影响临床医生关于在护理机构居民中使用POLST的决策的因素:一种定性研究
Connie S Cole1,2,3, Hillary D Lum2, Susan E Hickman1,3,4,5
1Indiana University School of Nursing, Indianapolis, Indiana, USA.
Journal of the American Geriatrics Society
|December 21, 2023
概括
国家POLST的指导是针对那些患有危及生命的疾病的人,但它是.
科学领域:
- 老年学是一门学科.
- 生物伦理学生物伦理学
- 医疗保健政策 医疗保健政策
背景情况:
- 国家POLST (医生订单维持生命治疗) 指南针对严重疾病的个人,面临危及生命的事件.
- 在护理机构中,POLST的使用非常普遍,超出了预期的患者群体.
- 了解临床医生的决策对于在护理机构中适当地实施POLST至关重要.
研究的目的:
- 探索护理机构临床医师对影响POLST使用决策的因素的观点.
- 在护理机构环境中区分适当和不适当的POLST使用.
主要方法:
- 这是一项描述性的定性研究,涉及14个州的28名护理机构临床医生.
- 通过半结构面试收集数据,录音和转录.
- 使用快速定性分析,确定临床医生决策中的关键主题.
主要成果:
- 出现在四个主题:"每个人都适合"的信念,居民/家庭偏好,居民健康状况和设施政策.
- 适当的POLST使用通常涉及居民/家庭对治疗限制和临床预后的偏好.
- 不当使用与要求POLST的设施政策有关,超过临床判断.
结论:
- 国家POLST指南与其在护理设施中的应用之间存在很大的差距.
- 强制性POLST政策和"每个人都适合"的思维方式可能导致不适当的使用和限制临床医生的自主权.
- 需要将POLST的使用与其在护理机构的预期人口重新调整.
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