurses believed that patients' values and preferences should be discussed. More than 70% of the nurses supported transferring patients from critical care settings to general wards for end-of-life scenarios.
Critical care specialist nurses in Japan exhibit limited engagement in family conferences and often fail to address their patients' values and preferences. Educational programs and enhanced interprofessional collaborations are warranted to improve nurse involvement in family conferences and ensure continuity of care between critical care and general ward settings.
在重症监护环境中，人们越来越认识到在治疗家庭会议期间多学科协作的重要性。我们旨在阐明重症监护专科护士在家庭会议过程中是如何参与实际讨论、推荐话题以及他们对将重症监护患者转至普通病房的看法的。
2020年10月至12月期间进行了这项全国性的自填式调查，目标是从740名重症监护专科护士中随机抽取样本。基于既定指南和预试验的匿名问卷被用于评估被调查护士在家庭会议过程中的参与程度、讨论内容、关于停止或撤销治疗的考虑因素以及对患者护理地点和停止维持生命治疗的看法。
在396份回收问卷（回复率51.9%）中，对384份进行了分析。不到35%的护士始终参与家庭会议，并确保在会议后重新评估关于停止或撤销维持生命治疗的决定。讨论主要集中在患者的身体方面，而护士们认为应该讨论患者的价值观和偏好。超过70%的护士支持在临终情况下将患者从重症监护环境转至普通病房。
日本的重症监护专科护士在家庭会议中的参与有限，并且常常未能关注患者的价值观和偏好。有必要开展教育项目并加强跨专业协作，以提高护士在家庭会议中的参与度，并确保重症监护和普通病房环境之间护理的连续性。
