Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care
| Autor: | Lois Downey, J. Randall Curtis, Patsy D. Treece, Elizabeth L. Nielsen, Kathleen J. Ramos, Sarah E. Shannon, Ruth A. Engelberg |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Washington medicine.medical_specialty Quality management Attitude to Death Critical Care Attitude of Health Personnel Interprofessional Relations MEDLINE Psychological intervention Nursing Staff Hospital law.invention 03 medical and health sciences 0302 clinical medicine Nursing Randomized controlled trial law Professional-Family Relations Intervention (counseling) Physicians Surveys and Questionnaires Medicine Humans 030212 general & internal medicine General Nursing Aged Quality of Health Care Aged 80 and over Terminal Care business.industry Communication General Medicine Original Articles Middle Aged Intensive care unit Quality Improvement Intensive Care Units Anesthesiology and Pain Medicine 030228 respiratory system Family medicine Observational study Female business End-of-life care |
| Popis: | Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve.Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU).This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008). Nurses completed surveys for patients dying in the ICU. We examined associations between nurse-assessed predictors (physician-nurse communication, physician-family communication) and nurse ratings of patients' quality of dying (nurse-QODD-1).Based on 1173 nurse surveys, four of six physician-nurse communication topics were positively associated with nurse-QODD-1: family questions, family dynamics, spiritual/religious issues, and cultural issues. Discussions between nurses and physicians about nurses' concerns for patients or families were negatively associated. All physician-family communication ratings, as assessed by nurses, were positively associated with nurse-QODD-1: answering family's questions, listening to family, asking about treatments patient would want, helping family decide patient's treatment wishes, and overall communication. Path analysis suggested overall physician-family communication and helping family incorporate patient's wishes were directly associated with nurse-QODD-1.Several topics of physician-nurse communication, as rated by nurses, were associated with higher nurse-rated quality of dying, whereas one topic, nurses' concerns for patient or family, was associated with poorer ratings. Higher nurse ratings of physician-family communication were uniformly associated with higher quality of dying, highlighting the importance of this communication. Physician support of family decision making was particularly important, suggesting a potential target for interventions to improve end-of-life care. |
| Databáze: | OpenAIRE |
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