[The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

BACKGROUND: The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE: To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS: A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. RESULTS: Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p < .01), and whether the patient had signed a currently valid advance healthcare directive (Eta = .223, p = .002). Furthermore, a significantly negative correlation was found between these intentions and length of stay in the ICU (r = -.263, p < .01). Patient age, whether the patient had signed a currently valid advance healthcare directive, and length of stay in the ICU were all predictive factors for the behavioral intentions underlying the medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

[Enhancing nurse implementation of oral healthcare in an intensive care unit].

BACKGROUND: Oral health professionals identified inadequate levels of patient oral health in our intensive care unit (ICU). A post-review analysis of collected data and field observation notes concluded that this problem resulted from several factors including: (1) Failure of ICU nurses to follow mouth care standards; (2) lack of oral injury care procedures; (3) lack of oral injury consultation procedures; (4) lack of oral care monitoring; (5) substandard oral care assistive devices. PURPOSE: The authors designed this project to raise general nursing staff knowledge of oral hygiene standards and increase the ability of nurses to implement proper oral healthcare. RESOLUTION: After discussions with oral health professionals and reviewing articles in the literature, the authors implemented Critical Patient Oral Care Standards and Oral Injury Consultation Procedures and purchased new assistive care devices. The authors also conducted regular on-the-job training sessions for hospital staff that were reinforced by regular monitoring. RESULTS: Training significantly increased nursing staff recognition of oral health care. Oral health care test scores rose from an initial average of 16% correct to a final average of 90% correct. Accurate implementation of oral health care in the ICU rose from an initial 19.69% to 78.66% of cases. CONCLUSION: This project significantly enhanced the accuracy and appropriateness of nurse oral health care delivery and quality health care promotion in the ICU.