3 years ago

Decisiones en los cuidados al final de la vida. ¿Jugamos en el mismo equipo?

M.m. Lomero-martínez, M.f. Jiménez-herrera, M.a. Bodí-saera, M. Llauradó-serra, N. Masnou-burrallo, E. Oliver-juan, A. Sandiumenge-camps

Publication date: October–December 2018

Source: Enfermería Intensiva, Volume 29, Issue 4

Author(s): M.M. Lomero-Martínez, M.F. Jiménez-Herrera, M.A. Bodí-Saera, M. Llauradó-Serra, N. Masnou-Burrallo, E. Oliver-Juan, A. Sandiumenge-Camps

Resumen
Antecedentes

La limitación del tratamiento de soporte vital es cada vez más frecuente en las unidades de críticos, y la donación en asistolia controlada se está empezando a incluir como una opción dentro del plan de cuidados de los pacientes. La falta de conocimientos y los malos entendidos pueden suponer una barrera entre los profesionales sanitarios.

Objetivo

Determinar la percepción, conocimientos y actitud de los médicos y enfermeras que trabajan en las unidades de críticos sobre la limitación del tratamiento de soporte vital y donación en asistolia controlada.

Diseño, ajustes y participantes

Se llevó a cabo un estudio transversal en 13 hospitales españoles utilizando un cuestionario diseñado a tal efecto.

Métodos

Para analizar las respuestas se utilizaron tablas de contingencia, el test de Chi cuadrado de Pearson, la «t» de Student y el test de Mann-Whitney para el análisis estadístico descriptivo bivariante y multivariante.

Resultados

Aunque la limitación del tratamiento de soporte vital es una práctica muy extendida, el trabajo muestra cómo los enfermeros se sienten excluidos tanto del desarrollo de protocolos como de los procesos de decisión, mientras que la percepción de los médicos es que tienen mayores conocimientos y que las decisiones se toman conjuntamente.

Conclusiones

Para solventar estas diferencias, los programas formativos multidisciplinares pueden ayudar a los profesionales de la salud a trabajar conjuntamente, con mayor coordinación, beneficiando tanto a pacientes como a sus familias, y proporcionando cuidados de calidad al final de la vida.

Abstract
Background

Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals.

Objective

To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death.

Design, settings and participants

Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire.

Methods

Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses.

Results

Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus.

Conclusions

Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care.

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