Expert critical care nurses’ practices to assist patients’ families with surrogate decision-making regarding life-sustaining treatment

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  • Yoshida Noriko
    自治医科大学看護学部成人看護学
  • Nakamura Misuzu
    自治医科大学看護学部成人看護学 自治医科大学大学院看護学研究科クリティカルケア看護学

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Other Title
  • クリティカルケア熟練看護師が見出した延命治療に関する家族の代理意思決定を支える看護実践
  • クリティカルケア ジュクレン カンゴシ ガ ミイダシタ エンメイ チリョウ ニ カンスル カゾク ノ ダイリ イシ ケッテイ オ ササエル カンゴ ジッセン

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The purposes of this study were to describe nursing practices of expert critical care nurses who assist patients’ families with surrogate decision-making regarding life-sustaining treatment, and draw some implications regarding such practices. The study participants were 13 expert nurses from 7 facilities（emergency medical care centers and intensive care units）in the suburbs of the Kanto area. A semi-structured interview was conducted to clarify their nursing practices to help patients’ families make a decision on life-sustaining treatment. The obtained data were analyzed based on Krippendorff’s method. As a result, 6 categories were extracted in relation to the nursing practices：［developing relationships among those involved in making a decision］ , ［preparing the family for the challenge of making a decision］,［enhancing the strength of and cooperation between medical and nursing teams］,［supporting the family’s feelings］ , ［providing support throughout the decision-making process］, and ［facilitating consensus-building efforts among family members］ . One of the characteristics of nursing practices was associated with a role in promoting harmony among those involved in decision-making, as represented by the categories of ［enhancing the strength of and cooperation between medical and nursing teams］ , ［developing relationships among those involved in making a decision］ , and ［facilitating consensus-building efforts among family members］. Another characteristic was related to a role in attending to and engaging with the family, as indicated by the categories of ［preparing the family for the challenge of making a decision］ , ［providing support throughout the decision-making process］, and ［supporting the family’s feelings］. Nursing practices to facilitate decision-making among patients’ families were suggested to involve a process whereby critical care nurses take a multi-tiered and multi-faceted approach to provide support.

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