RESUMO
OBJECTIVES: Decision-making processes concerning end-of-life decisions are not well understood for patients admitted into stroke units with severe stroke. To assess the influence of nurses on the medical perspectives and approaches that lead to withholding and/or withdrawing treatments related to end-of-life (EOL) decisions. PATIENTS AND METHODS: This secondary analysis nested within the TELOS French national survey was based on a physicians' self-report questionnaire and on a I-Score which was linked to nurses' involvement. Physician's responses were evaluated to assess the potential influence of nurse's involvement on physician's choices during an end-of-life decision. RESULTS: Among the 120 questionnaires analyzed, end-of-life decisions were more often made during a round-table discussion (58% vs. 35%, pâ¯=â¯0.004) when physicians declare to involve nurses in the decision process. Neurologists involved with nurses in decision making were more likely to withhold a treatment (98% vs. 88%, pâ¯=â¯0.04), to withdraw artificial feeding and hydration (59% vs. 39%, pâ¯=â¯0.04), and more frequently prescribed analgesics and hypnotics at a potentially lethal dose (70% vs. 48%, pâ¯=â¯0.03). CONCLUSION: The involvement of nurses during end-of-life decisions for patients with acute stroke in stroke units seemed to influence neurologists' intensivist practices and behaviors. Nurses supported the physicians' decisions related to forgoing life sustaining treatment for patients with acute stroke and may positively impact on the family's choice to participate in end-of-life decisions.
Assuntos
Tomada de Decisão Clínica , Papel do Profissional de Enfermagem/psicologia , Papel do Médico/psicologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Assistência Terminal/psicologia , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Estudos Retrospectivos , Inquéritos e Questionários , Assistência Terminal/métodos , Assistência Terminal/normasRESUMO
Chronic illness is perceived as a particular kind of event. The aim of this paper is to understand the personal, familial and professional difficulties experienced by patients in France who have a neurodegenerative disease and undergo cerebral implants. This paper is based on the assumption that a treatment using biotechnical techniques is a unique disruptive experience which redefines the patient's life. Thirty patients (13 women and 17 men) from two French hospitals were interviewed at different stages of their medical history. Despite the excellent overall outcome of neurosurgery in patients with Parkinson's disease, there is often a contrast between the improvement in motor disability and the patient's difficulty in returning to normal life. These results allow us to analyse the link between the neurosciences and the experience of chronic illness.
Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/psicologia , Doença de Parkinson/terapia , Qualidade de Vida/psicologia , Papel do Doente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Autocuidado/psicologia , AutoimagemRESUMO
The new European directive REACH constitutes a potential step forward for the prevention of health risks linked to industrial chemical production. The conflicts of interest expressed throughout its development and the compromises resulting from those opposing interest situate this directive at the cross-roads of the multiple rationales operating in the occupational health field. The precautionary principal, risk assessment, prevention, regulation, and corporate responsibility will have a role to play in the practical implementation of REACH.
