Intensive care nurses' experiences of end-of-life care

The Effect on the Care Behaviors of Nurses Working in Intensive Care Clinics of Moral Distress Experienced During End of Life Patient Care

This research was conducted as a descriptive study in order to examine the effects of the moral problems experienced by nurses working in intensive care clinics on their end of life care behaviors. The data were collected using the Moral Distress Scale and Caring Behaviors Inventory. It was found that 74.5% of the nurses were women and their mean age was 32.60 ± 6.6 years. The frequency of moral distress in the nurses was 44.27 ± 16.25 and total score was 111.02 ± 63.85. There were significant differences in the scores of the concept the use of futile treatment by nurses, the decision not to begin life-support treatment being made only by physicians, and moral distress and discomfort felt by pediatric intensive care nurses (p < .05). A statistically significant relationship was found between total scores of discomfort on moral distress and assurance, knowledge and skills, connectedness, and being respectful on the end of life care behaviors (p < .05).

Barriers in providing quality end-of-life care as perceived by nurses working in critical care units: an integrative review

BACKGROUND

Despite increasing interest in quality end-of-life care (EOLC), critically ill patients often receive suboptimal care. Critical care nurses play a crucial role in EOLC, but face numerous barriers that hinder their ability to provide compassionate and effective care.

METHODS

An integrative literature review was conducted to investigate barriers impacting the quality of end-of-life care. This review process involved searching database like MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, and ScienceDirect up to November 2023. Search strategies focused on keywords related to barriers in end-of-life care and critical care nurses from October 30th to November 10th, 2023. The inclusion criteria specified full-text English articles published between 2010 and 2023 that addressed barriers perceived by critical care nurses. This integrative review employs an integrated thematic analysis approach, which combines elements of deductive and inductive analysis, to explore the identified barriers, with coding and theme development overseen by the primary and secondary authors.

RESULTS

Out of 103 articles published, 11 articles were included in the review. There were eight cross-sectional descriptive studies and three qualitative studies, which demonstrated barriers affecting end-of-life care quality. Quality appraisal using the Mixed Method Appraisal Tool was completed by two authors confirmed the high credibility of the selected studies, indicating the presence of high-quality evidence across the reviewed articles. Thematic analysis led to the three main themes (1) barriers related to patients and their families, (2) barriers related to nurses and their demographic characteristics, and (3) barriers related to health care environment and institutions.

CONCLUSION

This review highlights barriers influencing the quality of end of life care perceived by critical care nurses and the gaps that need attention to improve the quality of care provided for patients in their final stages and their fsmilies within the context of critical care. This review also notes the need for additional research to investigate the uncover patterns and insights that have not been fully explored in the existing literature to enhance understanding of these barriers. This can help to inform future research, care provision, and policy-making. Specifically, this review examines how these barriers interact, their cumulative impact on care quality, and potential strategies to overcome.

Intensive Care Unit Nurses' Experiences in Caring for End-of-Life Patients in Saudi Arabia: A Qualitative Study

Background: Although extensive research on appropriate treatments has been conducted, how nurses provide care to patients at the end-of-life (EOL) is unclear, particularly among intensive care unit (ICU) nurses in Saudi Arabia. Purpose: To explore intensive care unit nurses' experiences in providing end-of-life care in Saudi Arabia. Methods: This study utilized an exploratory, descriptive, qualitative approach. A purposive sampling technique was used to recruit ICU nurses (n = 10) working in ICUs at a tertiary teaching hospital in Riyadh, Saudi Arabia. Using a semi-structured interview guide, ten individual interviews were conducted. Data were analyzed using thematic analysis. The trustworthiness of this study was ensured by following Lincoln and Guba's (1985) criteria. Findings: Four major themes related to ICU nurses' experiences of providing EOL care emerged, including: "feeling challenged but driven", "holistic caring", "collaborative working ethics", and "caring for the undying and dying". Conclusions: This study adds to the body of knowledge about the experience of ICU nurses caring for EOL patients. It offers valuable insights into challenges, coping strategies, holistic caring, collaboration, and the management of critical or dying patients at EOL in the ICUs.

