Emergency nurses’ perceptions of the difficult factors of surrogate decision support for patients’ families
Purpose: This study aim to evaluate the actual status of practice and importance perceived by emergency nurses for support of patients’ families who make surrogate decisions, and to clarify the factors that make it difficult to practice.Methods: We conducted an anonymous questionnaire survey among 1...
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| Published in | Journal of Japanese Society for Emergency Medicine Vol. 25; no. 3; pp. 522 - 532 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Emergency Medicine
30.06.2022
一般社団法人 日本臨床救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-0581 2187-9001 |
| DOI | 10.11240/jsem.25.522 |
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| Abstract | Purpose: This study aim to evaluate the actual status of practice and importance perceived by emergency nurses for support of patients’ families who make surrogate decisions, and to clarify the factors that make it difficult to practice.Methods: We conducted an anonymous questionnaire survey among 164 nurses working in emergency centers at 64 facilities.Results: The age of the subjects was 35.6±8.1 years, and the number of years working in the emergency center was 5.1±4.2 years. There was a strong correlation between the level of importance perceived by the emergency nurses and the level of practice (r=0.89, p<0.001). However, there were some items that could not be practiced sufficiently, and items related to support from multiple professions were the most common. The most common reason for the difficulty in practice was that they had to prioritize life-saving nursing tasks for patients.Conclusion: Surrogate decision-making support for emergency nurses was found to be a challenge in that they were not able to devote enough time to family support in the emergency situation, and furthermore, there was a lack of collaboration and coordination with other professions and the need to improve this system. |
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| AbstractList | Purpose: This study aim to evaluate the actual status of practice and importance perceived by emergency nurses for support of patients’ families who make surrogate decisions, and to clarify the factors that make it difficult to practice.Methods: We conducted an anonymous questionnaire survey among 164 nurses working in emergency centers at 64 facilities.Results: The age of the subjects was 35.6±8.1 years, and the number of years working in the emergency center was 5.1±4.2 years. There was a strong correlation between the level of importance perceived by the emergency nurses and the level of practice (r=0.89, p<0.001). However, there were some items that could not be practiced sufficiently, and items related to support from multiple professions were the most common. The most common reason for the difficulty in practice was that they had to prioritize life-saving nursing tasks for patients.Conclusion: Surrogate decision-making support for emergency nurses was found to be a challenge in that they were not able to devote enough time to family support in the emergency situation, and furthermore, there was a lack of collaboration and coordination with other professions and the need to improve this system. Purpose: This study aim to evaluate the actual status of practice and importance