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Bloomer MJ, Ranse K, Adams L, Brooks L, Coventry A. "Time and life is fragile": An integrative review of nurses' experiences after patient death in adult critical care. Aust Crit Care 2023; 36:872-888. [PMID: 36371292 DOI: 10.1016/j.aucc.2022.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses' experiences after patient death. AIM The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care. DESIGN A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings. RESULTS From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses; (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support; and (iii) nurses' emotional response to patient death including coping mechanisms. CONCLUSIONS Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.
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Affiliation(s)
- Melissa J Bloomer
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Queensland Health, Queensland, Australia.
| | - Kristen Ranse
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia
| | - Leah Adams
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; Intensive Care Unit, Latrobe Regional Hospital, Victoria, Australia
| | - Laura Brooks
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Deakin University, Victoria, Australia
| | - Alysia Coventry
- End of Life Advisory Panel, Australian College of Critical Care Nurses, Victoria, Australia; St Vincent's Health Network Sydney, St Vincent's Hospital, Melbourne and Australian Catholic University, Australia
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Sanli D, Iltus F. Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:936-957. [PMID: 32955992 DOI: 10.1177/0030222820961232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.
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Affiliation(s)
- Deniz Sanli
- Department of Surgical Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Fatma Iltus
- Department of Nursing, Aksehir Kadir Yallagoz School of Health, Selcuk University, Konya, Turkey
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Thompson GN, Mcclement SE, Daeninck PJ. “Changing Lanes”: Facilitating the Transition from Curative to Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200205] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little empirical work has been conducted assessing the perspectives of nurses regarding the barriers, facilitators, and strategies associated with achieving quality patient care at the end of life. A grounded theory study was conducted examining nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of generalist nurses (n=10) working in an acute care setting. An inductively derived preliminary model, “creating a haven for safe passage”, was developed based on the findings from this study and has been published elsewhere (1). This article provides a detailed description of one of the subprocesses of the model regarding the transition from curative to palliative care—the subprocess of “facilitating and maintaining a lane change”. The various strategies which nurses used to effect a lane change, as well as the facilitators and barriers they encountered in this process, are presented. The consequences associated with both successful and unsuccessful lane changes are reported.
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Affiliation(s)
| | - Susan E. Mcclement
- Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg
| | - Paul J. Daeninck
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Karbasi C, Pacheco E, Bull C, Evanson A, Chaboyer W. Registered nurses' provision of end-of-life care to hospitalised adults: A mixed studies review. NURSE EDUCATION TODAY 2018; 71:60-74. [PMID: 30245257 DOI: 10.1016/j.nedt.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/04/2018] [Accepted: 09/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe, critically appraise and synthesise research regarding nurses' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives. DESIGN Mixed studies review. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching. REVIEW METHODS Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically. RESULTS Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care. CONCLUSIONS Registered Nurses have aligned their end-of-life care with practice with the profession's expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.
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Affiliation(s)
- C Karbasi
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - E Pacheco
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - C Bull
- Centre for Applied Health Economics (CAHE), Griffith University, Nathan Campus, 4111 QLD, Australia.
| | - A Evanson
- North West Hospital and Health Service, Mount Isa Hospital, 30 Camooweal Street, QLD 4825, Australia.
| | - W Chaboyer
- Menzies Health Institute Queensland, Griffith University, 4215 QLD, Australia.
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Oncology nurses' perceptions of obstacles and role at the end-of-life care: cross sectional survey. BMC Palliat Care 2017; 16:74. [PMID: 29258492 PMCID: PMC5735910 DOI: 10.1186/s12904-017-0257-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/30/2017] [Indexed: 01/09/2023] Open
Abstract
Background Major obstacles exist in the care of patients at the end of life: lack of time, poor or inadequate communication, and lack of knowledge in providing care. Three possible nursing roles in care decision-making were investigated: Information Broker, Supporter, and Advocate. The purpose of this study was to examine obstacles faced by oncology nurses in providing end-of-life (EOL) care and to examine roles of nurses in providing care. Methods A descriptive, cross-sectional, correlational design was applied. The study was conducted at two major University Hospitals of Oncology in Lithuania that have a combined total of 2365 beds. The study sample consisted of 239 oncology registered nurses. Data collection tool included a questionnaire about assessment of obstacles and supportive behaviors, nursing roles, and socio-demographic characteristics. Results The two items perceived by respondents as the most intense obstacles to providing EOL care were The nurse’s opinion on immediate patient care is not welcome, valued or discussed and. Family has no access to psychological help after being informed about the patient’s diagnosis. The majority of respondents self-assigned the role of Supporter. Conclusions Major obstacles in providing care included the nurse’s opinion that immediate patient care was not valued, lack of nursing knowledge on how to treat the patient’s grieving family, and physicians who avoided conversations with the patient and family members about diagnoses and prospects. In EOL care nurses most frequently acted as Supporters and less frequently as Advocates.
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Jakimowicz S, Perry L, Lewis J. An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit. J Clin Nurs 2017; 26:4153-4171. [PMID: 28699268 DOI: 10.1111/jocn.13957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. BACKGROUND Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. DESIGN An integrative literature review. REVIEW METHOD Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. RESULTS In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. CONCLUSION Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. RELEVANCE TO CLINICAL PRACTICE Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.
