Clinicians’ Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study
| Autor: | Louise Terry, David J. Werring, Siobhan Mc Lernon |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Neurology Critical Care media_common.quotation_subject Decision Making Psychological intervention Nurses Neurocritical care (NCC) Intracerebral hemorrhage (ICH) Critical Care and Intensive Care Medicine Perceived inappropriate care (PIC) 03 medical and health sciences 0302 clinical medicine Perception Intensive care medicine Humans 030212 general & internal medicine Intensive care medicine Qualitative Research media_common Aged Cerebral Hemorrhage business.industry Distress Doctors Neurointensive care Stroke Prognostic uncertainty Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery Original Work Qualitative research |
| Zdroj: | Neurocritical Care |
| ISSN: | 1556-0961 1541-6933 |
| Popis: | Background and Objective Clinicians working in intensive care frequently report perceptions of inappropriate care (PIC) situations. Intracerebral haemorrhage (ICH) is associated with high rates of mortality and morbidity. Prognosticating after ICH is complex and may be influenced by clinicians’ subjective impressions and biases, which may, in turn, influence decision making regarding the level of care provided. The aim of this study was to qualitatively explore perceptions of neurocritical care in relation to the expected functional outcome for ICH patients. Design Qualitative study using semi-structured interviews with neurocritical care doctors and nurses. Setting Neurocritical care (NCC) department in a UK neuroscience tertiary referral center. Subjects Eleven neurocritical care nurses, five consultant neurointensivists, two stroke physicians, three neurosurgeons. Intervention None. Measurements and Main Results We conducted 21 semi-structured interviews and identified five key themes: (1) prognostic uncertainty (2) subjectivity of good versus poor outcome (3) perceived inappropriate care (PIC) situations (including for frail elderly patients) (4) challenging nature of decision-making (5) clinician distress. Conclusions Caring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision making involving the family, taking into account patients’ previously expressed values and preferences and incorporating these into bespoke care planning. |
| Databáze: | OpenAIRE |
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