perceived by emergency nurses for support of patients’ families who make surrogate decisions, and to clarify the factors that make it difficult to practice.Methods: We conducted an anonymous questionnaire survey among 164 nurses working in emergency centers at 64 facilities.Results: The age of the subjects was 35.6±8.1 years, and the number of years working in the emergency center was 5.1±4.2 years. There was a strong correlation between the level of importance perceived by the emergency nurses and the level of practice (r=0.89, p<0.001). However, there were some items that could not be practiced sufficiently, and items related to support from multiple professions were the most common. The most common reason for the difficulty in practice was that they had to prioritize life-saving nursing tasks for patients.Conclusion: Surrogate decision-making support for emergency nurses was found to be a challenge in that they were not able to devote enough time to family support in the emergency situation, and furthermore, there was a lack of collaboration and coordination with other professions and the need to improve this system. 目的：救急看護師がとらえた代理意思決定を行う患者家族に対する看護支援の重要度の認識と実践度の実態を評価し，実践が困難な背景を明らかにすることを目的とする。方法：64施設の救命救急センターに勤務する164名の救急看護師を対象に，無記名アンケート調査を行った。結果：対象者の年齢は35.6±8.1歳であり，救命救急センター勤務年数は5.1±4.2年であった。救急看護師が認識した重要度と実践度には強い相関性を認めた（r=0.89，p<0.001）。 しかし，十分に実践できない項目も存在し，他職種からのサポートに関する項目が上位を占めた。実践が困難な理由には患者に対する救命の看護業務を優先せざるを得ない状況がもっとも多かった。結論：救急看護師の代理意思決定支援は，救急の状況のなかで家族支援に十分に時間を割くことができていない課題があり，さらに他職種との連携や調整の不足と，その体制の整備が必要であることが明らかになった。 |
| Author | KAKEYA, Kazumi YANAGI, Hisako MOMIYAMA, Sadami |
| Author_FL | 掛谷 和美 柳 久子 樅山 定美 |
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| Author_xml | – sequence: 1 fullname: MOMIYAMA, Sadami organization: Faculty of Nursing, Iryo Sosei University – sequence: 1 fullname: KAKEYA, Kazumi organization: Faculty of Nursing, Iryo Sosei University – sequence: 1 fullname: YANAGI, Hisako organization: Graduate School of Comprehensive Human Sciences, University of Tsukuba |
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| DocumentTitle_FL | 代理意思決定を担う患者家族への看護支援の重要度の認識と困難度の実態 |
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| References | 13) White DB, Cua SM, Walk R, et al: Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. Am J Crit Care 2012; 21: 396-409. 19) 上澤弘美, 中村美鈴: 初療で代理意思決定を担う家族員への関わりに対して看護師が抱える困難と理由. 日クリティカルケア看会誌 2013; 9 (1): 6-18. 5) 浦野知美, 神山美沙子, 杉本厚子: 訪問看護におけるアドバンスケアプランニング: ACPに関する文献レビュー. 足利大看研紀 2021; 9 (1): 55-62. 14) 長岡佳世子, 市村久美子: ICUにおける看護師の終末期ケアへの認識に関連する要因. Palliat Care Res 2021; 16: 289-299. 18) 中村美鈴, 山本洋子, 内海香子, 他: 生命の危機状況にある患者に代わり延命治療の実施に関する意思決定を行う家族への看護師の関わり. 自治医大看ジャーナル 2009; 9: 107-9. 3) Ernst E, Cohen MH: Informed consent in complementary and alternative medicine. Arch Intern Med 2001; 161: 2288-92. 12) Davidson JE, Powers K, Hedayat KM, et al: Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35: 605-22. 20) 樅山定美: 救急領域における患者の延命治療に対する代理意思決定を担う家族への看護支援の重要度と実践度の看護師の認識. 横浜創英大学研究論集 2017; 4: 1-12. 7) 中村美鈴, 水野照美, 山本洋子, 他: 生命の危機状態にある患者に代わり延命治療の意思決定を担う家族の体験. 自治医大看ジャーナル 2007; 5: 59-61. 9) Azoulay E, Chevret S, Leleu G, et al: Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28: 3044-9. 4) Stewart MA: Effective physician-patient communication and health outcomes: A review. CMAJ 1995; 152: 1423-33. 1) 竹内昌代, 杉崎一美: 集中治療室における積極的治療継続の断念を告げられた代理意思決定をする家族への看護支援. 四日市看医療大紀 2020; 13 (1): 21-31. 