重症监护室安宁疗护研究热点可视化分析

目的对2010-2020年Web of Science核心合集数据库中ICU安宁疗护相关文献进行可视化分析,梳理研究热点,为ICU安宁疗护的发展提供参考。方法检索选取Web of Science核心合集收录的2010-2020年ICU安宁疗护的文献,并使用VOS viewer软件对核心合集数据库中有关ICU安宁疗护的文章进行描述和可视化分析。结果2010-2020年有关ICU安宁疗护的发文数量呈持续增长趋势;发文数量前3位的国家是美国、加拿大、德国;发文机构主要集中在大学或研究所。研究的热点主要聚集在7个方面:重症患儿、结局指标、丧亲辅导、预立医疗、满意度、伦理道德、临终决策。结论有关ICU安宁疗护的研究已成为国际关注的热点,国外ICU安宁疗护的发展已经较为成熟,而我国对ICU安宁疗护的研究尚处于初级阶段,在未来的研究中,需要加强对ICU安宁疗护的关注,加强国际间的合作交流,促进我国ICU安宁疗护事业的发展。     

重症监护室安宁疗护研究热点可视化分析

目的对2010-2020年Web of Science核心合集数据库中ICU安宁疗护相关文献进行可视化分析,梳理研究热点,为ICU安宁疗护的发展提供参考。方法检索选取Web of Science核心合集收录的2010-2020年ICU安宁疗护的文献,并使用VOS viewer软件对核心合集数据库中有关ICU安宁疗护的文章进行描述和可视化分析。结果2010-2020年有关ICU安宁疗护的发文数量呈持续增长趋势;发文数量前3位的国家是美国、加拿大、德国;发文机构主要集中在大学或研究所。研究的热点主要聚集在7个方面:重症患儿、结局指标、丧亲辅导、预立医疗、满意度、伦理道德、临终决策。结论有关ICU安宁疗护的研究已成为国际关注的热点,国外ICU安宁疗护的发展已经较为成熟,而我国对ICU安宁疗护的研究尚处于初级阶段,在未来的研究中,需要加强对ICU安宁疗护的关注,加强国际间的合作交流,促进我国ICU安宁疗护事业的发展。     

老年痴呆患者安宁疗护的研究进展

对开展老年痴呆患者安宁疗护的必要性、影响因素进行综述,提出实施老年痴呆患者安宁疗护的策略,包括：完善症状管理措施、推进预立医疗照护计划的实施、建立健全安宁疗护相关法律政策、推进中医安宁疗护,旨在为老年痴呆患者安宁疗护的发展提供参考。     

居家安宁疗护患者及家属对移动医疗真实体验与需求质性研究的Meta整合

目的 系统整合关于居家安宁疗护患者及其家属移动医疗体验的质性研究,为移动医疗在居家安宁疗护患者中的应用和发展提供循证依据。方法 计算机检索PubMed、web of science、PsycINFO、CINAHL、Embace、Cochrane Library、中国知网、中国生物医学文献数据库、万方及维普数据库,搜集关于居家安宁疗护患者或其家属使用移动医疗体验的质性研究,检索时限从建库至2021年6月。根据澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,运用Meta整合方法对研究结果进行整合。结果 共纳入11篇文献,提取37个研究发现,并归纳成11个类别和3个研究整合。整合结果一：移动医疗技术能给居家安宁疗护患者带来切实的益处;整合结果二：居家安宁疗护患者及家属使用移动医疗面临的挑战;整合结果三：居家安宁疗护患者及家属使用移动医疗的长期需求。结论 移动医疗为居家安宁疗护的发展提供了新的思路,其效果受到多数居家安宁疗护患者的肯定,但未来研究应注意加强移动医疗设备及技术支持工作,并丰富功能内容及参与形式,探索居家远程安宁疗护干预模式,以进一步促进移动医疗的推广及应用。     

ICU护士安宁疗护认知和行为的Meta整合

目的 :整合相关质性研究,系统评价ICU护士对安宁疗护的认知和行为。方法 :检索Cochrane Library、PubMed、Embase、WebofScience、CINAHL、PsycINFO、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFangData)和维普数据库(VIP),纳入所有符合标准的质性研究,采用Meta整合方法对结果进行整合。结果 :共纳入17项研究,提炼68个完整结果,经分析汇总形成34个新类别,最终归纳出4个整合结果 :安宁疗护中ICU护士的专业职责、安宁疗护中ICU护士的情感体验、安宁疗护中的人际沟通、安宁疗护实践中的阻碍因素。结论 :ICU护士对安宁疗护中应承担的职责有着较为准确全面的认识,但仍存在缺乏沟通技能、缺乏心理疏导技能、缺乏精力和时间等问题,医院应为ICU护士提供系统的安宁疗护培训,帮助ICU护士掌握实施安宁疗护所需技能,定期为ICU护士提供情绪疏导和心理支持,以促进ICU环境中安宁疗护的开展。     

