影响重症监护治疗目标决策过程的因素:系统整合性审查
Diane Kelly1, Jonathan Barrett2, Gabrielle Brand3
1Intensive Care Unit, Epworth Hospital, Richmond, VIC, Australia; Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia; Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia.
概括
了解影响重症监护室 (ICU) 决策的因素对于以患者为中心的护理至关重要. 本综述综合了关于ICU治疗决策过程的研究,以改善临床医生和患者之间的一致性.
科学领域:
- 医学伦理 医学伦理
- 密集护理医学 密集护理医学
- 健康决策的制定方法
背景情况:
- 在重症监护室 (ICU) 中以患者为中心的护理需要将治疗与患者价值观相协调.
- 了解决策过程对于医疗保健专业人员来说至关重要,以实现这种协调.
研究的目的:
- 探索影响有关实施和限制重症监护治疗的决策过程的因素.
主要方法:
- 一个系统的综合性审查,综合了83项定量,定性和混合方法研究.
- 搜索了五个数据库 (Medline,Cochrane,Embase,PsycINFO,CINAHL plus) 搜索了2010年至2022年的英语研究.
- 员工批判性评估技能计划和医学教育研究质量工具是质量选的工具.
主要成果:
- 七个关键主题出现了,包括决策者,预测,沟通和影响决策一致性的因素.
- 拒绝治疗是最常见的决定,临床医生是最常见的决策者.
- 机构文化和临床医生的连续性显著影响了治疗建议的一致性.
结论:
- 关于治疗目标的重症监护室 (ICU) 决策是复杂的,涉及各种决策者和交叉因素.
- 现有的干预措施还没有充分纳入决策者的广度或影响因素的复杂性.
- 结果为未来的研究和培训提供了基础,以加强ICU环境中的决策一致性.
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