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Affiliation(s)
| | - Lin Perry
- Department of Nursing Research & Practice Development, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, University of Technology, Sydney, NSW, Australia
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Libo-On ILM, Nashwan AJ. Oncology nurses' perceptions of end-of-life care in a tertiary cancer centre in Qatar. Int J Palliat Nurs 2017; 23:66-73. [PMID: 28245161 DOI: 10.12968/ijpn.2017.23.2.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nurses who work in oncology settings may lack the knowledge and skills required for end-of-life (EoL) care. A clear understanding of nurses' perceptions of EoL care is crucial for the successful improvement of care for terminally ill patients with cancer. Although many studies have underlined nurses' perspectives on EoL care, this is the first such study conducted on oncology nurses in Qatar. PURPOSE This study primarily sought to measure nurses' perceptions of EoL care at the National Center for Cancer Care and Research (NCCCR) in Qatar. METHODS A quantitative, cross-sectional, self-reported study. Nurses at the NCCCR reported their perceptions of EoL care using the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, which consisted of 30 items scored on a five-point Likert scale. Seventy-eight nurses working in oncology settings completed the tool. RESULTS Approximately one third (33-35%) of the participants had positive perceptions of EoL care. The majority (67%) of the participants were uncertain or ambivalent regarding EoL events and situations. There was no significant relationship between the participants' profiles and their perceptions of EoL care. However, very few of them had completed educational courses in death and dying. CONCLUSION Nurses have an important impact on EoL care, and continuous education is necessary to improve their confidence when they work with dying patients and their families. An in-house programme to help nurses cope with compassionate exhaustion and humanistic and relational care is highly recommended.
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Affiliation(s)
- Izette Larraine M Libo-On
- Registered Nurse, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Qatar
| | - Abdulqadir J Nashwan
- Nurse Research Scientist, NCCCR, Hamad Medical Corporation, Qatar Adjunct Senior Instructor, University of Calgary (Qatar)
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Cobanoğlu N, Algier L. A Qualitative Analysis of Ethical Problems Experienced by Physicians and Nurses in Intensive Care Units in Turkey. Nurs Ethics 2016; 11:444-58. [PMID: 15362354 DOI: 10.1191/0969733004ne723oa] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this qualitative study, we aimed to identify and compare the ethical problems perceived by physicians and nurses in intensive care units at Baskent University hospitals in Turkey. A total of 21 physicians and 22 nurses were asked to describe ethical problems that they frequently encounter in their practice. The data were analyzed using an interactive model. The core problem for both physicians and nurses was end-of-life decisions (first level). In this category, physicians were most frequently concerned with euthanasia while nurses were more concerned with do-not-resuscitate orders (second level). At the third level, we saw that almost all of the participants’ responses related to negative perceptions about euthanasia. Communication and hierarchical problems were the second most reported main category. Nurses were more likely to cite problems with hierarchy than physicians. At the third level, a large percentage of nurses described communication problems with authority and hierarchical problems with physicians. In the same category, physicians were most often concerned with communication problems with patients’ relatives. The ethical problems were reported at different frequencies by physicians and nurses. We asked the participants about ethical decision-making styles. The results show that nurses and physicians do not follow a systematic pattern of ethical decision making.
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Affiliation(s)
- Nesrin Cobanoğlu
- Faculty of Medicine, Medical Ethics Department, Baskent University, Eskisehir Yolu 20.km, Ankara, Turkey.
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McAdam JL, Erikson A. Bereavement Services Offered in Adult Intensive Care Units in the United States. Am J Crit Care 2016; 25:110-7. [PMID: 26932912 DOI: 10.4037/ajcc2016981] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Losing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs. OBJECTIVE To describe current bereavement follow-up services in adult ICUs. METHOD A cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of Critical-Care Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression. RESULTS A total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care. CONCLUSIONS The study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an associate professor, Samuel Merritt University, School of Nursing, Oakland, California. Alyssa Erikson is an assistant professor, California State University, Monterey Bay, Seaside, California
| | - Alyssa Erikson
- Jennifer L. McAdam is an associate professor, Samuel Merritt University, School of Nursing, Oakland, California. Alyssa Erikson is an assistant professor, California State University, Monterey Bay, Seaside, California
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Andrews T. To cure sometimes, to relieve often and to comfort always: nurses' role in end-of-life decision-making. Nurs Crit Care 2015; 20:227-8. [PMID: 26268198 DOI: 10.1111/nicc.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tom Andrews
- School of Nursing and Midwifery, University College Cork, Ireland.