远程医疗在居家安宁疗护中的应用现状

检索居家安宁疗护相关文献，从远程医疗的概念、远程医疗在居家安宁疗护中的应用、远程医疗在居家安宁疗护应用中尚存的问题及改进策略等方面进行综述，以期为远程医疗在国内居家安宁疗护中的应用提供参考。     

国内护理人员安宁疗护知信行的研究现状

安宁疗护是对没有治愈希望的终末期病人及家属提供的减轻其不适与痛苦,改善生活质量的医疗护理服务,它是对生命的终极关怀。随着医学技术的不断进步,延长生命的医疗技术不断发展,我国疾病谱的改变,安宁疗护的开展势在必行。护士作为安宁疗护执行的主体,对安宁疗护知信行的情况将直接影响安宁疗护实施的效果。综述了国内护理人员对安宁疗护知信行现状,以期能为临床护士更好地实施安宁疗护提供依据。     

安宁疗护门诊的构建与应用效果

目的 建立安宁疗护门诊,满足更多终末期患者的需求。 方法 设置安宁疗护诊室,由护士出诊,对患者进行筛查、签订安宁疗护知情同意和意愿确认书、全面评估、建立档案、发起多学科会诊、制订照护方案、合理转介、定期随访、提供安宁疗护信息咨询。统计门诊工作量和成效。 结果 2020年10月安宁疗护门诊开诊,至2021年5月30日,门诊量为136例次,针对患者痛苦症状,出诊护士能独立解决108项,发起多学科会诊28次;开展“互联网+”居家照护59例次、收治入院52例、转介基层医院25例;随访388例次。患者的安宁疗护需求满足程度较高;患者综合服务满意度为99.5%,家属综合服务满意度为99.3%。 结论 安宁疗护门诊能够满足终末期患者的需求,体现公立医院的公益性,整合地区资源进行区域安宁疗护联动,促进安宁疗护分级诊疗的开展,加强安宁疗护专科护士培养,推动安宁疗护事业的进一步发展。     

安宁疗护高级实践护士核心能力指标体系的构建

目的:构建安宁疗护专业高级实践护士的核心能力指标体系。方法:通过文献回顾,根据专家协调小组意见,自行设计专家咨询问卷,对全国7个省份15所医院从事临终护理实践、护理管理、姑息医疗以及从事院校安宁疗护教育4个领域的23名资深专家进行两轮德尔菲专家咨询。结果:构建的安宁疗护高级实践护士的核心能力指标体系包括沟通及合作能力、临床实践能力、专业发展能力、文化和灵性照护能力、伦理与法律相关能力、教育教学能力、系统资源管理能力、循证护理及科研能力共8个方面31个二级指标。结论:明确了安宁疗护高级实践护士应具备的核心能力,为培养安宁疗护领域高级实践护士提供依据。     

远程医疗在居家安宁疗护中的研究进展

本文从远程医疗的概念、远程医疗在居家安宁疗护中的应用、远程医疗在居家安宁疗护应用中尚存的问题及改进策略进行综述,旨在为远程医疗在我国居家安宁疗护中的应用提供参考依据。     

Critical caring. Promoting good end-of-life care in the intensive care unit.

Changing the culture in the ICU to include palliative care interventions along with curative interventions is already underway. Further work is needed, however. This is a role for the critical care nurse. Critical care nurses can be involved in research and education to enhance their future practice in end-of-life care. Research to establish evidence-based protocols for use in patients who require palliative care in the ICU needs to be done. Critical care nurses can prepare themselves for carrying or dying patients by attending palliative care seminars and continuing education courses or by taking a short clinical sabbatical or internship in a local hospice to observe and help give end-of-life care. Hospice nurses can be invited to the ICU to give inservice sessions and to help nurses and other staff understand the transition to dying, including the services that need to be offered to the patient and the family. Nurses from the hospital palliative care team can consult and be available for follow-up. Promoting good end-of-life care should be a goal for all intensive care nurses and critical care units. This goal is reached one patient at a time.     

