在ICU中提供终身护理的障碍和促进者:质量研究
Lauren M Janczewski1,2, Adithya Chandrasekaran1,2,3,4,5,6, Egide Abahuje1,2
1Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Critical care medicine
|February 19, 2024
概括
前线ICU临床医生因工作系统问题和临床医生的变化而面临终身护理沟通障碍. 标准化沟通任务可以改善终身讨论,并减少临床医生的道德困扰.
科学领域:
- 关键护理医学 关键护理医学
- 抚慰性护理是一种缓解性护理.
- 卫生系统工程 卫生系统工程
背景情况:
- 在重症监护室 (ICU) 提供有效的终身护理对患者和家庭的福祉至关重要.
- 了解临床医生的看法对于改善终身护理流程至关重要.
研究的目的:
- 探索前线ICU临床医生在提供终身护理方面的观点.
- 确定影响生命终端护理沟通和交付在ICU环境中的障碍和促进者.
主要方法:
- 在一个综合学术卫生系统的七个ICU中进行了一项定性观测横截面研究.
- 与ICU临床医生进行了27次半结构化访谈,包括医生,高级实践提供者,护士,社会工作者和牧师.
- 以系统工程倡议为患者安全模型为指导的专题分析被用来确定与工作系统,临床医生因素和患者/家庭优先事项相关的关键主题.
主要成果:
- 工作系统障碍,如过度依赖特定角色进行讨论,延迟沟通.
- 临床医生对生命终端沟通方法的变化影响了讨论过程和结果.
- 临床医生-家庭-患者优先级发生了错误调整,但定期的联合讨论改善了家庭的信心.
- 临床医师的道德困境与提供无益护理有关,突出了对标准化流程的需求.
结论:
- 标准化的工作系统沟通任务对于改善临床医生和家庭之间的终身护理讨论至关重要.
- 解决工作系统障碍和促进一致的沟通实践,可以改善终身护理,减少临床医生的道德困境.
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