まとめ
"蘇生禁止令" (DNR) は,積極的な治療を認める政策にも関わらず,しばしば集中治療を減らせる. この研究は,DNR指定後の患者の目標を個別化するために,包括的なケアプランの必要性を強調しています.
科学分野:
- 医療倫理 医療倫理について
- ヘルスケア・マネジメント・ヘルスケア・マネジメント
- クリニカル・プラクティス クリニカル・プラクティス
背景:
- Do-not-resuscitate (DNR) 指定は,倫理的にも臨床的にも重要な決定です.
- DNR命令が後の治療の強度に及ぼす影響を理解することは,患者の福祉にとって不可欠です.
研究 の 目的:
- Do-not-resuscitate (DNR) 指定後に患者に提供されるケアの強度を分析する.
- 積極的ケアに関する制度的DNR政策と実際の臨床実務との連携を評価する.
主な方法:
- コミュニティ病院で半年以上にわたって,書面によるDNR命令を受けた333人の患者を遡及的に調査した.
- 医療記録の分析により,治療目標と治療の強度に関する文書を評価し,病院料金で測定します.
主要な成果:
- 治療目標は,DNR指定後の患者の記録の60%で文書化されていない.
- 介護の強度の尺度である病院料金は,DNR命令後に大幅に減少しました.
- DNR指定後に提供されたほとんどのケアは非侵襲的であり,積極的なケアを支援する政策と矛盾しています.
結論:
- 実際には,DNR命令は,政策の勧告から逸脱して,より低濃度の集中治療をしばしばもたらします.
- DNRの決定は,包括的な患者ケア計画に統合されるべきである.
- 個別化された治療目標は,DNR状態の患者にとって極めて重要です.
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