| Project/Area Number |
15K11606
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Clinical nursing
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| Research Institution | Kanto Gakuin University (2016-2019)
Jikei University School of Medicine (2015) |
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Principal Investigator |
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| Co-Investigator(Kenkyū-buntansha) |
西開地 由美 秀明大学, 学校教師学部, その他 (50712725)
吉野 靖代 関東学院大学, 看護学部, 助教 (50806255)
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| Project Period (FY) |
2015-04-01 – 2020-03-31
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| Project Status |
Completed (Fiscal Year 2019)
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| Budget Amount *help |
¥4,550,000 (Direct Cost: ¥3,500,000、Indirect Cost: ¥1,050,000)
Fiscal Year 2018: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
Fiscal Year 2017: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2016: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
Fiscal Year 2015: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
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| Keywords | ICU / End of Life Care / 意思決定過程 / 意思決定支援 / ICU入室患者 / 緩和ケア / ストレス経験 / 人工呼吸器管理 / コンフォート / ディスコンフォート |
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| Outline of Final Research Achievements |
In order to clarify the current status of End of Life Care in ICU, we conducted a medical record survey of patients who entered ICU from April 2014 to December 2016 and had a fatal outcome. As a result, the median occupancy was 1.77 days. The medical condition was 56.7% for tracheal intubation, 81.9% for use of vasopressor, 45.7% for transfusion, and 20.5% for continuous nutrition. DNAR was 80.5% and withhold/withdraw was 48.8%, both increasing over time, and were not significantly different by age, disease group, or entry route. Treatment restrictions included vasopressor restriction, no dialysis, and no circuit renewal (PCPS, CHD). Withdraw was for 3 patients. The patient was intubated, the ventilator was stopped, surgery and administration of vasopressor were discontinued. Nursing records of the decision-making process regarding treatment accounted for 62.4%, and 58.4% described palliative care for patients with pain and dry mouth and adjustment of analgesics and sedatives.
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| Academic Significance and Societal Importance of the Research Achievements |
救急・集中治療における終末期医療に関するガイドラインにおいて、患者の意思を尊重しチームで適切な対応を判断する必要性が提言されている。2014年から2016年にかけて患者の治療に関する意思決定プロセスにおいて、家族によって患者の推定意思を尊重した治療選択や家族介入が記載されていることは、End of Life Care実施の証拠となり得ると考える。しかし、患者本人の事前意思表示は皆無で、治療に関する意思確認は困難な状況も明らかとなり、特に意識がある状態の患者の意思決定プロセスに、家族の代理意思決定を含めてどのように看護師が関わるかはEnd of Life Careの今後の重要な課題である。
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