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11
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Ramasamy Venkatasalu M, Whiting D, Cairnduff K. Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life care. J Adv Nurs 2015; 71:2108-18. [PMID: 25974729 DOI: 10.1111/jan.12680] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
Abstract
AIM To explore the experiences, challenges and practices of critical care practitioners since the discontinuation of the Liverpool Care Pathway in critical care settings. BACKGROUND The Liverpool Care Pathway was widely used with an aim to improve communication and care for dying individuals and their relatives. However, widespread media criticism prompted a review, which resulted in the discontinuation of the Liverpool Care Pathway across all UK clinical settings. DESIGN A qualitative study. METHOD The study was carried out in two large acute hospitals in England. Semi-structured interviews were conducted with 14 critical care practitioners, 6 months after discontinuation of the Liverpool Care Pathway. Transcribed verbatim data were analysed using framework analysis. RESULTS Three key themes emerged: 'lessons learned', 'uncertainties and ambivalences' and 'the future'. Critical care practitioners reported that life after the Liverpool Care Pathway in critical care settings often involved various clinical ambivalences, uncertainties and inconsistencies in the delivery of end-of-life care, especially for less experienced practitioners. Critical care practitioners had 'become accustomed' to the components of the Liverpool Care Pathway, which still guide them in principle to ensure quality end-of-life care. The Liverpool Care Pathway's structured format was perceived to be a useful clinical tool, but was also criticized as a 'tick-box exercise' and for lacking in family involvement. CONCLUSIONS This study posits two key conclusions. Despite experienced critical care practitioners being able to deliver quality end-of-life care without using the Liverpool Care Pathway, junior nursing and medical staff need clear guidelines and support from experienced mentors in practice. Evidence-based guidelines related to family involvement in end-of-life care planning in critical care settings are also needed to avoid future controversies.
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Affiliation(s)
- Munikumar Ramasamy Venkatasalu
- Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Aylesbury, Buckinghamshire, UK
| | - Dean Whiting
- Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Aylesbury, Buckinghamshire, UK
| | - Karen Cairnduff
- Department of Healthcare Practice, Faculty of Health and Social Sciences, University of Bedfordshire, Buckinghamshire Campus, Oxford House, Oxford Road, Aylesbury, Buckinghamshire, UK
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Ranse K, Yates P, Coyer F. Factors influencing the provision of end-of-life care in critical care settings: development and testing of a survey instrument. J Adv Nurs 2014; 71:697-709. [PMID: 25429994 DOI: 10.1111/jan.12576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Abstract
AIM To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. BACKGROUND Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. DESIGN A cross-sectional survey of critical care nurses. METHOD An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. RESULTS Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. CONCLUSION This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.
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Affiliation(s)
- Kristen Ranse
- Disciplines of Nursing & Midwifery, Faculty of Health, University of Canberra, Australian Capital Territory, Australia
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Holms N, Milligan S, Kydd A. A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit. Int J Palliat Nurs 2014; 20:549-56. [PMID: 25426882 DOI: 10.12968/ijpn.2014.20.11.549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Natalie Holms
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Stuart Milligan
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Angela Kydd
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
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Efstathiou N, Walker W. Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: a qualitative study. J Clin Nurs 2014; 23:3188-96. [DOI: 10.1111/jocn.12565] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nikolaos Efstathiou
- School of Health and Population Sciences (Nursing); College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Wendy Walker
- Centre for Health and Social Care Improvement; School of Health and Wellbeing; University of Wolverhampton; Wolverhampton UK
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Borhani F, Hosseini SH, Abbaszadeh A. Commitment to care: a qualitative study of intensive care nurses' perspectives of end-of-life care in an Islamic context. Int Nurs Rev 2013; 61:140-7. [PMID: 24382147 DOI: 10.1111/inr.12079] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking. AIM The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran. METHODS A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. RESULTS Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews. LIMITATION Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context. CONCLUSIONS This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process. IMPLICATIONS FOR NURSING AND HEALTH POLICY These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.
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Affiliation(s)
- F Borhani
- School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman
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Mak YW, Lim Chiang VC, Chui WT. Experiences and perceptions of nurses caring for dying patients and families in the acute medical admission setting. Int J Palliat Nurs 2013; 19:423-31. [DOI: 10.12968/ijpn.2013.19.9.423] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Vico Chung Lim Chiang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Wai To Chui
- Department of Psychiatry, Kowloon Hospital, Hong Kong
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King PA, Thomas SP. Phenomenological Study of ICU Nurses’ Experiences Caring for Dying Patients. West J Nurs Res 2013; 35:1292-308. [DOI: 10.1177/0193945913492571] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This existential phenomenological study explored caring for the dying based on the philosophical works of Merleau-Ponty. Fourteen critical care nurses were asked to describe lived experiences of caring for dying patients. An encompassing theme of Promises to Keep emerged, with five subthemes, including the following: (a) promise to be truthful: “Nurses are in the game of reality,” (b) promise to provide comfort: “I’ll make him comfortable,” (c) promise to be an advocate: “Just one more day,” (d) “Promise that couldn’t be kept,” and (e) “Promise to remain connected.” The essence of intensive care nurses’ lived experience of caring for dying patients is captured in the theme Promises to Keep. Nurses accept the reality of death and express strong commitment to making it as comfortable, peaceful, and dignified as possible, despite critical care unit environments that foster a “paradigm of curing” rather than a “paradigm of caring.”
