治疗中断和痛苦:认识到需要在重症监护中获得更好的支持-一个范围审查
Louise Chartrand1, Trinh Nguyen-Lu2, Lea Soliman1
1College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada.
概括
医疗保健专业人员在重症监护室的治疗中经历了严重的情感和道德痛苦. 审查发现缺乏机构支持,强调需要结构化干预,如协作规划和汇报.
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.
- 医疗保健道德 医疗保健道德
背景情况:
- 重症监护病房 (ICU) 管理需要复杂干预的重症患者.
- 终止治疗是ICU生命终端护理的必要,但在情感和道德上具有挑战性的方面.
- 医疗保健提供者,特别是护士,在这些程序中面临严重的痛苦.
研究的目的:
- 综合医疗保健提供者在成人重症监护室中治疗中断期间所经历的道德,情感和心理痛苦类型.
- 总结旨在减轻这种困境的现有支持策略.
主要方法:
- 对9项涉及8个国家的883名医疗保健专业人员的研究进行了系统审查.
- 分析报告的痛苦经历和支持机制.
主要成果:
- 与重复暴露于死亡,患者家庭动态和输出管相关的情绪困扰.
- 道德上的痛苦源于被认为的痛苦延长,患者的矛盾愿望,以及被排除在决策之外.
- 护士报告的负担最高;心理痛苦没有直接测量,表明研究缺口.
- 机构支持策略基本上不存在;提供者依靠个人应对机制.
结论:
- 停止治疗会给医疗专业人员带来可预测的情感和道德痛苦.
- 在可预测的困境和缺乏系统的机构支持之间存在很大的差距.
- 实施协作规划,标准化协议,休息和汇报可以改善终身护理体验.
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