Improving End-of-Life Care in the Intensive Care Unit: Clinician's Experiences with the 3 Wishes Project

被引：25

作者：

Neville, Thanh H. ^{[1
]}

Agarwal, Neha ^{[2
]}

Swinton, Marilyn ^{[3
]}

Phung, Peter ^{[4
]}

Xu, Xueqing ^{[5
]}

Kao, Yuhan ^{[5
]}

Seo, Jiyeon ^{[2
]}

Granone, Maria C. ^{[1
]}

Hjelmhaug, Kristen ^{[5
]}

Hainje, Jessica ^{[5
]}

Pavlish, Carol ^{[6
]}

Clarke, France ^{[3
,7
]}

Cook, Deborah J. ^{[3
,7
,8
]}

机构：

[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Pulm & Crit Care Med, Dept Med, BOX 951690,43-229 CHS, Los Angeles, CA 90095 USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Div Gen Internal Med, Los Angeles, CA 90095 USA

[5] Univ Calif Los Angeles, Dept Nursing, Los Angeles, CA 90095 USA

[6] Univ Calif Los Angeles, Sch Nursing, Los Angeles, CA 90095 USA

[7] St Josephs Healthcare, Dept Crit Care, Hamilton, ON, Canada

[8] McMaster Univ, Dept Med, Hamilton, ON, Canada

来源：

JOURNAL OF PALLIATIVE MEDICINE | 2019年 / 22卷 / 12期

关键词：

death; end of life; intensive care unit; palliative care; patient-centered care; PALLIATIVE CARE; FAMILY-MEMBERS; POSTTRAUMATIC-STRESS; MORAL DISTRESS; ICU; DEPRESSION; STATEMENT; SYMPTOMS; BURNOUT; DEATH;

D O I：

10.1089/jpm.2019.0135

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: End-of-life (EOL) care is an important aspect of practice in the intensive care unit (ICU), where approximately one of every five patients may die. Objective: The objective of this study was to describe clinicians' experiences with the 3 Wishes Project (3WP) and understand the influence of the project on care in the ICU. Design: The 3WP is a palliative care intervention in which clinicians elicit and implement final wishes for patients dying in the ICU; it had been implemented for seven months at the time of this study. This mixed-methods study includes quantitative data from clinician surveys and qualitative data from clinician focus groups. Setting: A 24-bed medical ICU in a tertiary academic center. Subjects: Perspectives of 97 clinicians working in the ICU during the study period were obtained by self-administered surveys. Five focus groups with 25 nurses and 5 physicians were held, digitally recorded, transcribed, and analyzed. Measurements and Results: During the 7-month period, 67 decedents and their families participated in the 3WP. The overarching concept identified through analysis of the survey and focus group data is that the 3WP improves EOL care in the ICU, which was supported by three main themes: (1) The 3WP facilitates meaningful EOL care; (2) The 3WP has a positive impact on nurses and physicians; and (3) clinicians observe a positive influence of the 3WP on families. Conclusions: This patient-centered and family-partnered intervention facilitates meaningful EOL care, favorably impacting the ICU team and positively influencing family members.

引用

页码：1561 / 1567

页数：7

共 40 条

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