학술논문
Percepción, actitud y conocimiento sobre la limitación del soporte vital y la donación en asistolia en medicina y enfermería ¿jugamos en el mismo equipo?
Document Type
Dissertation/Thesis
Source
TDX (Tesis Doctorals en Xarxa)
Subject
Language
Spanish; Castilian
Abstract
Justificación: La Limitación del Tratamiento de Soporte Vital (LTSV) es una práctica frecuente en las unidades de críticos, mientras que la donación en asistolia controlada (DAC) se ha incorporado como opción dentro de los cuidados al final de la vida. La falta de conocimientos y los malos entendidos pueden actuar como barrera entre los distintos profesionales sanitarios. Objetivo: Determinar los conocimientos y actitudes de medicina y enfermería de las unidades de críticos antes y después de un programa formativo multidisciplinar sobre la LTSV y DAC. Metodología: Se llevó a cabo un estudio transversal mediante un análisis bivariante utilizando tablas de contingencia, test de Chi cuadrado de Pearson, test T de Student y test U de Mann-Whitney. Igualmente se realizó análisis multivariante cuando se encontraron significación estadística en el análisis bivariado. Resultados: Realizaron el curso 143 participantes, 133 cumplimentaron el cuestionario inicial, y 72 el final. Un 44,3% de los participantes afirmaron sentirse cómodos a la hora de aplicar la LTSV, sintiéndose mucho más cómodos el personal médico (55,7%) que el de enfermería (32,3%). El 88,9% del personal de enfermería cree que la LTSV debe ser una decisión conjunta, aumentando al 100% tras la formación. Antes de la formación menos del 20% del personal de enfermería sabían describir que era un DAC y su regulación, frente a más de un 60% del personal médico, diferencias que desaparecen tras la formación. Enfermería se siente excluida en el desarrollo de protocolos y en la toma de decisiones, mientras que la percepción de medicina es que tienen mayor conocimiento y que las decisiones se alcanzan por consenso. La formación ayuda a que los profesionales trabajen con mayor coordinación, beneficiando a los pacientes y a sus familias ofreciendo unos cuidados al final de la vida de calidad.
Background: Limitation of life-sustaining treatment (LLST) is a common practice in critical care units, and donation after circulatory death (DCD) has come to be included as an option within this care plan. Lack of knowledge and misunderstandings can act as a barrier between healthcare providers. Aim: The aim of this study is to determine the knowledge and attitude of nurses and doctors in intensive care units before and after a multi-disciplinary training program in LLST and DCD. Methodology: A cross-sectional study was carried out, after which contingency tables, Pearson’s chi-squared test, Student’s t-test and the Mann-Whitney u-test were used to perform descriptive and bivariate statistical analyses and multivariant analysis when the bivariate analysis produced a statistical significant level. Results: A total of 143 participants completed the course, of whom 133 completed the pre-training survey and 72 the post-training questionnaire (54.1%). 44.3% of the participants felt comfortable when deciding whether to implement LLST, although physicians did so in greater number (55.7%) than nurses (32.3 %). 88.9% of nurses agreed that LLST decisions should be made jointly, a figure that reached 100% after the training. At the beginning, only 20% of nurses were able to describe the DCD process and they were less familiar with the legislation regulating DCD in comparison to the 60% recorded by physicians, a difference that disappeared after the training. 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 by consensus. Training helps healthcare providers to work together with greater coordination, benefitting patients and their next of kin by providing excellent end-of-life care.
Background: Limitation of life-sustaining treatment (LLST) is a common practice in critical care units, and donation after circulatory death (DCD) has come to be included as an option within this care plan. Lack of knowledge and misunderstandings can act as a barrier between healthcare providers. Aim: The aim of this study is to determine the knowledge and attitude of nurses and doctors in intensive care units before and after a multi-disciplinary training program in LLST and DCD. Methodology: A cross-sectional study was carried out, after which contingency tables, Pearson’s chi-squared test, Student’s t-test and the Mann-Whitney u-test were used to perform descriptive and bivariate statistical analyses and multivariant analysis when the bivariate analysis produced a statistical significant level. Results: A total of 143 participants completed the course, of whom 133 completed the pre-training survey and 72 the post-training questionnaire (54.1%). 44.3% of the participants felt comfortable when deciding whether to implement LLST, although physicians did so in greater number (55.7%) than nurses (32.3 %). 88.9% of nurses agreed that LLST decisions should be made jointly, a figure that reached 100% after the training. At the beginning, only 20% of nurses were able to describe the DCD process and they were less familiar with the legislation regulating DCD in comparison to the 60% recorded by physicians, a difference that disappeared after the training. 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 by consensus. Training helps healthcare providers to work together with greater coordination, benefitting patients and their next of kin by providing excellent end-of-life care.