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Riegel M, Buckley T, Randall S. Family's preferences for and experiences of writing practices in adult intensive care and its use in early bereavement: A descriptive qualitative study. Aust Crit Care 2024; 37:614-620. [PMID: 38360470 DOI: 10.1016/j.aucc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Family partaking in writing practices, such as writing intensive care unit (ICU) patient diaries, personal diaries/journaling, social media, or instant messaging services, during ICU admission may allow the family to unintentionally participate in a form of expressive writing. These writing practices could provide structure for the family authors to explore emotions and manage significant life events, including death of a loved one. Limited studies have explored the family's postmortem experiences and perceived value of writing practices maintained during an ICU admission. OBJECTIVES The objective of this study was to explore the family member's preferences for and experiences of writing practices in the adult ICU and its use in early bereavement. METHODS descriptive qualitative design using inductive reflexive thematic analysis from a purposeful, convenience sample of 16 bereaved participants from a tertiary referral, adult ICU in Australia who discussed their experiences of and preferences in writing practices. Reporting adheres to the consolidated criteria for reporting qualitative research checklist. FINDINGS Six participants maintained writing practices during the ICU admission and 10 did not. Three themes were generated from the data: the decision to maintain writing practices was shaped by past behaviours and perceived utility; moments captured were influenced by the loved ones' clinical status and their ability to access the writing medium; and writing practices have limited utility as a memory making object in early bereavement. CONCLUSIONS Based on the generated findings, participants who did not maintain writing practices did not later regret this decision during early bereavement. Participants who did maintain writing practices predominately used a personal diary/journal that they carried with them. As the loved one approached death, the written entries became shorter, then ceased. Most of the written entries were not read during early bereavement, suggesting the writing practices' psychological value might have been predominately gained at the time of writing, rather than during early bereavement.
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Affiliation(s)
- Melissa Riegel
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sue Randall
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Broken Hill Department of Rural Health, University of Sydney, Australia
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MacEachen D, Johnston B, McGuire M. Memory making in critical care: A qualitative thematic synthesis. Nurs Crit Care 2024; 29:795-806. [PMID: 37807724 DOI: 10.1111/nicc.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Caring for bereaved families is an important aspect of the nursing role in critical care. Memory making practices are one way in which dying, death and bereavement can be acknowledged and supported within critical care. Memory making was introduced into the care of stillborn babies and neonatal deaths to improve parents' experiences of bereavement, and has since become common practice in adult critical care. AIMS The aim of this qualitative thematic synthesis was to explore families' experiences of memory making in critical care, with a view of gaining greater understanding of the ways in which memory making impacts bereaved families. METHODS A systematic search strategy was developed, and five databases were searched (Medline, CINAHL, PsychINFO, Embase and ASSIA). Seven qualitative studies were included: four were conducted in adult and three in paediatric critical care settings in which memory making was initiated between 2014 and 2020. Memory making practices included, patient diaries, general keepsakes, word clouds and photography. RESULTS The thematic synthesis generated four main themes to describe families' experience of memory making in critical care: 'connection', 'compassion', 'engagement and creation' and 'continuation'. CONCLUSIONS Memory making is a meaningful activity for families whose loved one dies in critical care; it brings focus and meaning during a devastating process in a highly technical environment. Families rely heavily on nursing staff for support and guidance. The creation of memories and/or keepsakes can have a positive impact on the bereavement experience for families and can facilitate a continuing bond with their loved one. RELEVANCE TO CLINICAL PRACTICE Memory making is a worthwhile practice to support and guide family bereavement within critical care. It can provide structure and purpose during an emotionally challenging transition, by supporting families to focus on a meaningful activity during a devasting time.
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Affiliation(s)
- Doreen MacEachen
- Critical Care, Queen Elizabeth University Hospital, Glasgow, Scotland
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
| | - Bridget Johnston
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
- School of Medicine, Dentistry and Nursing, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Margaret McGuire
- Chief Nurse Reserach, NHS, Greater Glasgow & Clyde, Glasgow, Scotland
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Farrow KA, Felber Neff D. Bereavement Care Team: Improving ICU Nurses' Professional Bereavement and Patient Family Experience. Nurs Adm Q 2024; 48:97-106. [PMID: 38564720 DOI: 10.1097/naq.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
When nurses care for dying patients, their compassion fatigue may increase and lead to burnout and feelings of professional bereavement. However, if a nurse perceives that the patient had a "good death," it may have a positive impact on them and reduce their emotional distress. The purpose of this project is to reduce nurses' feelings of professional bereavement by implementing a Bereavement Care Team (BCT) in the intensive care unit (ICU). This study is a pre-post quasi-experimental design. The Chen and Chow bereavement subscales Factor 1 and Factor 2 measured elements of a nurse's professional bereavement, and 5 items were statistically significant. Nurses felt a reduction in their exhaustion, frustration, and feeling fatigue in their job, reduced feelings about being nervous and worried about potential professional/patient conflicts, and nurses were moved by the patient's family's understanding of the patient's death. Implementing a BCT in the ICU provided an environment that created a "good death" for the patient and their loved ones. These findings supported the need for the BCT as they demonstrated an improvement in the ICU nurses' feelings of professional bereavement.
