1
|
Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020288. [PMID: 36837489 PMCID: PMC9962237 DOI: 10.3390/medicina59020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Palliative care is an interdisciplinary medical specialty focused on improving the quality of life of critically ill patients, including those with frailty, during their illness. Materials and Methods: We conducted an extensive literature review on Pubmed focusing on palliative care in neuro-oncology patients admitted to intensive care units (ICUs). Results: We identified 967 articles and, after excluding 952 articles in accordance with the PRISMA flow chart, we included a total of 15 articles in the final selection. The potential role of palliative care in neuro-oncology appears necessary to ensure comprehensive end-of-life patient care. However, this seems underestimated and poorly applied, especially in the context of intensive care units. Medical personnel also face ethical dilemmas, considering not only the pathology but also the socio-spiritual context of the patient. In addition, caregivers' understanding of prognosis and realistic goals is critical for optimal end-of-life management. Conclusions: The provision of palliative care to neuro-oncological patients admitted to ICU is a complex challenge supported by fragmented evidence. Additional research on palliative care and communication about end-of-life care in the neuro-oncology and neuro-ICU setting is needed.
Collapse
|
2
|
Juranić B, Včev A, Vuletić S, Rakošec Ž, Roguljić D, Mikšić Š, Jakab J, Vujanić J, Lovrić R. (Dis)Agreement with Dysthanasia, Religiosity and Spiritual Experience as Factors Related to Nurses' Workload during End-of-Life Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:955. [PMID: 36673711 PMCID: PMC9859098 DOI: 10.3390/ijerph20020955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
This study intended to investigate whether the workload of nurses in the course of providing end-of-life care correlated with their religiousness, spiritual experience and level of agreement with dysthanasia procedures. The respondents included 279 nurses from four Croatian hospitals. A structured and validated instrument was applied. Almost 90% of respondents are religious, and almost 45% of them have daily spiritual experiences. Respondents, especially those with high levels of religiousness and spiritual experience, express a low level of agreement with dysthanasia (mean = 58.21; score = 25−125). Moreover, nurses self-rated (on a scale of 1−5) their workload as quite high, especially when performing contradictory tasks imposed on them by their superiors (mean = 3.05) and during direct contact with dying patients and their family members (mean = 2.56). This significantly highest level of workload was experienced by the youngest nurses (p = 0.01) and nurses with little work experience (p < 0.01). This study also indicated that nurses who agree with dysthanasia experienced a higher level of workload when providing end-of-life care (r = 0.178; p < 0.01), while more frequent spiritual experiences reduced the level of workload (r = −0.205; p < 0.01). A deeper understanding of nurses’ attitudes toward dysthanasia, as well as of their religiousness and spiritual experiences, may ensure the collection of data beneficial to the timely identification of potential risks caused by workload.
Collapse
Affiliation(s)
- Brankica Juranić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinic for Internal Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Aleksandar Včev
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinic for Internal Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Suzana Vuletić
- Catholic Faculty of Theology in Đakovo, Josip Juraj Strossmayer University of Osijek, 31400 Đakovo, Croatia
| | - Željko Rakošec
- The Ministry of the Interior of the Republic of Croatia, 10000 Zagreb, Croatia
| | - Domagoj Roguljić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Štefica Mikšić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jelena Jakab
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jasenka Vujanić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Robert Lovrić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| |
Collapse
|
3
|
Rakhshan M, Joolaee S, Mousazadeh N, Hakimi H, Bagherian S. Causes of futile care from the perspective of intensive care unit nurses (I.C.U): qualitative content analysis. BMC Nurs 2022; 21:225. [PMID: 35953793 PMCID: PMC9371949 DOI: 10.1186/s12912-022-01004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Medical care that has therapeutic effects without significant benefits for the patient is called futile care. Intensive Care Units are the most important units in which nurses provide futile care. This study aimed to explain the causes of futile care from the perspective of nurses working in Intensive Care Units are. Method The study was conducted using a qualitative approach. Qualitative content analysis was used to analyze the data. Study participants were 17 nurses who were working in the Intensive Care Units are of hospitals in the north of Iran. They were recruited through a purposeful sampling method. Data was gathered using in-depth, semi-structured interviews from March to June 2021. Recruitment was continued until data saturation was reached. Results Two main themes, four categories, and thirteen subcategories emerged from the data analysis. The main themes were principlism and caring swamp. The categories were moral foundation, professionalism, compulsory care, and patient’s characteristics. Conclusion In general, futile care has challenged nursing staff with complex conflicts. By identifying some of these conflicts, nurses will be able to control such situations and plan for better management strategies. Also, using the findings of this study, nursing managers can adopt supportive strategies to reduce the amount of futile care and thus solve the specific problems of nurses in intensive care units such as burnout, moral stress, and intention to leave.
