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The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members' experiences. Intensive Crit Care Nurs 2023; 76:103399. [PMID: 36731266 DOI: 10.1016/j.iccn.2023.103399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. DESIGN A constructivist qualitative study. SETTING One hospitals intensive care unit in Southeast China. METHODS Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. FINDINGS A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. CONCLUSION The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members' needs when the patient has been transferred and dies at home in mainland China. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.1.
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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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]
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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).
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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
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Hutchinson AL, Van Wissen KA. Home to die from the intensive care unit: A qualitative descriptive study of the family’s experience. Intensive Crit Care Nurs 2017; 43:116-122. [DOI: 10.1016/j.iccn.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/17/2017] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
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Lin Y, Myall M, Jarrett N. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review. J Adv Nurs 2017. [DOI: 10.1111/jan.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yanxia Lin
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Michelle Myall
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Nikki Jarrett
- Faculty of Health Sciences; University of Southampton; Southampton UK
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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.
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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.
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Coombs M, Long-Sutehall T, Darlington AS, Richardson A. Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study. Palliat Med 2015; 29:354-62. [PMID: 25519147 PMCID: PMC4370931 DOI: 10.1177/0269216314560208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. AIM To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. DESIGN Exploratory two-stage qualitative study SETTING/PARTICIPANTS Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. FINDINGS The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. CONCLUSION There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.
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Affiliation(s)
- Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Coombs MA, Darlington AS, Long-Sutehall T, Richardson A. Transferring critically ill patients home to die: developing a clinical guidance document. Nurs Crit Care 2015; 20:264-70. [DOI: 10.1111/nicc.12169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Capital and Coast District Health Board; Wellington New Zealand
| | | | | | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust & University of Southampton; Southampton UK
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