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Guay D, Michaud C, Mathieu L. Conditions facilitant les « bons soins » palliatifs aux soins intensifs selon la perspective infirmière. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.112.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Arantzamendi M, Addington-Hall J, Saracibar M, Richardson A. Spanish nurses’ preparedness to care for hospitalised terminally ill patients and their daily approach to caring. Int J Palliat Nurs 2012; 18:597-605. [DOI: 10.12968/ijpn.2012.18.12.597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Arantzamendi
- School of Nursing, University of Navarra, C/Irunlarrea, 1 31.008, Pamplona, Spain
| | | | | | - Alison Richardson
- Cancer Nursing and End of Life Care, University of Southampton & Southampton University Hospitals NHS Trust
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20
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Prognostic communication of critical care nurses and physicians at end of life. Dimens Crit Care Nurs 2012; 31:170-82. [PMID: 22475704 DOI: 10.1097/dcc.0b013e31824e0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many critical care nurses express reluctance to communicate prognostic information to patients and family members, especially prior to physician communication of this information. Yet, the findings from this study indicate that critical care nurses play a crucial, complementary role to physicians in prognostic communication. Nurses' contributions result in a broader picture of prognosis to patients and family members and facilitate end-of-life discussions.
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Gutierrez KM. Prognostic categories and timing of negative prognostic communication from critical care physicians to family members at end-of-life in an intensive care unit. Nurs Inq 2012; 20:232-44. [PMID: 22672664 DOI: 10.1111/j.1440-1800.2012.00604.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end-of-life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision-making, drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision-making to drive prognostic communication resulted in delayed prognostic communication to families until end-of-life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision-making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end-of-life decision-making.
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Affiliation(s)
- Karen M Gutierrez
- Metropolitan State University, St. Paul, Minneapolis, MN 55331, USA.
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22
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Kryworuchko J, Hill E, Murray MA, Stacey D, Fergusson DA. Interventions for Shared Decision-Making About Life Support in the Intensive Care Unit: A Systematic Review. Worldviews Evid Based Nurs 2012; 10:3-16. [DOI: 10.1111/j.1741-6787.2012.00247.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 12/12/2022]
Affiliation(s)
- Jennifer Kryworuchko
- Assistant Professor, College of Nursing; University of Saskatchewan; Saskatoon; SK; Canada
| | - Elina Hill
- Student, Department of English; University of Victoria; Victoria; BC; Canada
| | - Mary Ann Murray
- School of Nursing, Faculty of Health Sciences; University of Ottawa; Ottawa; ON; Canada
| | - Dawn Stacey
- Associate Professor, School of Nursing, Faculty of Health Sciences; University of Ottawa; Associate Scientist and Director Patient Decision Aids Research Group Ottawa Hospital Research Institute; Nursing Best Practice Research Unit; Ottawa; ON; Canada
| | - Dean A. Fergusson
- Senior Scientist and Associate Director, Clinical Epidemiology Program, Ottawa Health Research Institute; Director, OHRI Methods Centre; Director, University of Ottawa Centre for Transfusion Research; Assistant Professor, Departments of Medicine, Surgery, & of Epidemiology and Community Medicine; University of Ottawa; Ottawa; ON; Canada
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23
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Ranse K, Yates P, Coyer F. End-of-life care in the intensive care setting: A descriptive exploratory qualitative study of nurses’ beliefs and practices. Aust Crit Care 2012; 25:4-12. [DOI: 10.1016/j.aucc.2011.04.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 03/15/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022] Open
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Broyles LM, Rodriguez KL, Price PA, Bayliss NK, Sevick MA. Overcoming barriers to the recruitment of nurses as participants in health care research. QUALITATIVE HEALTH RESEARCH 2011; 21:1705-1718. [PMID: 21844286 DOI: 10.1177/1049732311417727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Adequate participant recruitment is critical for the successful execution of research studies involving human subjects. Participant recruitment can be particularly challenging when the intended study participants are health care providers as opposed to patients. Discussions of the challenges and successful strategies associated with provider recruitment are limited, particularly regarding providers other than physicians and settings outside of primary care. Using a case study format, we present our experiences recruiting inpatient nurses into a study which involved focus group methodology at a United States Veterans Health Administration facility. We describe the initial logistical and ethical issues involved, various challenges we encountered, and five successful action strategies used during a second recruitment wave addressing logistical issues; on-site recruitment; increased scheduling flexibility and peer-to-peer recruitment; attention to the sensitive nature of the research topic; and increased involvement of stakeholders. In conclusion, we advocate for multimodal recruitment strategies that facilitate ongoing investigator-clinician partnerships.
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Affiliation(s)
- Lauren Matukaitis Broyles
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15206, USA.
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25
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Negotiated dying: A grounded theory of how nurses shape withdrawal of treatment in hospital critical care units. Int J Nurs Stud 2011; 48:1466-74. [DOI: 10.1016/j.ijnurstu.2011.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 06/09/2011] [Accepted: 06/14/2011] [Indexed: 11/20/2022]
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Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature. Nurs Res Pract 2011; 2011:527834. [PMID: 21994831 PMCID: PMC3184494 DOI: 10.1155/2011/527834] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 07/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022] Open
Abstract
The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research.