End-of-life care in the intensive care unit: a research agenda

BACKGROUND: The intensive care unit (ICU) represents a unique clinical setting in which mortality is relatively high and the professional culture tends to be one of "rescue therapy" using technological and invasive interventions. For these reasons, the ICU is an important environment for understanding and improving end-of-life care. Although there have been consensus statements and review articles on end-of-life care in the ICU, there is limited evidence on which to base an assessment of best practices for providing high-quality end-of-life care in this setting. OBJECTIVE: To convene a Working Group of experts in critical care, palliative medicine, medical ethics, and medical law to address the question "What research needs to be done to improve end-of-life care to patients in the ICU?" METHODS: Participants were identified for membership in the Working Group by purposive sampling within the fields of critical care medicine and nursing, palliative medicine, and medical ethics; others were chosen to represent social work and hospital chaplains. Through a process of breakout and plenary sessions, the group identified important questions that need to be addressed in the areas of defining the problem, identifying solutions, evaluating solutions, and overcoming barriers. CONCLUSIONS: Outlining unanswered questions on end-of-life care in the ICU is a first step to providing the answers that will allow us to improve care to patients dying in the ICU. These questions also serve to focus clinicians and educators on the important areas for improving quality of care.     

Incorporating palliative care into critical care education: principles, challenges, and opportunities.

OBJECTIVE: To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU). DATA SOURCES AND STUDY SELECTION: A status report on palliative care, a summary report of recent research on palliative care education, articles in the medical literature on end-of-life care and critical care, and expert opinion were considered. DATA EXTRACTION: A working group, including specialists in critical care, palliative care, medical ethics, consumer advocacy, and communications, was convened at the "Medical Education for Care Near the End of Life National Consensus Conference." A modified nominal group process was used to develop a consensus. DATA SYNTHESIS: In the ICU, life and death decisions are often made in a crisis mode or in the face of uncertainty, and may necessitate the withholding and withdrawal of life-supporting technologies. Because critical illness often diminishes the capacity of patients to make decisions, clinicians must often make decisions in conjunction with surrogates, rather than with patients. Discontinuity of care can threaten trusting relationships, and cultural diversity can have a particularly powerful impact on choices for care. In the face of these realities, it is possible and appropriate to give compassionate palliative care to dying patients and their families in the ICU. CONCLUSIONS: Teaching care of the dying in the ICU should emphasize the following: a) the goals of care should guide the use of technology; b) understanding of prognostication and treatment withholding and withdrawal is essential; c) effective communication and trusting relationships are crucial to good care; d) cultural differences should be acknowledged and respected; and e) the delivery of excellent palliative care is appropriate and necessary when patients die in the ICU.     

Caring for patients with critical illness and their families: the value of the integrated clinical team

Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Approximately 20% of all deaths in the United States occur in ICUs. Although optimal palliative care of out-patients may prevent many ICU admissions, the ICU will always remain an important setting for end-of-life care because of the severity of illness of patients in the ICU. This review provides an overview of the principles and practice of integrating palliative and critical care, with a focus on 4 specific areas: the role of palliative care in the ICU; symptom assessment and management; communication with patients and family members; and interdisciplinary communication and collaboration. This review also describes the development and evaluation of a new intervention for hospitals and individual ICUs: Integrating Palliative and Critical Care (IPACC). The goal of the IPACC intervention and this paper is to teach ICU clinicians basic palliative care skills and the language of palliative care, and to encourage all ICU clinicians to prioritize palliative care as one of the important things that we do in the ICU.     

Providing a "good death" for oncology patients during the final hours of life in the intensive care unit

Cancer is a leading cause of death in the United States. Aggressiveness of cancer care continues to rise in parallel with scientific discoveries in the treatment of a variety of malignancies. As a result, patients with cancer often require care in intensive care units (ICUs). Although growth in hospice and palliative care programs has occurred nationwide, access to these programs varies by geographic region and hospital type. Thus, critical care nurses may be caring for patients with cancer during the final hours of life in the ICU without the support of palliative care experts. This article provides an overview of the meaning of the final hours of life for cancer patients and uses principles of a "good death" and the tenets of hospice care to organize recommendations for critical care nurses for providing high quality end-of-life care to patients with cancer in the ICU.     

Interactive collaborative consultation model in end-of-life care

With interactive communication becoming an engaging and accessible venue, the specialized field of end-of-life care could greatly benefit by utilizing the Internet to ensure comprehensive palliative care for many underserved areas worldwide. Interactive communication can enhance the care of patients with advanced disease and their families by providing practitioners with current research-based information to empower their clinical decision-making. A collaborative consultative Internet relationship can support practitioners in providing comprehensive palliative interventions for their patients in a timely manner. This paper describes the development of the interactive collaborative consultation model and its demonstration between a rural palliative care nurse practitioner and an urban medical research physician. Expert consultation for individual patients through the Internet can help improve access to palliative consultation and, ultimately, enhance the care of many dying persons living within underserved or remote areas worldwide.     