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Affiliation(s)
- Kerry-Ann Farrow
- Author Affiliations: System Nursing Department, Advent Health, Orlando, Florida (Dr Farrow); and Department of Nursing Systems, College of Nursing, University of Central Florida, Orlando, Florida (Dr Felber Neff)
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Xu DD, Zhang GX, Ding XB, Ma J, Suo YX, Peng YY, Zeng JL, Liu M, Hou RT, Li J, Hu F. Bereaved parents' perceptions of memory making: a qualitative meta-synthesis. BMC Palliat Care 2024; 23:24. [PMID: 38273273 PMCID: PMC10809512 DOI: 10.1186/s12904-024-01339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE This study aims to investigate the experiences of parents who have experienced bereavement in their efforts to preserve memories of their deceased child. METHODS Employing a qualitative meta-synthesis approach, this study systematically sought relevant qualitative literature by conducting searches across various electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley, up until July 2023. RESULTS Nine studies are eligible for inclusion and included in the meta-synthesis. Three overarching categories are identified: (1) Affirming the Significance of Memory Making. (2) Best Practices in Memory Making. (3) Barriers to Effective Memory Making. CONCLUSION Bereaved parents highly value the act of creating lasting memories, emphasizing its profound significance. While forming these memories, it is imperative to offer family-centered care and honor diverse preferences and needs. It is essential to offer effective support to parents, offering them a range of choices. Furthermore, a more comprehensive examination of memory-making practices is required to better understand their influence on parents' recollections of their deceased child.
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Affiliation(s)
- Dan-Dan Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Guang-Xiong Zhang
- Department of Anesthesiology, Hubei Province Corps Hospital of The Chinese Armed Police Force (CAPF), Wuhan, China
| | - Xin-Bo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Ya-Xi Suo
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Yang-Yao Peng
- Department of Neurosurgical Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ji-Li Zeng
- Department of Otorhinolaryngology, General Hospital of Central Theater Command, Wuhan, China
| | - Miao Liu
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui-Tong Hou
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
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Högvall LM, Egerod I, Herling SF, Rustøen T, Berntzen H. Finding the right words: A focus group investigation of nurses' experiences of writing diaries for intensive care patients with a poor prognosis. Aust Crit Care 2023; 36:1011-1018. [PMID: 36934046 DOI: 10.1016/j.aucc.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis. OBJECTIVES The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis. METHODS This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. FINDINGS The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses. CONCLUSIONS Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient.
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Affiliation(s)
- Lisa Maria Högvall
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health & Medical Sciences, University of Copenhagen, Denmark
| | - Suzanne Forsyth Herling
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Helene Berntzen
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
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Riegel M, Buckley T, Randall S. Family's experience of memory making in adult intensive care and its use in early bereavement: A descriptive qualitative study. J Clin Nurs 2023; 32:6648-6661. [PMID: 37186006 DOI: 10.1111/jocn.16725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/15/2022] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
AIM AND OBJECTIVES To explore the family's experience being offered memory making during end-of-life care in the adult intensive care unit and its use in early bereavement. BACKGROUND Family members of individuals who develop a critical illness requiring emergency hospitalisation are unlikely to be prepared for a possible death. This places them at increased risk of poorer bereavement experiences. One potential intervention is memory making, which is an act that provides tangible objects such as a handprint, footprint, lock of hair, or teddy bear, that allows connections with and provides meaningful memories about a person. Families in the adult acute population reportedly have positive reactions regarding the objects, but it is unknown the object's effects on early bereavement experiences. DESIGN Descriptive qualitative study utilising inductive reflexive thematic analysis. Reporting adheres to the COREQ checklist. METHODS Between May 2019-December 2020, a purposeful, convenience sample of 21 participants from a tertiary referral, adult intensive care unit in Australia were recruited to explore their experiences being offered memory making during end-of-life care and the objects use in early bereavement. Interviews were conducted using a semi-structured format and occurred at the participants' location of choice. RESULTS Data analysis generated three themes: guidance during end of life by healthcare professionals that recognises the autonomy of the family; object used as a trigger to access memories; and storage and preservation of the object as an indication of its sentimental value and use in early bereavement CONCLUSION: Memory making objects such as handprints, locks of hair, or teddy bears received in the adult intensive care unit were valued and utilised during early bereavement by most recipients. RELEVANCE TO CLINICAL PRACTICE Findings inform practice evidence gaps regarding the family's experiences of memory making received as a bereavement intervention in the adult acute population. PATIENT OR PUBLIC CONTRIBUTION Participants contributed through sharing their first-hand experiences of receiving memory making in the adult intensive care unit.