Views of Hong Kong Chinese medicine practitioners on the application of the "Chinese Medicine Anti-epidemic Plans" prepared by the Chinese medicine expert group of central authorities: a focus group study

BACKGROUND

Drawing on the extensive utilization of traditional Chinese medicine (TCM) to combat COVID-19 in Mainland China, experts designed a series of TCM anti-epidemic strategies. This study aims to understand Hong Kong CM practitioners' application of and opinions on the "Chinese Medicine Anti-epidemic Plans."

METHODS

Online focus group interviews were conducted, and purposive sampling was employed to invite 22 CM practitioners to voluntarily participate in three interview sessions. The interviews were audio recorded, then transcribed verbatim. The transcripts were analyzed using template analysis.

RESULTS

Three themes were derived: (1) facilitators of the "Chinese Medicine Anti-epidemic Plans," (2) barriers of the "Chinese Medicine Anti-epidemic Plans," and (3) expectations on improving the "Chinese Medicine Anti-epidemic Plans." The participants could obtain relevant information from various sources, which highlights the value of the plans for TCM medicinal cuisine and non-pharmacologic therapies and guiding junior CM practitioners, supplementing Western medicine interventions, and managing Chinese herb reserves in clinics. However, the barriers included the lack of a specialized platform for timely information release, defective plan content, limited reference value to experienced CM practitioners, and lack of applicability to Hong Kong. The expectations of the CM practitioners for improving the plans were identified based on the barriers.

CONCLUSIONS

To enhance the implementation of the anti-epidemic plans, CM practitioners in Hong Kong expect to utilize a specific CM platform and refine the plans to ensure that they are realistic, focused, comprehensive, and tailored to the local context.

What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review

BACKGROUND

As many patients are spending their last days in critical care units, it is essential that they receive appropriate end-of -life care. However, cultural differences, ethical dilemmas and preference practices can arise in the intensive care settings during the end of life. Limiting therapy for dying patients in intensive care is a new concept with no legal definition and therefore there may be confusion in interpreting the terms 'no resuscitation' and 'comfort care' among physicians in Middle East. Therefore, the research question is 'What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries?'

METHODS

The authors conducted a comprehensive systematic literature review using five electronic databases. We identified primary studies from Medline, Embase, CINAHL, Psycinfo and Scopus. The team assessed the full-text papers included in the review for quality using the Joanna Briggs Institute checklist (JBI). We completed the literature search on the first of April 2022 and was not limited to a specific period.

RESULTS

We identified and included nine relevant studies in the review. We identified five main themes as end-of-life care challenges and/or facilitators: organisational structure and management, (mis)understanding of end-of-life care, spirituality and religious practices for the dying, communication about end-of-life care, and the impact of the ICU environment.

CONCLUSIONS

This review has reported challenges and facilitators to providing end-of-life care in ICU and made initial recommendations for improving practice. These are certainly not unique to the Middle East but can be found throughout the international literature. However, the cultural context of Middle East and North Africa countries gives these areas of practice special challenges and opportunities. Further observational research is recommended to confirm or modify the results of this review, and with a view to developing and evaluating comprehensive interventions to promote end-of-life care in ICUs in the Middle East.

Bereavement Care Team: Improving ICU Nurses' Professional Bereavement and Patient Family Experience

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.

Understanding nursing personnel's health while working in end-of-life care-A hermeneutical study

AIM

This study aimed to explore nursing personnel's health while working in end-of-life care.

INTRODUCTION

End-of-life care is challenging both for nursing personnel and for the healthcare organisation, as retaining nursing staff is difficult. Although end-of-life care involves the risk of burnout, it also encompasses protective factors that can lead to personal and professional development and satisfaction, and that can enable personnel to encounter their own inner selves. In order to focus on the health of nursing personnel we chose the theory of caritative caring as our theoretical perspective.

METHOD

A qualitative inductive research design with a hermeneutical approach was chosen to explore nursing personnel's health while working in end-of-life care. Two assistant nurses and six registered nurses with experience in end-of-life care at a palliative care unit participated. The study was approved by a Regional Ethical Review Board.

RESULTS

The results are presented on three levels: rational, structural and existential. In the rational level, fellowship and togetherness with colleagues, as well as being able to distinguish between private life and work were important for nursing personnel's strategies for maintaining their health. At the structural level, social togetherness, sharing emotions and being involved in each other's emotions were important for nursing personnel's health. The existential level showed that the nursing personnel's own existential situation was affected when their inner self was emotionally affected by the patients' suffering. The awareness of suffering, life and death made the nursing personnel feel inner security, both as nursing professionals and as human beings.

