重症患者家属参与体外膜肺氧合治疗决策体验的质性研究

doi:10.3761/j.issn.2096-7446.2024.12.002

摘要/Abstract

摘要： 目的了解重症患者家属参与ECMO治疗决策的体验和可能影响决策效率的相关因素。方法采用描述性质性研究方法,于2021年11月—2022年6月对浙江省某三级甲等医院ICU符合纳入标准的19名重症患者家属进行半结构式访谈,采用内容分析法进行资料分析。结果通过分析获得4个主题10个亚主题。①艰难的抉择：突发状况下的进退两难,放弃后的内疚与自责;②决策合理化：伦理道德引导决策,预期疗效影响决策,既往决策经验推进决策;③决策方式：独立决策,群体决策,基于患者意愿的决策;④决策影响因素：信息与沟通,社会支持。结论重症患者家属参与ECMO治疗决策是一段十分艰难的过程,医护人员应重视家属参与ECMO治疗决策过程中的心理变化,提供及时的情感支持、信息和多方位的社会支持,在尊重决策主体治疗意愿的前提下协助其高效决策。

关键词: 危重病, 体外膜肺氧合, 家属, 决策, 质性研究

Abstract: Objective To understand the experience of family members of critically ill patients participating in ECMO treatment decision making and related factors that may affect the efficiency of decision making. MethodsDescriptive qualitative research method was used to conduct semi-structured interviews with 19 family members of critically ill patients who met the inclusion criteria in the ICU of a tertiary Grade A hospital in Zhejiang Province from November 2021 to June 2022. Content analysis method was used to analyze the interview data. Results 5 themes and 10 subthemes emerged：① tough choices：the dilemma in the emergency situation,the guilt and remorse after giving up;②rationalization of decision-making：ethics and morality guide decision-making,expected outcome influences decision making,and previous decision making experience promotes decision making;③decision-making methods：independent decision-making,group decision-making,decision making based on patient preferences;④ influencing factors of decision making：information and communication,social support. Conclusion It is a very difficult process for family members of critically ill patients to participate in ECMO treatment decision-making. Medical staff should pay attention to the psychological changes of family members in decision-making process,provide timely emotional support,information support and multi-directional social support,and assist them in efficient decision-making on the premise of respecting the treatment wishes of decision-makers.

Key words: Critical Illness, Extracorporeal Membrane Oxygenation, Family Members, Decision Making, Qualitative Research

杨湘英, 汤阿毛, 林瑶, 戴伟英, 张茜, 曾小康, 宁丽. 重症患者家属参与体外膜肺氧合治疗决策体验的质性研究[J]. 中华急危重症护理杂志, 2024, 5(12): 1068-1073.

YANG Xiangying, TANG Amao, LIN Yao, DAI Weiying, ZHANG Qian, ZENG Xiaokang, NING Li. A qualitative study on experience of family members of critically ill patients participating in ECMO treatment decision-making[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(12): 1068-1073.

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