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27
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Kramer DB, Ottenberg AL, Gerhardson S, Mueller LA, Kaufman SR, Koenig BA, Mueller PS. "Just Because We Can Doesn't Mean We Should": views of nurses on deactivation of pacemakers and implantable cardioverter-defibrillators. J Interv Card Electrophysiol 2011; 32:243-52. [PMID: 21805140 DOI: 10.1007/s10840-011-9596-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/05/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to identify nurses' concerns about the clinical, ethical, and legal aspects of deactivating cardiovascular implantable electronic devices (CIEDs). METHODS We used focus groups to discuss decision making in CIED management. RESULTS Fourteen nurses described the informed consent process as overly focused on procedures, with inadequate coverage of living with a device (e.g., infection risks and device shocks). Elderly patients were especially vulnerable to physician or family pressure about CIED implantation. Nurses believed that initial advance care planning discussions were infrequent and rarely revisited when health status changed. Many patients did not know that CIEDs could be deactivated; it was often addressed reactively (i.e., after multiple shocks) or when patients became too ill to participate in decision making. Nurses generally were supportive of CIED deactivation when it was requested by a well-informed patient. However, nurses distinguished between withholding versus withdrawing treatment (i.e., turning off CIEDs vs. declining implantation). Although most patients viewed their device as lifesaving, others perceived them as a "ticking time bomb." CONCLUSIONS Nurses identified concerns about CIED decision making from implantation through end-of-life care and device deactivation and suggested avenues for improving patient care including early and regular advance care planning.
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Affiliation(s)
- Daniel B Kramer
- Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA, 02215, USA.
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Kryworuchko J, Stacey D, Peterson WE, Heyland DK, Graham ID. A qualitative study of family involvement in decisions about life support in the intensive care unit. Am J Hosp Palliat Care 2011; 29:36-46. [PMID: 21737407 DOI: 10.1177/1049909111414176] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We explored family involvement in decisions about life support interventions in the intensive care unit study using a critical incident technique to focus on specific case exemplars contributed by participants. A total of 6 family members and 9 health care professionals were interviewed. Participants described 2 options (life support or comfort care) and values associated with options: maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, needing adjustment time, and judicious health care resource use. Barriers to involvement included not being offered alternative options; no specific trigger to initiate decision making; dominant influence of professionals' values; and families lacking understandable information. Family members are unlikely to engage in decision making unless professionals identify the decision and address other barriers to family involvement.
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29
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Lago PM, Nilson C, Piva JP, Halal MG, Carvalho Abib GMD, Garcia PCR, Vieira AC. Nurses’ participation in the end-of-life — process in two paediatric intensive care units in Brazil. Int J Palliat Nurs 2011; 17:264, 267-70. [DOI: 10.12968/ijpn.2011.17.6.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patrícia M Lago
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Cristine Nilson
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Jefferson Pedro Piva
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Michel Georges Halal
- Fellow, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | | | - Pedro Celiny R Garcia
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Ana Cláudia Vieira
- Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul, Brazil
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Staff Perceptions of End-of-Life Care in the Acute Care Setting: A New Zealand Perspective. J Palliat Med 2011; 14:623-30. [DOI: 10.1089/jpm.2010.0470] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Critical care nurses' perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimens Crit Care Nurs 2011; 29:297-306. [PMID: 20940587 DOI: 10.1097/dcc.0b013e3181f0c43c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In response to critical care nurses' perceptions of increasing stress and conflict in difficult end-of-life (EOL) situations, the researchers conducted a study to identify perceived obstacles, supports, and knowledge needed to provide quality EOL care. The conclusions were as follows: (1) families and patients need clear, direct, and consistent information to make EOL decisions; (2) physician-related issues affect nurses' ability to provide quality EOL care; (3) critical care nurses need more knowledge, skill, and a sense of cultural competency to provide quality care; and (4) having properly completed advance directives can reduce confusion about the goals of care. Recommendations for improving EOL care were made as a result of the study.
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32
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Festic E, Wilson ME, Gajic O, Divertie GD, Rabatin JT. Perspectives of physicians and nurses regarding end-of-life care in the intensive care unit. J Intensive Care Med 2011; 27:45-54. [PMID: 21257636 DOI: 10.1177/0885066610393465] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement. OBJECTIVE To explore the differences of physicians and nurses on EOLC in the ICU and how these differences vary according to self-reported proficiency level and primary work unit. DESIGN Cross-sectional survey of 69 ICU physicians and 629 ICU nurses. SETTING Single tertiary care academic medical institution. RESULTS A total of 50 physicians (72%) and 331 nurses (53%) participated in the survey. Significant differences between physicians and nurses were noted in the following areas: ability to safely raise concerns, do not resuscitate (DNR) decision making, discussion of health care directives, timely hospice referral, spiritual assessment documentation, utilization of social services, and the availability of EOLC education. In every domain of EOLC, physicians reported a more positive perception than nurses. Additional differences were noted among physicians based on experience, as well as among nurses based on their primary work unit and self-reported proficiency level. CONCLUSIONS Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.
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Affiliation(s)
- Emir Festic
- Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
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33
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Guay D, Michaud C, Mathieu L. De « bons soins » palliatifs aux soins intensifs : une perspective infirmière. Rech Soins Infirm 2011. [DOI: 10.3917/rsi.105.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Nurses spend more time with patients at the end of life than any other member of the health care team, giving them early insight into futility-of-care issues for a particular patient. Providing futile care to dying patients is a well-known source of moral distress for nurses. Traditional ethical models are not always effective in dealing with these issues. The purpose of this article was to describe moral distress that is often experienced by nurses providing care to patients at the end of life and to propose the use of a model in dealing with associated ethical dilemmas in an effort to decrease the incidence of moral distress.