CONCLUSION

A common perspective based on a theory of caritative care may be helpful for retaining nursing personnel. While the study highlights nursing personnel's health while working in an end-of-life care context, the results may also be applicable to nursing professionals' health in other contexts.

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19

BACKGROUND

Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied.

OBJECTIVES

To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout.

METHODS

This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables.

RESULTS

Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms.

CONCLUSIONS

Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.

"A Life Slips Through Our Fingers" Experiences of Nurses Working in Pediatric Intensive Care Units About Children's Death: A Qualitative Study

Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

Nurses' perceptions of the obstacles and supportive behaviors of end-of-life care in intensive care units

PURPOSE

This study examined the Jordanian registered nurses' perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples' demographics.

METHODS

A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe's post hoc test.

RESULTS

The registered nurses' scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses' certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses' age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019).

CONCLUSIONS

The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals.

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review

Objective

Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU.

Method

An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation.

Result

A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life.

Conclusion

The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

The nurses' perceptions of spiritual care competency in intensive care units

The health-care system around the world has recognized the importance and usefulness of spirituality in the delivery of care. The goal of this study was to describe nurses' self-perceived ability in providing spiritual care to patients in Intensive Care Units, as well as to look into the relationship between demographic variables and their competencies. The researchers used a descriptive correlation design. There were 106 surveys distributed in total. Two large hospitals in Jouf, Saudi Arabia, had an 83.01% response rate. The self-reported questionnaire was completed by 88 nurses. The majority of nurses said they were capable of providing spiritual care to patients of the Islamic faith. Religions had statistically significant mean Spiritual Care Competency scores. It is critical to have a unified health strategy based on multidisciplinary collaborations to control spiritual care delivery, particularly in Intensive Care Units.

Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes

BACKGROUND

Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known.

OBJECTIVES

The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process.

METHODS

The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care.

RESULTS

The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98.

CONCLUSION

It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001).

DISCUSSION

It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.

Midwifery care for late termination of pregnancy: Integrative review

Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role.

"Time and life is fragile": An integrative review of nurses' experiences after patient death in adult critical care

INTRODUCTION

Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses' experiences after patient death.

AIM

The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care.

DESIGN

A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.

RESULTS

From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses; (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support; and (iii) nurses' emotional response to patient death including coping mechanisms.

CONCLUSIONS

Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.

Nursing interventions in palliative care in the intensive care unit: A systematic review

CONTEXT

Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff.

OBJECTIVE

The aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU).

DATA SOURCES

US National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used.

DATA EXTRACTION

After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used.

DATA ANALYSIS

The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.

RESULTS

The findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU.

CONCLUSION

This review highlighted the need for specific nursing interventions aimed at palliative care patients at ICU to promote patient autonomy and the focus on patient needs, always sharing decisions with the patient and family. However, it showed that there is a need for the continuous training of the nursing staff because factors such as the nurses' lack of technical-scientific knowledge and, concomitantly, the absence of a standardized and specific intervention model linked to a bureaucratic system, make it difficult to carry out a specialized care for this type of patient.

How pancreatic cancer impacts carers in the UK: why do we know so little?

BACKGROUND

Pancreatic cancer is a disease with poor life expectancy and high symptom burden. The experiences of the spouses, family and friends who care for this group is poorly understood, especially during palliative care and within the UK.

AIMS

To highlight the current gaps within research and provide some insight into the challenges faced by carers assisting those living with pancreatic cancer, and how community nurses can support this group.

METHODS

A total of five research databases were searched using the terms 'pancreatic cancer', 'carer' and 'experience'. Cancer and palliative charity websites were also referenced for grey literature.

FINDINGS

There is limited research exploring pancreatic cancer carers experiences in the UK healthcare system and community. Available information suggests that this group is likely to face significant psychological and physical challenges to caring.

CONCLUSIONS

It is vital for community nurses to have an awareness of challenges this group face, to better recognise and support these vulnerable carers.

An Exploratory Study of ICU Pediatric Nurses' Feelings and Coping Strategies after Experiencing Children Death

BACKGROUND

This study aims to explore the feelings and experiences of nursing staff when faced with the death of a pediatric patient in the ICU.