Collapse
Affiliation(s)
- Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodabeh Joolaee
- Department of Evaluation & Research Service, Fraser health authority, Surrey, Canada.,Research Center of Health Evaluation & Outcome Science, UBS, Vancouver, Canada.,Nursing Care Research Center, Iran University of Medical Science, Tehran, Iran
| | - Noushin Mousazadeh
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
| | - Hamideh Hakimi
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Bagherian
- Department of Operating Room, School of Paramedical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| |
Collapse
|
4
|
Ramathuba DU, Ndou H. Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa. Health SA 2020; 25:1183. [PMID: 32391174 PMCID: PMC7203238 DOI: 10.4102/hsag.v25i0.1183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/21/2020] [Indexed: 12/04/2022] Open
Abstract
Background Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained. Aim This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa. Setting The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured. Methods This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch’s method of data analysis was used. Ethical considerations were adhered to. Results Patients’ care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and ‘use once’ pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist. Conclusion Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.
Collapse
Affiliation(s)
- Dorah U Ramathuba
- Department of Advanced Nursing Science, University of Venda, Thohoyandou, South Africa
| | - Hulisani Ndou
- Department of Advanced Nursing Science, University of Venda, Thohoyandou, South Africa
| |
Collapse
|
5
|
Malek MM, Abdul Rahman NN, Hasan MS, Haji Abdullah L. Islamic Considerations on the Application of Patient's Autonomy in End-of-Life Decision. JOURNAL OF RELIGION AND HEALTH 2018; 57:1524-1537. [PMID: 29417395 DOI: 10.1007/s10943-018-0575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate. In the future, patient autonomy is expected to become prevalent. The extent of patient autonomy has not been widely discussed among Muslim scholars. In Islam, there are certain considerations that must be adhered to.
Collapse
Affiliation(s)
- Mohammad Mustaqim Malek
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Centre for Science and Environment Studies, Institute of Islamic Understanding Malaysia, No. 2, Langgak Tunku, Off Jalan Tuanku Abdul Halim, 50480, Kuala Lumpur, Malaysia.
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Luqman Haji Abdullah
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
Yildirim G, Karagozoglu S, Ozden D, Cınar Z, Ozveren H. A scale-development study: Exploration of intensive-care nurses' attitudes towards futile treatments. DEATH STUDIES 2018; 43:397-405. [PMID: 29947583 DOI: 10.1080/07481187.2018.1479470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study was conducted to determine the validity and reliability of the tool used to assess nurses' attitudes towards futility, and to explore intensive-care nurses' attitudes towards futility. Principal components analysis revealed that 18item scale was made up of four subdimensions that assess Identifying(beliefs), Decision-Making, Ethical Principles and Law, and Dilemma and Responsibilities related to futile treatments. The internal consistency of the scale was in the acceptable range, with a total Cronbach's alpha value of 0.72. Overall the results of study suggest that scale can be used as a valid and reliable assessment tool to assess nurses' attitudes towards futility.