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Affiliation(s)
- Melissa Riegel
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Prince of Wales Hospital, New South Wales, Randwick, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Binette E, Elwell J, Parekh de Campos A, Anderson RV. Show and Tell: Photography and Storytelling to Better Understand the End-of-Life Experience of Families in the Intensive Care Unit. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231190957. [PMID: 37496111 DOI: 10.1177/00302228231190957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
End-of-life in the Intensive Care Unit (ICU) is common, costly, and can contribute to negative health outcomes for bereaved family members. Insufficient understanding of the family experience results in poor quality, highly variable care riddled with deficiencies including effective identification and application of evidence-based clinical interventions. Successfully managing the multitude of transitions, for example changes in family role or personal identity requires creative practice guided by theory. This project supports the feasibility of using peri-mortem photographs captured by family members with story-telling and a standardized measurement of grief to explore the family experience of end-of-life in the ICU. Project findings reveal shared experiential themes and emphasize the value of photography and storytelling as meaning-making interventions for families. Further study to generalize findings and develop additional preventative and therapeutic interventions at and beyond end-of-life in the ICU is needed to better meet family needs and improve their health outcomes.
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Affiliation(s)
| | - Joy Elwell
- University of Connecticut, Storrs, CT, USA
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Becker C, Taniyama Y, Kondo-Arita M, Sasaki N, Yamada S, Yamamoto K. How funerals mediate the psycho-social impact of grief: Qualitative analysis of open-ended responses to a national survey in Japan. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Green L, Stewart-Lord A, Baillie L. End-of-life and immediate postdeath acute hospital interventions: scoping review. BMJ Support Palliat Care 2022:bmjspcare-2021-003511. [PMID: 35896320 DOI: 10.1136/spcare-2021-003511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospital remains the most common place of death in the UK, but there are ongoing concerns about the quality of end-of-life care provision in this setting. Evaluation of interventions in the last days of life or after a bereavement is methodologically and ethically challenging. AIM The aim was to describe interventions at the very end of life and in the immediate bereavement period in acute hospitals, with a particular focus on how these are evaluated. METHOD A scoping review was conducted. Studies were restricted to peer-reviewed original research or literature reviews, published between 2011 and 2021, and written in the English language. Databases searched were CINAHL, Medline and Psychinfo. RESULTS From the search findings, 42 studies were reviewed, including quantitative (n=7), qualitative (n=14), mixed method (n=4) and literature reviews (n=17). Much of the current research about hospital-based bereavement care is derived from the intensive and critical care settings. Three themes were identified: (1) person-centred/family-centred care (memorialisation), (2) institutional approaches (quality of the environment, leadership, system-wide approaches and culture), (3) infrastructure and support systems (transdisciplinary working and staff support). There were limited studies on interventions to support staff. CONCLUSION Currently, there are few comprehensive tools for evaluating complex service interventions in a way that provides meaningful transferable data. Quantitative studies do not capture the complexity inherent in this form of care. Further qualitative studies would offer important insights into the interventions.
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Affiliation(s)
- Laura Green
- Faculty of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Adele Stewart-Lord
- Department of Allied Health Sciences, London South Bank University, London, UK
| | - Lesley Baillie
- Florence Nightingale Foundation Chair, London South Bank University, London, UK
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Riegel M, Randall S, Buckley T. Factors associated with the decision to offer memory making in end-of-life: A survey of healthcare professionals in adult intensive care. J Clin Nurs 2022; 32:2627-2641. [PMID: 35415864 DOI: 10.1111/jocn.16323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
AIM Report experiences and behaviour influences with healthcare professionals' decision to and experiences of offering memory making during end-of-life care in the adult acute population. BACKGROUND Little is known about healthcare professionals' experiences offering memory making during adult acute end-of-life care. DESIGN Survey. METHODS Registered nurses, medical practitioners and social workers employed at a single tertiary referral adult intensive care, where memory making had been implemented nearly two years prior were invited to participate between June and August 2017. Reporting adheres to the STROBE checklist. RESULTS Ninety-six valid surveys (75% response rate: 75 registered nurses, 19 medical practitioners, and 2 social workers) were analysed with 67 participants reporting experience offering memory making. Highest overall agreement scores included believing families value memory making and the offer of memory making being beneficial. Enablers were described as organisational supports, personal qualities and good interpersonal relationships. Barriers identified included the intensive care environment, workload, inexperience