在心脏前手术之前,护士主导的预先护理计划的可行性:一项描述性研究
Kyoko Shigetomi1, Eiji Hiraoka2, Miho Takahashi3
1Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, JPN.
Cureus
|December 7, 2023
概括
在日本,在高风险的心脏手术之前,护士主导的预先护理计划 (ACP) 是可行的. 虽然它可以影响手术决策,但它对手术后生命终端讨论的影响需要进一步探索.
科学领域:
- 心脏病学 心脏病学
- 外科手术决策的制定能力
- 抚慰性护理是一种缓解性护理.
背景情况:
- 共同决策对于高风险的手术和终身护理至关重要,需要外科医生了解患者的价值观.
- 手术前的预先护理计划 (ACP) 对于将患者价值观纳入决策至关重要.
- 在日本,在手术前由护士领导的ACP的可行性,特别是对于心脏手术的可行性,仍然没有得到评估.
研究的目的:
- 评估在日本接受高风险心脏手术的成年患者的护士领导的手术前预先护理计划 (ACP) 的可行性.
- 调查护士主导的ACP访谈的内容及其对外科决策的影响.
- 在随后的终身护理讨论中评估披露的患者价值的利用.
主要方法:
- 对接受开放心脏手术,胸前动脉手术或穿皮动脉植入 (TAVI) 的成年患者进行了回顾性,单中心的描述性研究.
- 护士带领的半结构面试在手术前进行,以记录患者的护理目标,不可接受的情况,不受欢迎的程序,预先指示和代孕.
- 采访内容的回顾性分析及其对决策和终身讨论的影响.
主要成果:
- 包括64名患者 (平均年龄82岁);最明确的护理目标 (98.4%),不可接受的条件 (87.5%) 和不需要的程序 (20.3%).
- 只有1.6%的人有书面的预先指示,而17.2%的人与他们指定的代用人讨论了他们的价值观.
- 由于患者向护士而不是外科医生透露了病人的愿望,两次手术被取消;在三个术后死亡的生命终结决定中,ACP内容没有被使用.
结论:
- 在高风险心脏手术之前,护士主导的ACP是可以实施的,在日本的背景下证明了可行性.
- 手术前由护士领导的ACP可以影响外科手术决策,取消的手术证明了这一点.
- 需要进一步的研究,以优化在外科医生领导的决策和术后生命终端讨论中整合ACP内容.
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