Collapse
Affiliation(s)
- Gulay Yildirim
- a Cumhuriyet Universitesi Tip Fakultesi , Sivas , Turkey
| | | | - Dilek Ozden
- c Dokuz Eylul Universitesi Hemşirelik Fakültesi , Izmir , Turkey
| | - Ziynet Cınar
- a Cumhuriyet Universitesi Tip Fakultesi , Sivas , Turkey
| | - Husna Ozveren
- d Kirikkale Universitesi Sağlık Bilimleri Fakültesi, Kirikkale , Turkey
| |
Collapse
|
7
|
Díaz-Cortés MDM, Granero-Molina J, Hernández-Padilla JM, Pérez Rodríguez R, Correa Casado M, Fernández-Sola C. Promoting dignified end-of-life care in the emergency department: A qualitative study. Int Emerg Nurs 2018; 37:23-28. [DOI: 10.1016/j.ienj.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/11/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
|
8
|
Fernández-Sola C, Granero-Molina J, Díaz-Cortés MDM, Jiménez-López FR, Roman-López P, Saez-Molina E, Aranda-Torres CJ, Muñoz-Terrón JM, García-Caro MP, Hernández-Padilla JM. Characterization, conservation and loss of dignity at the end-of- life in the emergency department. A qualitative protocol. J Adv Nurs 2018; 74:1392-1401. [PMID: 29421848 DOI: 10.1111/jan.13536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Abstract
AIMS To explore and understand the experiences of terminally ill patients and their relatives regarding dignity during end-of-life care in the emergency department. BACKGROUND The respect given to the concept of dignity is significantly modifying the clinical relationship and the care framework involving the end-of-life patient in palliative care units, critical care units, hospices and their own homes. This situation is applicable to in-hospital emergency departments, where there is a lack of research which takes the experiences of end-of-life patients and their relatives into account. DESIGN A phenomenological qualitative study. METHODS The protocol was approved in December 2016 and will be carried out from December 2016-December 2020. The Gadamer's philosophical underpinnings will be used in the design and development of the study. The data collection will include participant observation techniques in the emergency department, in-depth interviews with terminally ill patients and focus groups with their relatives. For the data analysis, the field notes and verbatim transcriptions will be read and codified using ATLAS.ti software to search for emerging themes. DISCUSSION Emerging themes that contribute to comprehending the phenomenon of dignity in end-of-life care in the emergency department are expected to be found. This study's results could have important implications in the implementation of new interventions in emergency departments. These interventions would be focused on improving: the social acceptance of death, environmental conditions, promotion of autonomy and accompaniment and assumption (takeover) of dignified actions and attitudes (respect for human rights).
Collapse
Affiliation(s)
- Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - José Granero-Molina
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - María Del Mar Díaz-Cortés
- Emergency Department, Hospital Torrecárdenas, Almería, Spain.,Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almería, Spain
| | - Francisca Rosa Jiménez-López
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain
| | - Pablo Roman-López
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almería, Spain.,Department of Nursing, Universitat Jaume I, Castellon, Spain
| | | | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing Science, Physiotherapy and Medicine, Research Group of Health Sciences CTS-451, University of Almeria, Almería, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| |
Collapse
|
9
|
Morata L. An evolutionary concept analysis of futility in health care. J Adv Nurs 2018; 74:1289-1300. [DOI: 10.1111/jan.13526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Lauren Morata
- College of Nursing; University of Central Florida; Orlando FL USA
| |
Collapse
|
10
|
Abstract
The American Association of Colleges of Nursing specifies that all nurses must be prepared to deliver high-quality palliative care upon entry into practice. To achieve this aim, a clear understanding of palliative care nursing is needed. The Walker and Avant model for concept analysis was used to review and analyze relevant literature from 2000 to 2016. The authors utilized findings of this extensive review to develop a concept model and other practical resources for guiding nurses, educators, and researchers in applying and evaluating competence in the delivery of high-quality palliative nursing care.
Collapse
|
11
|
Abstract
Background: Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. Objective: The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. Research design: A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013–2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). Findings: The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Discussion: Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Conclusion: Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.
Collapse
|
12
|
Loss of Dignity in End-of-Life Care in the Emergency Department: A Phenomenological Study with Health Professionals. J Emerg Nurs 2016; 42:233-9. [PMID: 26972367 DOI: 10.1016/j.jen.2015.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The objective of this study was to explore and describe the experiences of physicians and nurses with regard to loss of dignity in relation to end-of-life care in the emergency department. METHOD A phenomenological qualitative study was performed. Two focus groups and 12 individual interviews were conducted with a total of 26 participants, who had attended to patients in the emergency department an average of 14.3 years. An inductive analysis was carried out with the use of ATLAS.ti software to seek emerging themes. RESULTS Three themes that helped us understand the phenomenon of the loss of dignity in end-of-life care in the emergency department emerged: (1) "Being exposed in a cold world," with the subthemes "improvising dying person care" and "a lack of space to care for the dying person"; (2) "Being self-critical with professional attitudes," with the subthemes "being aware of undignified actions" and "lack of a palliative culture"; and (3) "Family obstinacy and hospital rescue," with the subthemes "making ill-advised choices" and "avoiding burden." DISCUSSION The dignity of people who are taken to the emergency department at the end of their life could be undermined by architectural and organizational characteristics, professionals' attitudes, and decisions made by family members.
Collapse
|