offering/facilitating memory making, being afraid to offer, lack of resources and legality concerns. Compared with non-experienced participants, experienced participants reported higher level of confidence and comfort offering memory making, pride in their ability, ability to spend time supporting families and had observed colleagues offering memory making. Experienced participants were less likely to be afraid to offer, be limited by the family's behaviours, report lack of resources or be time limited to offer memory making. CONCLUSION Findings identify elements needed for the development and support for offering memory making to assist bereaved families in adult acute care including role modelling, support to reduce negative emotions, workload assistance and leadership/organisational support. RELEVANCE TO CLINICAL PRACTICE Discoveries have important implications in addressing evidence gaps regarding behaviour influences linked to the decision to offer memory making. Findings inform development and sustainability to integrate memory making as routine end-of-life care intervention in adult acute care.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Yeung E, Sadowski L, Levesque K, Camargo M, Vo A, Young E, Duan E, Tsang JLY, Cook D, Tam B. Initiating and integrating a personalized end of life care project in a community hospital intensive care unit: A qualitative study of clinician and implementation team perspectives. J Eval Clin Pract 2021; 27:1281-1290. [PMID: 33501748 DOI: 10.1111/jep.13538] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
RATIONALE The end of life (EOL) experience in the intensive care unit (ICU) can be psychologically distressing for patients, families, and clinicians. The 3 Wishes Project (3WP) personalizes the EOL experience by carrying out wishes for dying patients and their families. While the 3WP has been integrated in academic, tertiary care ICUs, implementing this project in a community ICU has yet to be described. OBJECTIVES To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician and implementation team perspective. METHODS This qualitative descriptive study evaluated the implementation of the 3WP in a 20-bed community ICU in Southern Ontario, Canada. Patients were considered for the 3WP if they had a high likelihood of imminent death or planned withdrawal of life-sustaining therapy. Following the qualitative descriptive approach, semi-structured interviews were conducted with purposively sampled clinicians and implementation team. Data from transcribed interviews were analyzed in triplicate through qualitative content analysis. RESULTS Interviews with 12 participants indicated that the 3WP personalized and enriched the EOL experience. Interviewees indicated higher intensity education strategies were needed to enable spread as the project grew. Clinicians described many physical resources for the project but suggested more non-clinical project support for orientation, continuing education, and data collection. A majority of wishes focused on physical resources including keepsakes, which helped facilitate project spread when clinician capacity was attenuated by competing duties. CONCLUSIONS In this community hospital, ICU clinicians and implementation team members report perceived improved EOL care for patients, families, and clinicians following 3WP initiation and integration. Implementing individualized and meaningful wishes at EOL for dying patients in a community ICU requires adequate planning and time dedicated to optimizing clinician education. Adapting key features of an intervention to local expertise and capacity may facilitate spread during project initiation and integration.
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Affiliation(s)
- Eugenia Yeung
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Laurie Sadowski
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada
| | - Kelsea Levesque
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada
| | - Mercedes Camargo
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada
| | - Allen Vo
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada
| | - Elayn Young
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada
| | - Erick Duan
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Jennifer L Y Tsang
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Deborah Cook
- Department of Medicine, McMaster University, Hamilton, Canada.,Department Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Benjamin Tam
- Division of Critical Care Medicine, Niagara Health, St. Catharines, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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Pattison NA, White C, Lone NI. Bereavement in critical care: A narrative review and practice exploration of current provision of support services and future challenges. J Intensive Care Soc 2021; 22:349-356. [PMID: 35154374 PMCID: PMC8829769 DOI: 10.1177/1751143720928898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
This special article outlines the background to bereavement in critical care and scopes the current provision and evidence for bereavement support following death in critical care. Co-authored by a family member and former critical care patient, we aim to draw out the current challenges and think about how and where support can be implemented along the bereavement pathway. We draw on the literature to examine different trajectories of dying in critical care and explore how these might impact bereavement, highlighting important points and risk factors for complicated grief. We present graphic representation of the critical junctures for bereavement in critical care. Adjustment disorders around grief are explored and the consequences for families, including the existing evidence base. Finally, we propose new areas for research in this field.
