Chinese Journal of Nursing ›› 2024, Vol. 59 ›› Issue (14): 1746-1751.DOI: 10.3761/j.issn.0254-1769.2024.14.012

• Specialist Practice and Research • Previous Articles     Next Articles

Dilemmas in decision-making:a qualitative study of family surrogate decision-makers of severe stroke patients

GUO Zining(), LING Keyu, CHEN Shufan, LI Haihan, YAO Ting, ZENG Sining, XU Ling, ZHU Xiaoping()   

  • Received:2024-01-11 Online:2024-07-20 Published:2024-07-11
  • Contact: ZHU Xiaoping

重症脑卒中患者家属代理决策困境的质性研究

郭子宁(), 凌克玉, 陈述凡, 李海涵, 姚亭, 曾司甯, 徐玲, 朱晓萍()   

  1. 230012 合肥市 安徽中医药大学护理学院(郭子宁,姚亭,徐玲);同济大学附属第十人民医院护理部(凌克玉,陈述凡,李海涵,曾司甯,朱晓萍)
  • 通讯作者: 朱晓萍
  • 作者简介:郭子宁:女,本科(硕士在读),E-mail:zining1124@163.com
  • 基金资助:
    国家自然科学基金面上项目(72074168)

Abstract:

Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies. Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing’an District, Shanghai. semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate. Data were analyzed via Braun’s style of thematic analysis. Results 4 themes and 10 sub-themes were identified. Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty). Theme 2:supportive environment dilemmas(lack of information support delays decision-making; lack of family support increases decision-making stress; insufficient economic support increases the burden of decision-making). Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity). Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences). Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas. Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

Key words: Severe Stroke Patients, Family, Surrogate Decision-Making, Dilemmas in Decision-Making, Nursing Care, Qualitative Research

摘要:

目的 探究重症脑卒中患者家属在代理决策中面临的困境,为制订决策支持策略提供参考依据。方法 2023年4月—12月采用现象学研究方法,对上海市静安区某三级甲等医院神经内科重症监护室的16例重症脑卒中患者家属代理决策者进行半结构化深度访谈,运用Braun主题分析法进行资料分析。结果 提炼出4个主题和10个亚主题。①负性情绪困境:紧迫决策致使焦虑、恐惧;卒中轨迹未知导致的不确定感。②支持环境困境:信息支持匮乏致使决策延迟、家庭支持缺失加重决策压力、经济支持不足增添决策负担。③利弊权衡困境:风险-收益的困难权衡、现实-伦理的艰难抉择、生命-尊严的矛盾冲突。④偏好处理困境:依从患者偏好存在客观困难、未知患者偏好造成决策阻碍。结论 重症脑卒中患者家属在为患者进行临床决策时面临多重决策困境。医护人员应提供多途径情感指导及全方位辅助支持,以减轻脑卒中家属代理决策困境,同时需对家属代理决策者加强生死教育,并推广预立医疗照护计划,以减轻其决策压力。

关键词: 重症脑卒中, 家属, 代理决策, 决策困境, 护理, 质性研究