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35
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Kongsuwan W, Keller K, Touhy T, Schoenhofer S. Thai Buddhist intensive care unit nurses' perspective of a peaceful death: an empirical study. Int J Palliat Nurs 2010; 16:241-7. [PMID: 20679972 DOI: 10.12968/ijpn.2010.16.5.48145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To describe the concept of a peaceful death from Thai Buddhist intensive care unit (ICU) nurses' perspectives. METHOD A descriptive qualitative study of data generated from individual in-depth interviews of ten intensive care nurses who practiced in adult ICUs in the southern region of Thailand. Content analysis was used to analyse the data. FINDINGS Four core qualities of a peaceful death emerged as described by Thai Buddhist nurses who practised in the ICUs. These core qualities are: peaceful mind; no suffering; family's acceptance of patient's death; and being with others and not alone. CONCLUSION Thai Buddhist nurses described a peaceful death as 'a situation in which persons who are dying have peace of mind, and do not show signs and symptoms of suffering. Peaceful death occurs when family members declare acceptance of their loved one's dying and eventual death. Such a death is witnessed by relatives and friends and the dying person is not alone.' The findings encourage nurses to be with, and provide palliative care for, dying patients and families.
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Affiliation(s)
- Waraporn Kongsuwan
- Faculty of Nursing, Prince of Songkhla University, Hat Yai, Songkhla, Thailand.
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36
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Instrument development measuring critical care nurses' attitudes and behaviors with end-of-life care. Nurs Res 2010; 59:234-40. [PMID: 20467339 DOI: 10.1097/nnr.0b013e3181dd25ef] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care. OBJECTIVES The aim of this study was to develop an instrument to measure nursing attitudes and behaviors regarding end-of-life care. METHOD Phase 1 was focused on item development from a content analysis of the literature and qualitative interviews of critical care nurses. Phase 2 consisted of content validity assessment and pilot testing. Phase 3 included field testing, factor analysis, and reliability estimation. RESULTS The Values of Intensive Care Nurses for End-of-Life (n = 695) was found to have four factors: Self-appraisal, Appraisal of Others, Emotional Strain, and Moral Distress. Reliability estimates ([alpha]) were acceptable at .59-.78, but the interitem range (.12-.78) was wider than desirable. Test-retest reliability was deemed adequate based on Pearson's correlations (.68-.81) and intraclass correlation coefficients (.65-.79) but less so when considering [kappa] (.05-.30). The Behaviors of Intensive Care Nurses for End-of-Life (n = 682) was found to have two factors: Communication and Nursing Tasks. Reliability estimates were adequate when considering internal consistency ([alpha] = .67 and .78, respectively), item total correlations (.30-.61), and test-retest as judged by Pearson's and intraclass correlations (.77-.81) but not when [kappa] was considered (.02-.40). The interitem correlations (.20-.35) were also lower than desirable. DISCUSSION Both the Values of Intensive Care Nurses for End-of-Life and the Behaviors of Intensive Care Nurses for End-of-Life were found to have conceptually linked factors and acceptable internal consistency estimates ([alpha]). However, test-retest estimates were inconsistent, suggesting that further work needs to be done on the stability of these instruments.
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Abstract
Practitioners in critical care have made a significant progress in caring for dying patients in critical care by taking advantage of the suggestions from their professional groups. Progress has been made in responding to and controlling patients' pain. Major initiatives from the Joint Commission and the American Pain Society have helped direct this improvement. Palliative care consultations as well as ethics consultations have improved symptom control in the critically ill. Issues of consent have been problematic for dying patients in critical care especially in the area of discontinuing therapies. But, better policies related to advance directives have been developed to ensure good care. Spiritual care has received more attention, and now chaplains are recognized by the Society for Critical Care Medicine as integral to the critical care team. The American Association of Critical-Care Nurses has been a leader in improving end-of-life issues and continues to spearhead many projects to improve end-of-life care.
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Affiliation(s)
- Barbara B Ott
- College of Nursing, Villanova University, Villanova, Pennsylvania 19085, USA.
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39
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Abstract
The purpose of this qualitative study was to explore and describe the characteristics of a good death as defined by 15 critical care nurses working in the intensive care unit (ICU) at a hospital in a mid-sized urban city. The target population was registered nurses employed in the intensive care unit where the study was conducted. Given the fact that the sample population was a very specific group, a purposive, convenience sample was utilized to explore the personal thoughts and feelings of the nurses who volunteered for this project. A nondirective, in-depth interview technique was the method of data collection. Interviews lasted up to 60 minutes, and data was collected by tape recorder, then immediately transcribed verbatim; basic demographic data was collected at the beginning of each interview and this information was used to describe the sample. In describing a good death in the ICU, most participants identified multiple themes. Eight main themes emerged from the nurses' responses to the research question, and of those, 3 were mentioned most often. The 3 most frequently mentioned themes were patient does not die alone, patient does not suffer (pain management/symptom management), and acceptance of death by the patient and/or loved ones. Much of what nurses described as elements of a good death in the ICU supports other published results. The themes that were identified in this research study provide an initial framework that is important for further research in the area of critical care nursing.