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Affiliation(s)
- Natalie A Pattison
- East and North Herts NHS Trust, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK; the Florence Nightingale Foundation, London, UK
| | | | - Nazir I Lone
- University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
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13
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Riegel M, Randall S, Buckley T. Healthcare professionals' knowledge, skills, and role in offering and facilitating memory making during end-of-life care in the adult intensive care unit. Aust Crit Care 2021; 35:491-498. [PMID: 34531101 DOI: 10.1016/j.aucc.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND An activity to provide a tangible keepsake following the death of a loved one is termed 'memory making'. However, limited evidence is available related to professionals' education and support to provide memory making opportunities in the adult intensive care unit (ICU). Having a greater understanding of healthcare professionals' experiences can inform future patient/family care and support for professionals in end-of-life care. OBJECTIVE The objective of this study was to describe what participants perceive memory making to be, if they have facilitated memory making activities as part of their practice, if they perceive it as part of their role, and if they have the necessary skills to do so. METHODS Seventy-five registered nurses (75% response rate), 19 medical doctors (76% response rate), and two social workers (66.7% response rate) completed a survey at a single tertiary referral centre in an adult ICU. RESULTS Participants reported memory making to include the creation of tangible keepsakes as well as nontangible activities. Overall, participants reported high agreement scores that the responsibility for initiating memory making predominately belonged to the nurse. Participants reported skills most needed involved the ability to interact with the family, being open to the concept, and integrating memory making into their standard of care. Having developed a rapport with families was considered an enabler, whereas lack of knowledge and clinical workload were reported as inhibitors to offering memory making. CONCLUSIONS Overall, participants in this study reported positive experiences with offering memory making to families during end-of-life care in the adult ICU. Nurses are more likely to perceive professional responsibility for offering memory making, likely due to their increased time at the bedside and higher prominence and leadership in other end-of-life practices. To support professionals, education should include conceptual knowledge, procedural knowledge of keepsake creations, communication techniques using reflective practices, and organisational support to facilitate time requirements.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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14
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A national Position Statement on adult end-of-life care in critical care. Aust Crit Care 2021; 35:480-487. [PMID: 34384650 DOI: 10.1016/j.aucc.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
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15
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Galazzi A, Adamini I, Bazzano G, Cancelli L, Fridh I, Laquintana D, Lusignani M, Rasero L. Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review. Intensive Crit Care Nurs 2021; 68:103121. [PMID: 34373147 DOI: 10.1016/j.iccn.2021.103121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/30/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive. AIM To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit. METHODS Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal. RESULTS Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss. CONCLUSION The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.
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Affiliation(s)
- Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Health Sciences, University of Florence, Florence, Italy.
| | - Ileana Adamini
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Bazzano
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Livia Cancelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Dario Laquintana
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy.
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16
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Davies BM, Mowforth OD, Khan DZ, Yang X, Stacpoole SRL, Hazenbiller O, Gronlund T, Tetreault L, Kalsi-Ryan S, Starkey ML, Sadler I, Sarewitz E, Houlton D, Carter J, Howard E, Rahimi-Movaghar V, Guest JD, Aarabi B, Kwon BK, Kurpad SN, Harrop J, Wilson JR, Grossman R, Smith EK, McNair AGK, Fehlings MG, Kotter MRN. The development of lived experience-centered word clouds to support research uncertainty gathering in degenerative cervical myelopathy: results from an engagement process and protocol for their evaluation, via a nested randomized controlled trial. Trials 2021; 22:415. [PMID: 34172080 PMCID: PMC8235822 DOI: 10.1186/s13063-021-05349-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/01/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES AO Spine REsearch objectives and Common Data Elements for Degenerative Cervical Myelopathy [RECODE-DCM] is a multi-stakeholder consensus process aiming to promote research efficiency in DCM. It aims to establish the top 10 research uncertainties, through a James Lind Alliance Priority Setting Partnership [PSP]. Through a consensus process, research questions are generated and ranked. The inclusion of people with cervical myelopathy [PwCM] is central to the process. We hypothesized that presenting PwCM experience through word cloud generation would stimulate other key stakeholders to generate research questions better aligned with PwCM needs. This protocol outlines our plans to evaluate this as a nested methodological study within our PSP. METHODS An online poll asked PwCM to submit and vote on words associated with aspects of DCM. After review, a refined word list was re-polled for voting and word submission. Word clouds were generated and an implementation plan for AO Spine RECODE-DCM PSP surveys was subsequently developed. RESULTS Seventy-nine terms were submitted after the first poll. Eighty-seven refined words were then re-polled (which added a further 39 words). Four word clouds were generated under the categories of diagnosis, management, long-term effects, and other. A 1:1 block randomization protocol to assess word cloud impact on the number and relevance of PSP research questions was generated. CONCLUSIONS We have shown it is feasible to work with PwCM to generate a tool for the AO Spine RECODE-DCM nested methodological study. Once the survey stage is completed, we will be able to evaluate the impact of the word clouds. Further research will be needed to assess the value of any impact in terms of stimulating a more creative research agenda.
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Affiliation(s)
- Benjamin M Davies
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Danyal Z Khan
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Xiaoyu Yang
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Sybil R L Stacpoole
- Department of Clinical Neuroscience, Peterborough Hospital, North West Anglia NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Toto Gronlund
- James Lind Alliance, National Institute for Health Research, Southampton, UK
| | - Lindsay Tetreault
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-LC, University Health Network, Toronto, Ontario, Canada
| | - Michelle L Starkey
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Iwan Sadler
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Ellen Sarewitz
- The Goffin Consultancy, Goffin Consultancy Ltd, Riding House, Bossingham Road, Stelling Minnis, Canterbury, CT4 6AZ, UK
| | - Delphine Houlton
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Julia Carter
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | | | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D Guest
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, MD, USA
| | - Brian K Kwon
- Division of Spine Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Grossman
- Division of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | - Emma K Smith
- School of General Practice, NHS Health Education East of England, Cambridge, UK
| | - Angus G K McNair
- Center for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark R N Kotter
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK. .,Wellcome Trust & MRC Cambridge Stem Cell Institute, Cambridge, UK.