2) 藤丸清佳: 重症救急患者家族のニーズ 家族の語りからみえたもの. 日救急看会誌 2021; 23: 57-68. 6) 厚生労働省: 人生の最終段階における医療の普及・啓発の在り方に関する検討会（平成30年）. 人生の最終段階における医療に関する意識調査報告書. 2017, p1-123. 11) Azoulay E, Pochard F, Kentish-Barnes N, et al: Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171: 987-94. 16) 伊勢田暁子, 井上智子: 延命治療に関わる家族の意思決定. 家族看護 2003; 1 (1): 48-54. 15) 日本クリティカルケア看護学会, 日本救急看護学会: 救急・集中ケアにおける終末期看護プラクティスガイド. 2019. http://jaen.umin.ac.jp/pdf/EOL_guide1.pdf（最終アクセス: 2022.3.1） 17) 宮﨑美保, 渡邉百合香, 平松貴, 他: 終末期医療を困難にする要因からみたICUの現状と看護師の困難感. 東邦看会誌 2016; 13: 43-8. 10) 石塚紀美, 井上智子: 救命救急領域における家族の代理意思決定時の思いと看護支援の実態. 日クリティカルケア看会誌 2015; 11 (3): 11-23. DOI: https://doi.org/10.11153/jaccn.11.3_11. 8) Wendler D, Rid A: Systematic review: The effect on surrogates of making treatment decisions for others. Ann Intern Med 2011; 154: 336-46. |
| References_xml | – reference: 20) 樅山定美: 救急領域における患者の延命治療に対する代理意思決定を担う家族への看護支援の重要度と実践度の看護師の認識. 横浜創英大学研究論集 2017; 4: 1-12. – reference: 13) White DB, Cua SM, Walk R, et al: Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. Am J Crit Care 2012; 21: 396-409. – reference: 9) Azoulay E, Chevret S, Leleu G, et al: Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28: 3044-9. – reference: 11) Azoulay E, Pochard F, Kentish-Barnes N, et al: Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171: 987-94. – reference: 19) 上澤弘美, 中村美鈴: 初療で代理意思決定を担う家族員への関わりに対して看護師が抱える困難と理由. 日クリティカルケア看会誌 2013; 9 (1): 6-18. – reference: 15) 日本クリティカルケア看護学会, 日本救急看護学会: 救急・集中ケアにおける終末期看護プラクティスガイド. 2019. http://jaen.umin.ac.jp/pdf/EOL_guide1.pdf（最終アクセス: 2022.3.1） – reference: 16) 伊勢田暁子, 井上智子: 延命治療に関わる家族の意思決定. 家族看護 2003; 1 (1): 48-54. – reference: 8) Wendler D, Rid A: Systematic review: The effect on surrogates of making treatment decisions for others. Ann Intern Med 2011; 154: 336-46. – reference: 5) 浦野知美, 神山美沙子, 杉本厚子: 訪問看護におけるアドバンスケアプランニング: ACPに関する文献レビュー. 足利大看研紀 2021; 9 (1): 55-62. – reference: 14) 長岡佳世子, 市村久美子: ICUにおける看護師の終末期ケアへの認識に関連する要因. Palliat Care Res 2021; 16: 289-299. – reference: 4) Stewart MA: Effective physician-patient communication and health outcomes: A review. CMAJ 1995; 152: 1423-33. – reference: 3) Ernst E, Cohen MH: Informed consent in complementary and alternative medicine. Arch Intern Med 2001; 161: 2288-92. – reference: 18) 中村美鈴, 山本洋子, 内海香子, 他: 生命の危機状況にある患者に代わり延命治療の実施に関する意思決定を行う家族への看護師の関わり. 自治医大看ジャーナル 2009; 9: 107-9. – reference: 1) 竹内昌代, 杉崎一美: 集中治療室における積極的治療継続の断念を告げられた代理意思決定をする家族への看護支援. 四日市看医療大紀 2020; 13 (1): 21-31. – reference: 2) 藤丸清佳: 重症救急患者家族のニーズ 家族の語りからみえたもの. 日救急看会誌 2021; 23: 57-68. – reference: 7) 中村美鈴, 水野照美, 山本洋子, 他: 生命の危機状態にある患者に代わり延命治療の意思決定を担う家族の体験. 自治医大看ジャーナル 2007; 5: 59-61. – reference: 10) 石塚紀美, 井上智子: 救命救急領域における家族の代理意思決定時の思いと看護支援の実態. 日クリティカルケア看会誌 2015; 11 (3): 11-23. DOI: https://doi.org/10.11153/jaccn.11.3_11. – reference: 12) Davidson JE, Powers K, Hedayat KM, et al: Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35: 605-22. – reference: 6) 厚生労働省: 人生の最終段階における医療の普及・啓発の在り方に関する検討会（平成30年）. 人生の最終段階における医療に関する意識調査報告書. 2017, p1-123. – reference: 17) 宮﨑美保, 渡邉百合香, 平松貴, 他: 終末期医療を困難にする要因からみたICUの現状と看護師の困難感. 東邦看会誌 2016; 13: 43-8. |
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| SubjectTerms | critical care emergency nurses family nursing nursing support surrogate decision-making 代理意思決定 家族看護 救命救急 救急看護師 看護支援 |
| Title | Emergency nurses’ perceptions of the difficult factors of surrogate decision support for patients’ families |
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