End-of-life care for the critically ill: A national intensive care unit survey

OBJECTIVE: One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, availability, and perceived benefit of specific strategies that may improve this care. DESIGN: Self-administered mail survey. SETTING: Six hundred intensive care units. PARTICIPANTS: A random, nationally representative sample of nursing and physician directors of 600 adult ICUs in the United States. INTERVENTIONS: Mail survey. MEASUREMENTS AND MAIN RESULTS: We asked participants about barriers to end-of-life care (1 = huge to 5 = not at all a barrier), perceived benefit of strategies to improve end-of-life care, and availability of these strategies. From 468 ICUs (78.0% of sample), 590 ICU directors participated (406 nurses [65.1% response] and 184 physicians [31.7% response]). Respondents had a mean of 16.6 yrs (sd 7.6 yrs) of ICU experience. Important barriers to better end-of-life care included patient/family factors, including unrealistic patient/family expectations 2.5 (1.0), inability of patients to participate in discussions 2.7 (0.9), and lack of advance directives 2.9 (1.0); clinician factors, which included insufficient physician training in communication 2.9 (1.1) and competing demands on physicians' time 3.0 (1.1); and institution/ICU factors, such as suboptimal space for family meetings 3.5 (1.2) and lack of a palliative care service 3.4 (1.2). More than 80% of respondents rated 14 of 14 strategies as likely to improve end-of-life care, including trainee role modeling by experienced clinicians, clinician training in communication and symptom management, regular meetings of senior clinicians with families, bereavement programs, and end-of-life care quality monitoring. However, few of these strategies were widely available. CONCLUSIONS: Intensive care unit directors perceive important barriers to optimal end-of-life care but also universally endorse many practical strategies for quality improvement.     

ICU临终患者家属是否选择放弃治疗的影响因素

目的 了解ICU临终患者家属对放弃治疗的真实看法及其影响因素.方法 采用质性研究中现象学描述性定性研究方法,以深度访谈方式收集7例ICU患者家属的个案资料,并运用Colaizzi分析程序进行分析.结果 经过分析,共提取5个方面的主题,并将其归纳为影响临终患者家属是否选择放弃治疗的促进因素和阻碍因素：（1）经济因素是ICU临终患者家属决定是否选择放弃治疗的最重要影响因素;（2）情感及道德因素是ICU临终患者家属放弃治疗的重要阻碍因素;（3）放弃治疗的决策权不明确是导致ICU临终患者家属选择放弃治疗的阻碍因素;（4）患者对自身的病情知晓率低是导致其自身无法进行临床决策的阻碍因素;（5）对患者生命的尊重和死亡观念的改变是ICU临终患者家属放弃治疗的重要促进因素.结论 ICU临终患者家属对放弃治疗的临床决策受到多种因素的影响,应该进一步完善医保制度,使更多的ICU临终患者不因经济原因而放弃或过度治疗;逐步建立由患者、家属和医护人员共同组成的决策共享模式,对患者实现个体化的病情告知,让更多的患者和家属主动参与到临床决策的过程中,缓解其家属因签署放弃治疗而导致的巨大心理压力.     

Fin de vie en réanimation : la loi Leonetti est-elle suffisante ?

For a long time, there have been concerns with patients’ end-of-life in the intensive care unit (ICU), leading to the publication of French guidelines updated in 2009, taking into account the insights given by Leonetti’s law in regarding patients’ rights at end-of-life. Following the mission given to Professor Didier Sicard by the French president about end-of-life, the French society of intensive care (SRLF) wished to know the feelings of their members (physicians and nurses) about various aspects of end-of-life in the ICU. SRLF members were invited to respond to a questionnaire, directly sent by e-mail, in order to assess their knowledge about Leonetti’s law and to show how many caregivers agree with the authorization of lethal drug administration in selected situations of end-of-life. Out of 2700 requests, 616 answers were analyzed. A majority (82.5%) had a good knowledge of Leonetti’s law and most of them (88%) said they have often applied the law. They reported to have received a “help dying” request from a patient (one-third of respondents) and patient’s relatives (more than 50%). A quarter of the respondents agreed to give lethal drugs to end-of-life patients. Assuming that palliative cares in the ICU are wellconducted, 25.7% of the respondents would approve though a law authorizing euthanasia exception, while 26.5% did not. Answers were influenced by the fear of a possible risk of abuse. Doctors and nurses answered differently. In conclusion, Leonetti’s law appears well-known by ICU caregivers. Nevertheless, in selected clinical situations with adapted palliative care, a quarter of the respondents would be in favor of a law authorizing lethal drugs administration to patients.