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17
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Riegel M, Randall S, Ranse K, Buckley T. Healthcare professionals' values about and experience with facilitating end-of-life care in the adult intensive care unit. Intensive Crit Care Nurs 2021; 65:103057. [PMID: 33888382 DOI: 10.1016/j.iccn.2021.103057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs. RESEARCH DESIGN Using a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care. SETTING General adult intensive care unit at a tertiary referral hospital. RESULTS Compared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01). CONCLUSION Findings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@melissa_riegel
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@SueRandallPHC
| | - Kristen Ranse
- School of Nursing & Midwifery and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, QLD, Australia. https://twitter.com/@KristenRanse
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia. https://twitter.com/@TomBuckley6
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18
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Bloomer MJ, Bouchoucha S. Australian College of Critical Care Nurses and Australasian College for Infection Prevention and Control position statement on facilitating next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the intensive care unit. Aust Crit Care 2021; 34:132-134. [PMID: 32826150 PMCID: PMC7365101 DOI: 10.1016/j.aucc.2020.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems worldwide, none more so than critical and intensive care settings. Significant attention has been paid to the capacity of Australian intensive care unit (ICUs) to respond to a COVID-19 surge, particularly in relation to beds, ventilators, staffing, personal protective equipment, and unparalleled increase in deaths in ICUs associated with COVID-19 seen internationally. While death is not uncommon in critical care, the international experience demonstrates that restrictions to family presence at the end of life result in significant distress for families and clinicians. As a result, the Australian College of Critical Care Nurses and the Australasian College for Infection Prevention and Control supported the development of a position statement to provide critical care nurses with specific guidance and recommendations for practice for this emerging priority area. Where possible, position statements are founded on high-quality evidence. However, the short time period since the first recognition of a cluster of pneumonia-like cases in China in January, 2020, meant that an integrative approach was required to expedite timely development of this position statement in preparation for a COVID-19 surge in Australia. This position statement is intended to provide practical guidance to critical care nurses in facilitating next-of-kin presence for patients dying from COVID-19 in the ICU.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Research Advisory Panel, Australian College of Critical Care Nurses, Surrey Hills, Victoria, 3127, Australia.
| | - Stéphane Bouchoucha
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Australasian College for Infection Prevention and Control, 228 Liverpool Street, Hobart, Tasmania, 7000, Australia
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19
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Azad MA, Swinton M, Clarke FJ, Takaoka A, Vanstone M, Woods A, Boyle A, Hoad N, Toledo F, Piticaru J, Cook DJ. Experiences of Bereaved Family Members Receiving Commemorative Paintings: A Qualitative Study. JAMA Netw Open 2020; 3:e2027259. [PMID: 33346843 PMCID: PMC7753900 DOI: 10.1001/jamanetworkopen.2020.27259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored. OBJECTIVE To explore the influence of personalized paintings created to honor deceased critically ill patients on family members' bereavement experience. DESIGN, SETTING, AND PARTICIPANTS A qualitative descriptive analysis was conducted of semistructured interviews of grieving relatives who received a painting after the death of their loved one. The deceased patients were from a 21-bed medical-surgical intensive care unit. Eleven families were invited to receive a painting, of whom 1 family declined. A total of 22 family members of 10 patients who died in the intensive care unit were interviewed in the study between July 11, 2017, and May 19, 2019. INTERVENTIONS Patients were enrolled in an end-of-life care program that elicits and implements wishes of patients and their families to bring peace during the dying process. Selected families of 10 decedents were invited to receive a painting to honor their loved one 1 to 10 months after the patient's death. Using details about the patient's life story, the artist created individualized paintings to commemorate each patient. MAIN OUTCOMES AND MEASURES The experiences of family members receiving a personalized painting and its reported influence on their grieving experience. RESULTS The family members of 10 decedents (mean [SD] age, 60 [14] years; 5 women [50%]; 8 White patients [80%]) were interviewed. The central theme of art to facilitate healing was illustrated through the following domains: the cocreation process, painting narratives, postmortem connections, and legacy. The process of cocreating the paintings with the artist and family members involved reminiscing, storytelling, and creativity. Family members emphasized the role of art to facilitate healing, exemplified through connections with images portrayed that deeply resonated with memories of their loved one. Participants indicated that the paintings validated that the patient was remembered, helped families feel less alone during a time of grief, honored the loved one's life, and enhanced connections between family members and clinicians. CONCLUSIONS AND RELEVANCE This qualitative study's findings suggest that the creation of personalized paintings commemorating the lives of patients may help foster legacy and postmortem connections with clinicians and may help family members in their healing process.