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White DB, Malvar G, Karr J, Lo B, Curtis JR. Expanding the paradigm of the physician's role in surrogate decision-making: an empirically derived framework. Crit Care Med 2010; 38:743-50. [PMID: 20029347 PMCID: PMC3530842 DOI: 10.1097/ccm.0b013e3181c58842] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about what role physicians take in the decision-making process about life support in intensive care units. OBJECTIVE To determine how responsibility is balanced between physicians and surrogates for life support decisions and to empirically develop a framework to describe different models of physician involvement. DESIGN Multi-centered study of audio-taped clinician-family conferences with a derivation and validation cohort. SETTING Intensive care units of four hospitals in Seattle, Washington, in 2000 to 2002 and two hospitals in San Francisco, California, in 2006 to 2008. PARTICIPANTS Four hundred fourteen clinicians and 495 surrogates who were involved in 162 life support decisions. RESULTS In the derivation cohort (n = 63 decisions), no clinician inquired about surrogates' preferred role in decision-making. Physicians took one of four distinct roles: 1) informative role (7 of 63) in which the physician provided information about the patient's medical condition, prognosis, and treatment options but did not elicit information about the patient's values, engage in deliberations, or provide a recommendation about whether to continue life support; 2) facilitative role (23 of 63), in which the physician refrained from providing a recommendation but actively guided the surrogate through a process of clarifying the patients' values and applying those values to the decision; 3) collaborative role (32 of 63), in which the physician shared in deliberations with the family and provided a recommendation; and 4) directive role (1 of 63), in which the physician assumed all responsibility for, and informed the family of, the decision. In 10 out of 20 conferences in which surrogates requested a recommendation, the physician refused to provide one. The validation cohort revealed a similar frequency of use of the four roles, and frequent refusal by physicians to provide treatment recommendations. CONCLUSIONS There is considerable variability in the roles physicians take in decision-making about life support with surrogates but little negotiation of desired roles. We present an empirically derived framework that provides a more comprehensive view of physicians' possible roles.
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Affiliation(s)
- Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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41
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Doing one's utmost: Nurses’ descriptions of caring for dying patients in an intensive care environment. Intensive Crit Care Nurs 2009; 25:233-41. [DOI: 10.1016/j.iccn.2009.06.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/18/2009] [Accepted: 06/22/2009] [Indexed: 11/23/2022]
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Hansen L, Goodell TT, DeHaven J, Smith M. Nurses' perceptions of end-of-life care after multiple interventions for improvement. Am J Crit Care 2009; 18:263-71; quiz 272. [PMID: 19411585 DOI: 10.4037/ajcc2009727] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nurses working in intensive care units may lack knowledge and skills in end-of-life care, find caring for dying patients and the patients' families stressful, and lack support to provide this care. OBJECTIVES To describe nurses' perceptions of (1) knowledge and ability, (2) work environment, (3) support for staff, (4) support for patients and patients' families, and (5) stress related to specific work situations in the context of end-of-life care before (phase 1) and after (phase 2) implementation of approaches to improve end-of-life care. The approaches were a nurse-developed bereavement program for patients' families, use of a palliative medicine and comfort care team, preprinted orders for the withdrawal of life-sustaining treatment, hiring of a mental health clinical nurse specialist, and staff education in end-of-life care. METHODS Nurses in 4 intensive care units at a university medical center reported their perceptions of end-of-life care by using a 5-subscale tool consisting of 30 items scored on a 4-point Likert scale. The tool was completed by 91 nurses in phase 1 and 127 in phase 2. RESULTS Improvements in overall mean scores on the 5 sub-scales indicated that the approaches succeeded in improving nurses' perceptions. In phase 2, most of the subscale overall mean scores were higher than a desired criterion (<2.0, good). Analysis of variance indicated that some improvements occurred over time differently in the units; other improvements occurred uniformly. CONCLUSIONS Continued practice development is needed in end-of-life care issues.
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Affiliation(s)
- Lissi Hansen
- Lissi Hansen and Teresa Goodell are assistant professors, Josi DeHaven is a nursing practice and education coordinator, and MaryDenise Smith is a palliative care clinical nurse specialist at Oregon Health and Science University, Portland, Oregon
| | - Teresa T. Goodell
- Lissi Hansen and Teresa Goodell are assistant professors, Josi DeHaven is a nursing practice and education coordinator, and MaryDenise Smith is a palliative care clinical nurse specialist at Oregon Health and Science University, Portland, Oregon
| | - Josi DeHaven
- Lissi Hansen and Teresa Goodell are assistant professors, Josi DeHaven is a nursing practice and education coordinator, and MaryDenise Smith is a palliative care clinical nurse specialist at Oregon Health and Science University, Portland, Oregon
| | - MaryDenise Smith
- Lissi Hansen and Teresa Goodell are assistant professors, Josi DeHaven is a nursing practice and education coordinator, and MaryDenise Smith is a palliative care clinical nurse specialist at Oregon Health and Science University, Portland, Oregon
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Abstract
BACKGROUND Having a peaceful death is a common wish among Thai people. Thai culture and religious beliefs offer practical ways to enhance having a peaceful death. Dying in an intensive care unit (ICU) is unnatural and oftentimes painful for the patient and their loved ones. Promoting a peaceful death is one of the least understood yet critical roles of nurses who practise in ICUs. PURPOSE To explore the ways that ICU nurses in Thailand could promote peaceful death and to attempt a definition of the concept of 'peaceful death'. METHOD Data were generated from ICU nurses' descriptions of peaceful death. These were given during in-depth telephone interviews, tape-recorded and analysed using the grounded theory method of analysis. FINDINGS ICU nurses promote peaceful death through a three-dimensional process: awareness of dying; creating a caring environment; and promoting end-of-life care. CONCLUSIONS The study provided opportunities for nurses to understand and influence the practice of promoting peaceful death in ICUs in Thailand. Further research is needed to enhance the practices and processes necessary for promoting peaceful death among ICU patients. It is anticipated that this will advance policy changes in nursing care processes in Thailand.
