ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究

doi:10.3761/j.issn.2096-7446.2026.02.004

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (2): 155-161.doi: 10.3761/j.issn.2096-7446.2026.02.004

• ICU护理质量提升专题 • 上一篇下一篇

ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究

夏莲子¹(), 于斐², 冯波², 周慧², 吉康菱³, 王清⁴^,^*()

1.江苏大学附属南京鼓楼临床医学院重症医学科南京市 210000
2.南京大学医学院附属鼓楼医院重症医学科南京市 210000
3.云南省精神病医院护理部昆明市 650224
4.南京大学医学院附属鼓楼医院护理部南京市 210000

收稿日期:2025-03-07 出版日期:2026-02-10 发布日期:2026-02-02
通讯作者: 王清 E-mail:xialianzi@163.com;ruoyiwangqing@163.com
作者简介:夏莲子：女，硕士，护师，E-mail：xialianzi@163.com
基金资助:
南京鼓楼医院一般项目(2023-H516)

A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers

XIA Lianzi¹(), YU Fei², FENG Bo², ZHOU Hui², JI Kangling³, WANG Qing⁴^,^*()

1. Department of Intensive Care Unit， Nanjing Drum Tower Hospital Clinical College of Jiangsu University， Nanjing 210000， China
2. Department of Intensive Care Unit， Nanjing Drum Tower Hospital Affiliated Hospital of Medical School， Nanjing 210000， China
3. Department of Nursing， Yunnan Mental Hospital， Kunming 650224， China
4. Nursing Department， Nanjing Drum Tower Hospital Affiliated Hospital of Medical School， Nanjing 210000， China

Received:2025-03-07 Online:2026-02-10 Published:2026-02-02
Contact: WANG Qing E-mail:xialianzi@163.com;ruoyiwangqing@163.com
Supported by:
Nanjing Drum Tower Hospital Average Project(2023-H516)

摘要/Abstract

摘要：

目的探究ICU替代决策者参与预立医疗照护计划（advance care planning，ACP）决策的障碍因素，为制订决策辅助工具提供依据。方法 2024年10月—12月，基于理论域框架（theoretical domains framework，TDF）制订访谈提纲，选取南京市某三级甲等医院重症医学科18名ICU患者替代决策者进行面对面访谈。按照TDF的相关领域对转录后文本进行分析。结果结合TDF将ICU替代决策者参与ACP决策的障碍因素归纳出5个主题及13个亚主题：①患者意愿模糊下的执行障碍，②ACP参与过程机制失灵，③社会文化与舆论限制，④决策主体角色认知模糊，⑤情绪驱动下的非理性决策。结论 ICU替代决策者参与ACP决策受多种因素影响，需通过认知重构、沟通优化、情感支持及医疗-社会网络重建，减少其在决策中的负性体验。

关键词: 预立医疗照护计划, 重症监护病房, 替代决策者, 质性研究, 护理

Abstract:

Objective To explore the barriers to participation in advance care planning（ACP） decision-making among surrogate decision-makers in the ICU，and to provide a basis for developing decision support tools. Methods From October 2024 to December 2024，an interview guide was developed based on the Theoretical Domains Framework（TDF）. Face-to-face interviews were conducted with 18 surrogate decision-makers of ICU patients in a tertiary hospital in Nanjing. The transcribed texts were analyzed according to the relevant domains of the TDF. Results Based on the TDF，the barriers to ACP decision-making among ICU surrogate decision-makers were categorized into 5 themes and 13 sub-themes： ①Execution barriers under ambiguous patient preferences； ②Breakdown in the procedural mechanisms of ACP participation；③Constraints from sociocultural norms and public discourse； ④Blurred role recognition of the decision-making surrogate； ⑤Irrational decision-making driven by emotions. Conclusion The ACP decision-making of ICU surrogate decision-makers is influenced by multiple factors. Cognitive restructuring，improved communication，emotional support，and reconstruction of the medical-social network are needed to reduce negative experiences during the decision-making process.

Key words: Advance Care Planning, Intensive Care Unit, Surrogate Decision Maker, Qualitative Study, Nursing Care

夏莲子, 于斐, 冯波, 周慧, 吉康菱, 王清. ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究[J]. 中华急危重症护理杂志, 2026, 7(2): 155-161.

XIA Lianzi, YU Fei, FENG Bo, ZHOU Hui, JI Kangling, WANG Qing. A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 155-161.

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ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究

A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers

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