[1]祁聪慧,康凤英,赵文芳,等.ICU急性肾损伤患者连续性肾脏替代治疗上机时家属决策困境的现象学研究[J].军事护理,2023,40(03):41-44.[doi:10.3969/j.issn.2097-1826.2023.03.010]
 QI Conghui,KANG Fengying,ZHAO Wenfang,et al.Family Decision-making Dilemma of Continuous Renal Replacement Therapy for Patients with Acute Kidney Injury in ICU:A Phenomenological Study[J].Nursing Journal Of Chinese People's Laberation Army,2023,40(03):41-44.[doi:10.3969/j.issn.2097-1826.2023.03.010]
点击复制

ICU急性肾损伤患者连续性肾脏替代治疗上机时家属决策困境的现象学研究
分享到:

《军事护理》[ISSN:2097-1826/CN:31-3186/R]

卷:
40
期数:
2023年03期
页码:
41-44
栏目:
战创伤护理专栏
出版日期:
2023-03-15

文章信息/Info

Title:
Family Decision-making Dilemma of Continuous Renal Replacement Therapy for Patients with Acute Kidney Injury in ICU:A Phenomenological Study
文章编号:
2097-1826(2023)03-0041-04
作者:
祁聪慧1康凤英2赵文芳3范亚荣1马启涛1韩青1
(1.山西医科大学 护理学院,山西 太原 030000; 2.山西医科大学第一医院 规培基地,山西 太原030000; 3.山西医科大学第一医院 重症医学科)
Author(s):
QI Conghui1KANG Fengying2ZHAO Wenfang3FAN Yarong1MA Qitao1HAN Qing1
(1.School of Nursing,Shanxi Medical University,Taiyuan 030000,Shanxi Province,China; 2.Standardized Training Base,First Hospital of Shanxi Medical University,Taiyuan 030000,Shanxi Province,China; 3.Department of Critical Care Medicine,First Hospital of Shanxi Medical University)
关键词:
急性肾损伤 连续性肾脏替代治疗 决策困境 家属 重症监护病房
Keywords:
acute kidney injury continuous renal replacement therapy decision-making dilemma family members intensive care units
分类号:
R473
DOI:
10.3969/j.issn.2097-1826.2023.03.010
文献标志码:
A
摘要:
目的 探索ICU急性肾损伤患者连续性肾脏替代治疗上机时家属决策过程中面临的困境,为促进医患共同决策提供参考。方法 运用现象学研究方法,选取2022年6-8月在太原市某三级甲等医院ICU内行连续性肾脏替代治疗的患者家属15例进行半结构式访谈,采用Colaizzi七步分析法进行资料分析。结果 患者家属的决策困境包括3个主题:决策困境前因(决策内容复杂、信息来源广泛但利用程度低、决策时间紧急)、决策困境内容(权衡治疗利弊、家庭意见分歧、经济现实与舆论压力的冲突)、决策困境体验(情绪调节失控、认知处理能力下降)。结论 连续性肾脏替代治疗患者家属临床决策存在困境,受多重因素影响,医护人员应关注患者家属连续性肾脏替代治疗上机的决策困境,及时识别其决策状态,采取针对性措施改善其决策困境。
Abstract:
Objective To explore the family decision-making dilemmas of continuous renal replacement therapy(CRRT)for patients with acute kidney injury in ICU,so as to provide references for promoting shared decision-making between doctors and patients.Methods A phenomenological study was conducted and 15 family members of patients who received CRRT in the ICU of a tertiary hospital in Taiyuan City were selected for semi-structured interviews from June to August,2022.The Colaizzi 7-step analysis method was used to analyze the data.Results Three themes on the family decision-making dilemmas were extracted,including antecedents of decision conflicts(complex contents,abundant information with low utility,urgent time),contents of decision conflicts(weighing the pros and cons of treatment,family members holding different opinions,conflicts between economic reality and public pressure),experience of decision conflicts(uncontrolled emotional regulation,decreased cognitive processing ability).Conclusions There are decision-making dilemmas among family members of CRRT patients,which may be affected by multiple factors.Medical staff should pay attention to the family decision-making dilemmas of CRRT for the patients,identify their states of decision-making,and take targeted measures to resolve decision conflicts.

参考文献/References:

[1] 曹杰,赵宇亮,付平.急性肾损伤流行病学的新进展[J].中国循证医学杂志,2019,19(6):631-634.
[2] JIANG L,ZHU Y,LUO X,et al.Epidemiology of acute kidney injury in intensive care units in Beijing:the multi-center BAKIT study[J/OL].[2022-11-10].
[3] 陈泳清,伍民生.ICU危重患者急性肾损伤流行病学研究现状[J].中国临床研究,2021,34(1):122-125.
[4] KARKAR A,RONCO C.Prescription of CRRT:a pathway to optimize therapy[J/OL].[2022-11-10].
[5] 李英,邓超,谢斌,等.CRRT重症肺部感染相关脓毒症患者病死危险因素[J].中华医院感染学杂志,2020,30(24):3730-3733.
[6] ZHENG M,YIN C,CAO Y,et al.Development and evaluation of a decision aid for family surrogate decision-makers for patients with acute kidney injury requiring renal replacement therapy(RRT)in ICUs:a study protocol[J/OL].[2022-11-10].
[7] SIM J A,SHIN J S,PARK S M,et al.Association between information provision and decisional conflict in cancer patients[J].Ann Oncol,2015,26(9):1974-1980.
[8] 廖宗峰,王宗文,李赛君,等.神经内科ICU患者家属疾病不确定感与决策冲突的相关性分析[J].神经损伤与功能重建,2022,17(8):452-455.
[9] CHEUNG A K,CHANG T I,CUSHMAN W C,et al.Executive summary of the KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease[J].Kidney Int,2021,99(3):559-569.
[10]STACEY D,LÉGARÉ F,BOLAND L,et al.20th anniversary Ottawa decision support framework:part 3 overview of systematic reviews and updated framework[J].Med Decis Making.2020,40(3):379-398.
[11]PIGNATIELLO G A,MARTIN R J,HICKMAN R L.Decision fatigue:a conceptual analysis[J].J Health Psychol,2020,25(1):123-135.
[12]READING TURCHIOE M,MANGAL S,ANCKER J S,et al.“Replace uncertainty with information”:shared decision-making and decision quality surrounding catheter ablation for atrial fibrillation[J/OL].[2022-11-10].
[13]RUSSELL M L,CARR A H,KIERAN K.Using mind mapping in family meetings to support shared decision making with pediatric and geriatric patients[J].Patient,2020,13(6):709-717.
[14]AHMED S,JAFRI H,FARAN M,et al.Cascade screening for beta-thalassaemia in Pakistan:relatives' experiences of a decision support intervention in routine practice[J].Eur J Hum Genet,2022,30(4):406-412.
[15]CHAAR E A,HALLIT S,HAJJ A,et al.Evaluating the impact of spirituality on the quality of life,anxiety,and depression among patients with cancer:an observational transversal study[J].Support Care Cancer,2018,26(8):2581-2590.
[16]张冰冰,聂琴琪,王婉洁,等.治疗决策辅助在ICU长期机械通气病人家属中的应用效果[J].护理研究,2018,32(21):3453-3456.

备注/Memo

备注/Memo:
【 收稿日期 】 2022-11-08 【 修回日期 】 2023-02-24
【 作者简介 】 祁聪慧,硕士在读,电话:0351-4135203
【 通信作者 】 康凤英,电话:0351-4639424
更新日期/Last Update: 2023-03-15