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Affiliation(s)
- W Kongsuwan
- Faculty of Nursing, Prince of Songkla University, Thailand.
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Abstract
AIM This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy. BACKGROUND AND CONTEXT EoLC is an important international critical care issue, and currently provides a key focus for health care policy in the UK. While society holds that critical care is delivered in a highly technical area with a strong focus on cure and recovery, mortality rates in this speciality remain at approximately 20%. When patient recovery is not an outcome, discussions with patient, family and extended care teams turn towards futility of treatment and end-of-life management. However, there are specific barriers to overcome in EoLC for the critically ill. CONCLUSION A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose.
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Affiliation(s)
- Maureen Coombs
- Critical Care, Southampton University Hospitals Trust, Southampton, UK.
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Barriers to intensive care unit nurses providing terminal care: an integrated literature review. Crit Care Nurs Q 2008; 31:83-93. [PMID: 18316942 DOI: 10.1097/01.cnq.0000306402.55518.da] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditional goals of critical care center on curative interventions for patients with acute illness. However, death is a common occurrence in critical care, which means a shift from curative care to comfort care. For a number of reasons, the transition in care is often not a smooth one. An integrated literature review was completed on 22 studies related to provision of terminal care. These 13 quantitative studies along with 9 qualitative studies identified specific barriers to effective terminal care provision including (a) lack of involvement in the plan of care and comfort, (b) disagreement among physicians and other healthcare team members, (c) inadequacy of pain relief, (d) unrealistic expectations of families, (e) nurses' difficulty coping, (f) lack of experience and education, (g) staffing levels, and (h) environmental circumstances. Recommendations address strategies to improve terminal care and suggest future research needed.
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Goodridge D, Duggleby W, Gjevre J, Rennie D. Caring for critically ill patients with advanced COPD at the end of life: a qualitative study. Intensive Crit Care Nurs 2008; 24:162-70. [PMID: 18313923 DOI: 10.1016/j.iccn.2008.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 01/10/2008] [Accepted: 01/12/2008] [Indexed: 11/19/2022]
Abstract
Providing expert critical care for the high acuity patient with a diagnosis of COPD at the end of life is both complex and challenging. The purpose of this descriptive study was to examine intensive care unit (ICU) clinicians' perspectives on the obstacles to providing quality care for individuals with COPD who die within the critical care environment. Transcripts of three focus groups of ICU clinicians were analyzed using thematic analysis. The three themes of "managing difficult symptoms", "questioning the appropriateness of life-sustaining care" and "conflicting care priorities" were noted to be significant challenges in providing high quality end of life care to this population. Difficulties in palliating dyspnea and anxiety were associated with caregiver feelings of helplessness, empathy and fears about "killing the patient". A sense of futility, concerns about "torturing the patient" and questions about the patient/family's understanding of treatment pervaded much of the discourse about caring for people with advanced COPD in the ICU. The need to prioritize care to the most unstable ICU patients meant that patients with COPD did not always receive the attention clinicians felt they should ideally have. Organizational support must be made available for critical care clinicians to effectively deal with these issues.
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Affiliation(s)
- Donna Goodridge
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7T5E5, Canada.
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48
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Abstract
Much of the literature for end of life in the intensive care unit focuses on patients and their treatment. Families are usually present and should be a focus, as well as a resource, in end-of-life plans. Using categories from a recently published Society of Critical Care Medicine guideline on family support during an intensive care unit stay and 7 end-of-life domains, literature retrieved since 2000 was summarized. Topics addressed are decision making, spiritual and cultural support, emotional and practical support of families, including visitation and family preparation for death, and continuity of care.
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Calvin AO, Kite-Powell DM, Hickey JV. The neuroscience ICU nurse's perceptions about end-of-life care. J Neurosci Nurs 2007; 39:143-50. [PMID: 17591410 DOI: 10.1097/01376517-200706000-00004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this qualitative descriptive study was to describe neuroscience intensive care unit (NICU) nurses' perceptions regarding their roles and responsibilities in the decision-making process during the change in intensity of care and end-of-life care for patients. Twelve NICU nurses agreed to a private moderately structured interview. Three major themes summarize the data: (1) providing guidance, (2) being positioned in the middle of the communication process, and (3) feeling the emotions of patients and families. The nurse caring for a patient at the end of life provides guidance from the middle or "hub" of the communication process between family members and physicians. The nurses in this study describe an array of feelings associated with this role. This research adds to the limited body of knowledge concerning critical care nurses' experiences with end-of-life care. Providing guidance and being in the middle of the communication process can be a lonely, challenging, yet rewarding position. Results of this study provide a basis for offering emotional support to NICU nurses who care for patients at the end of life.
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Affiliation(s)
- Amy O Calvin
- School of Nursing, University of Texas Health Science Center, Houston, TX, USA.
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