Fixation d’un but thérapeutique pour les patients supportés à long terme par un DAV aux soins intensifs : l’expérience des soignants
A non eligible transplant patient on long term ventricular assist device (VAD) support in intensive care unit (ICU), can evolve in multiple ways. Alot of health care professionnals live a malaise when the patient surves with complications without neither possibility of cardiaque transplantation nor return home. In consequence, defferent goals of care are pursued in the health care team. This is why, the researcher maintained all along the study, the objectives to understand the goals pursued by the health care professionnals working towards the particular patient, to clarify the factors influensing these pursued goals and to learn more on the health care team difficulties to elaborate a common goal. Phenomenology has been the method used to define the problem. Twelve participants working in ICU were included in the reasearch sample representing the nurses, physicians and perfusionists working towards the concerned patient. Each of the participants had collaborated to an individual, semi structured and audio recorded interview. First, the researcher presented a vignette with which she asked everyone a certain number of identical questions. The questions permitted the participants to express as much on there experience than on the context of the phenomenon. A second meeting has been necessary to validate or correct the interpretation of what has been expressed by each participant during the interview. The data analyisis testify a lack of continuity concerning the goal to pursue with the patient in question. Almost half of the participants aim for a transplantation when the rest of them pursue other goals like discharge of ICU, treatment limitation or paliative care. By a majority, the participants are influenced by the patient’s will, the absence of formal communication mecanism, profesionnal factors such as : values, practices and environment and power differential. Thus, health care profesionnals that would want to pursue a common team goal are facing a certain number of barriers. The resercher realises that to overcome these barriers, multidisciplinary communication has do be the driving force of team goal- setting. Although, to acheave this, two pre-requisits have to be developed: the ethical intention and the engagement.
bioethics VAD goal of care health care team phenomenology