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Affiliation(s)
- Marisa A. Azad
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - France J. Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne Woods
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Department of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Anne Boyle
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Department of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Neala Hoad
- Critical Care Research, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Feli Toledo
- Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Joshua Piticaru
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J. Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Critical Care Research, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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20
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Neville TH, Clarke F, Takaoka A, Sadik M, Vanstone M, Phung P, Hjelmhaug K, Hainje J, Smith OM, LeBlanc A, Hoad N, Tam B, Reeve B, Cook DJ. Keepsakes at the End of Life. J Pain Symptom Manage 2020; 60:941-947. [PMID: 32574658 DOI: 10.1016/j.jpainsymman.2020.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Keepsakes are a relatively unexplored form of bereavement support that is frequently provided as part of the 3 Wishes Project (3WP). The 3WP is a palliative care intervention in which individualized wishes are implemented in the adult intensive care unit for dying patients and their families. OBJECTIVES We aimed to characterize and enumerate the keepsakes that were created as part of the 3WP and to understand their value from the perspective of bereaved family members. METHODS We performed a secondary analysis of family interviews during a multicenter study on the 3WP and characterized all wishes that involved keepsakes. Sixty interviews with family members regarding the 3WP were reanalyzed using qualitative analysis to identify substantive themes related to keepsakes. RESULTS Of 730 patients, 345 (47%) received keepsakes as part of their participation in 3WP. Most keepsakes were either tangible items that served as reminders of the patient's presence (thumbprints and locks of hair) or technology-assisted items (photographs and word clouds). The median cost per keepsake wish was $8.50 (interquartile range $2.00-$25.00). Qualitative analysis revealed two major themes: keepsakes are tangible items that are highly valued by family members; and the creation of the keepsake with clinical staff is valued and viewed as a gesture of compassion. CONCLUSION Keepsakes are common wishes that clinicians in the intensive care unit are able to provide and sometimes cocreate with families when patients are dying. Both the offering to create the keepsake and receipt of the final product are perceived by family members as helpful.
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Affiliation(s)
- Thanh H Neville
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California, USA.
| | - France Clarke
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marina Sadik
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter Phung
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, California, USA
| | | | - Jessica Hainje
- UCLA Department of Nursing, Los Angeles, California, USA
| | - Orla M Smith
- Critical Care Department, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Allana LeBlanc
- Department of Nursing, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Neala Hoad
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Benjamin Tam
- Department of Critical Care Medicine, Niagara Health, St. Catharine's, Ontario, Canada
| | - Brenda Reeve
- Department of Critical Care Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | - Deborah J Cook
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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21
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Andrews E, Hayes A, Cerulli L, Miller EG, Slamon N. Legacy Building in Pediatric End-of-Life Care through Innovative Use of a Digital Stethoscope. Palliat Med Rep 2020; 1:149-155. [PMID: 34223469 PMCID: PMC8241333 DOI: 10.1089/pmr.2020.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Legacy making has been the focus of recent literature; however, few studies examine how legacy making affects bereaved parents. Objective: To better understand legacy making's effect on bereaved parents, this study examined (1) the presentation of legacy making to parents, (2) parent satisfaction, and (3) parent utilization of the project. Design: Eko CORE (Eko Devices, Inc., Berkeley, CA), a digital stethoscope that generates a phonocardiogram, a graphical representation of S1 and S2 heart sounds, was used to record children's heartbeats as they approached end of life. The heartbeat was then overlaid to a song or voice recording or kept as a stand-alone file. An artistic embellishment of the phonocardiogram was also created. Parents were surveyed about their experience with the Music Therapy Heart Sounds (MTHS) program. Twelve parents completed the survey. Setting/subjects: Tertiary care children's hospital. The subjects were bereaved parents. Measurements: Five-question survey. Institutional Review Board review exempt. Results: All respondents would recommend the MTHS program to other families experiencing end-of-life decision making. Forty-two percent (N = 5) heard about the program from pediatric palliative physicians, and 50% (N = 6) heard about it from therapists such as music or child life. The respondents varied in how often they utilized their child's heartbeat recordings: 25% (N = 3) viewed or listened monthly, 33% (N = 4) not at all, 17% (N = 2) almost weekly, 17% less than monthly, and 8% (N = 1) daily. Conclusion: The MTHS program is an easy-to-implement and cost-effective way to perform legacy making that bereaved parents recommend for other families.
