这是慈悲的品质. 照顾有"不要复苏"命令的患者
D P Sulmasy1, G Geller, R Faden
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
JAMA
|February 5, 1992
概括
伦理教育干预改善了对没有复苏 (DNR) 命令的患者的护理,特别是关于并发护理问题 (CCC) 的护理. 根据患者的诊断,DNR护理的质量有所不同,这凸显了有针对性的伦理教育计划的需要.
科学领域:
- 医学伦理 医学伦理
- 改善临床实践的改善
- 患者护理质量 患者护理质量
背景情况:
- 围绕不复苏 (DNR) 命令的做法需要仔细注意,以确保患者的愿望和全面的护理.
- 已经观察到DNR订单文档和并发护理问题 (CCC) 的变化,可能与患者特征和医疗保健提供者的教育有关.
研究的目的:
- 评估伦理教育干预对医院官员关于DNR命令的做法的影响.
- 确定DNR护理质量,患者诊断和人口统计学变量之间的关联.
主要方法:
- 一个为期一年的随机对照试验,涉及一个城市大学教学医院的88名内科室官员.
- 众议院官员被分配到广泛的伦理干预,有限的干预或控制小组.
- 对符合医院政策的DNR订单的患者病历进行了审查,包括出席签名,记录原因,同意和11个并发护理问题 (CCC).
主要成果:
- 每个DNR订单的CCC数量在伦理教育组显著增加 (0.9至3.8),但在对照组 (1.9至1.0) 减少.
- 与其他诊断或恶性瘤相比,获得免疫缺陷综合征 (艾滋病) 患者对DNR政策的遵守,包括适当的同意,较低.
- 患者诊断,但不是人口统计学变量,是每DNR顺序中CCC的显著预测因素.
结论:
- 广泛的伦理教育干预可以提高DNR命令患者的护理质量,特别是在CCC方面.
- 对DNR患者的护理质量表现出基于诊断的系统变化,表明护理差异.
- 研究结果表明,伦理教育计划应该考虑患者的诊断来设计和实施,以改善护理的一致性.
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