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Affiliation(s)
- Elyse Andrews
- Thomas Jefferson University Pediatrics Residency Program, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Amelia Hayes
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Laura Cerulli
- Department of Child Life, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Elissa G Miller
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas Slamon
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Division of Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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22
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Bloomer MJ, Bouchoucha S. Editorial: COVID-19 and what it means for end-of-life care in ICU: Balancing the priorities. Collegian 2020; 27:248-249. [PMID: 32565714 PMCID: PMC7297167 DOI: 10.1016/j.colegn.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Australia
- Institute for Health Transformation, Deakin University, Australia
- Research Advisory Panel, Australian College of Critical Care Nurses, Australia
| | - Stephane Bouchoucha
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Australia
- Institute for Health Transformation, Deakin University, Australia
- Australasian College for Infection Prevention and Control, Australia
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23
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Vanstone M, Neville TH, Clarke FJ, Swinton M, Sadik M, Takaoka A, Smith O, Baker AJ, LeBlanc A, Foster D, Dhingra V, Phung P, Xu XS, Kao Y, Heels-Ansdell D, Tam B, Toledo F, Boyle A, Cook DJ. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann Intern Med 2020; 172:1-11. [PMID: 31711111 DOI: 10.7326/m19-2438] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care. OBJECTIVE To determine whether this palliative intervention could be successfully implemented-defined as demonstrating value, transferability, affordability, and sustainability-beyond the intensive care unit in which it was created. DESIGN Mixed-methods formative program evaluation. (ClinicalTrials.gov: NCT04147169). SETTING 4 North American intensive care units. PARTICIPANTS Dying patients, their families, clinicians, hospital managers, and administrators. INTERVENTION Wishes from dying patients, family members, and clinicians were elicited and implemented. MEASUREMENTS Patient characteristics and processes of care; the number, type, and cost of each wish; and semistructured interviews and focus groups with family members, clinicians, and managers. RESULTS A total of 730 patients were enrolled, and 3407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital administrators. Value included intentional comforting of families as they honored the lives and legacies of their loved ones while inspiring compassionate clinical care. Factors promoting transferability included family appreciation and a collaborative intensive care unit culture committed to dignity-conserving end-of-life care. Staff participation evolved from passive support to professional agency. Program initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 (SD, $17.14) per wish. Sustainability was demonstrated by the continuation of 3WP at each site after study completion. LIMITATION This descriptive formative evaluation describes tertiary care center-specific experiences rather than aiming for generalizability to all jurisdictions. CONCLUSION The 3WP is a transferrable, affordable, and sustainable program that provides value to dying patients, their families, clinicians, and institutions. PRIMARY FUNDING SOURCE Greenwall Foundation.
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Affiliation(s)
- Meredith Vanstone
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Thanh H Neville
- University of California Los Angeles, Los Angeles, California (T.H.N., P.P., X.(.X., Y.K.)
| | - France J Clarke
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Marilyn Swinton
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Marina Sadik
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Alyson Takaoka
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Orla Smith
- St. Michael's Hospital, Toronto, Ontario, Canada (O.S., A.J.B.)
| | - Andrew J Baker
- St. Michael's Hospital, Toronto, Ontario, Canada (O.S., A.J.B.)
| | - Allana LeBlanc
- Vancouver Coastal Health, Vancouver, British Columbia, Canada (A.L.)
| | - Denise Foster
- University of British Columbia, Vancouver, British Columbia, Canada (D.F., V.D.)
| | - Vinay Dhingra
- University of British Columbia, Vancouver, British Columbia, Canada (D.F., V.D.)
| | - Peter Phung
- University of California Los Angeles, Los Angeles, California (T.H.N., P.P., X.(.X., Y.K.)
| | - Xueqing Sherry Xu
- University of California Los Angeles, Los Angeles, California (T.H.N., P.P., X.(.X., Y.K.)
| | - Yuhan Kao
- University of California Los Angeles, Los Angeles, California (T.H.N., P.P., X.(.X., Y.K.)
| | - Diane Heels-Ansdell
- McMaster University, Hamilton, Ontario, Canada (M.V., F.J.C., M.S., M.S., A.T., D.H.)
| | - Benjamin Tam
- Niagara Health, St. Catherines, Ontario, Canada (B.T.)
| | - Feli Toledo
- St. Joseph's Healthcare, Hamilton, Ontario, Canada (F.T.)
| | - Anne Boyle
- McMaster University, St. Joseph's Healthcare, Hamilton, Ontario, Canada (A.B., D.J.C.)
| | - Deborah J Cook
- McMaster University, St. Joseph's Healthcare, Hamilton, Ontario, Canada (A.B., D.J.C.)
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24
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Ranse K, Coombs M. The courageous practitioner during end-of-life care: Harnessing creativity in everyday acts. Aust Crit Care 2019; 32:449-450. [PMID: 31615699 DOI: 10.1016/j.aucc.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kristen Ranse
- School of Nursing & Midwifery, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Australia.
| | - Maureen Coombs
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, UK
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