METHODOLOGY

A qualitative study based on hermeneutic phenomenology was conducted through semi-structured interviews. Ten nurses (30% of staff) from the Pediatric Intensive Care Unit of a referral hospital were interviewed in April 2022. Text transcripts were analysed using latent content analysis.

RESULTS

Content analysis indicated that the interviewees had feelings of sadness and grief; they had a misconception of empathy. They had no structured coping strategies, and those they practiced were learned through personal experience, not by specific training; they reported coping strategies such as peer support, physical exercise, or strengthening ties with close family members, especially their children. The lack of skills to cope with the death and the absence of support from personnel management departments were acknowledged. This can lead to the presence of compassion fatigue.

CONCLUSIONS

The feelings that PICU nurses have when a child they care for die are negative feelings and sadness, and they possess coping strategies focused on emotions learned from their own experience and without institutional training support. This situation should not be underestimated as they are a source of compassion fatigue and burnout.

Attitude of nurses caring critically ill patients admitted in the ICUs of AIIMS Hospital, Jodhpur

BACKGROUND

Nurses are internationally recognized to be largest group of registered and regulated practitioner in the health workforce of any country. There is an increase in number of critically ill patients seeking optimal care, and this rapidly increases the demand for the critical care nurses at the end of life. Caring for a critically ill patient creates anxiety and emotional exhaustion and may sometimes lead to burnout. So, it is imperative for the nurses to have an optimistic approach while caring patients in the ICU. The aim of the study was to assess the attitude of the nurses caring critically ill patients and to determine the association of the level of attitude with the selected personal variable. The study was conducted at ICUs of tertiary care hospital by using descriptive research design.

METHODS AND MATERIAL

A cross-sectional descriptive study was conducted in ICUs of tertiary care hospital from October to December 2018. The sample was selected by total enumeration technique. Data was collected from 60 critical care nurses with the help of self-structured five-point Likert scale to assess the attitude of nurses. Descriptive statistics and inferential statistics were used for data analysis such as mean, frequency, percentage, standard deviation, and Chi-square test.

RESULTS

Majority (81.7%) of the nurses were having favorable attitude toward caring the critically ill patients, and there was no significant association of the attitude score with the selected personal variable at P < 0.05.

CONCLUSIONS

Majority of critical care nurses have favorable attitude. If they have supportive environment at workplace, their willingness to work toward quality care will improve further.

End-of-life Care in the Intesive Care Unit and Nursing Roles in Communicating with Families

Introduction

Professionals in Intensive Care Units face death, shifting their role from therapists to caregivers in end-of-life management. The nursing attitude and response to death has been shown to affect the quality of palliative care and end-of-life services that are interrelated services.

Aim of the study

The aim of this research was to evaluate the professional attitude of nurses towards the care of the families of critically ill patients in the ICU, leading to the emergence of specific attitudes, relating them to their demographic and professional characteristics, with the aim of drawing conclusions for the improvement of quality in end-of-life care.

Material and Methods

The sample of the study was 81 nurses from a large tertiary hospital. Participants completed the "Nurse Activities for Communicating with Families" (NACF) questionnaire. The questions are about ways in which nurses can help the patient's family during the patient's stay in the ICU.

Results

The results revealed that the nurses took actions related to the information and psychological support of the patient's family. On the contrary, they did not focus on the spiritual / religious needs of the patient and the needs of the family based on their cultural background.

Conclusions

The professional treatment of staff is characterized by compassion and empathy, but it is necessary to train them on important issues related to diversity, including the religious, spiritual values and beliefs of patients and their relatives.

Experience of parents in delivering pediatric tuina to children with symptoms of attention deficit hyperactivity disorder during the COVID-19 pandemic: qualitative findings from focus group interviews

BACKGROUND

Evidence suggests that pediatric tuina, a modality of traditional Chinese medicine (TCM), might have beneficial effects on the symptoms of attention deficit hyperactivity disorder (ADHD), such as overall improvements in concentration, flexibility, mood, sleep quality, and social functioning. This study was conducted to understand the facilitators and barriers in the delivery of pediatric tuina by parents to children with ADHD symptoms.

METHODS

This is a focus group interview embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for ADHD in preschool children. Purposive sampling was employed to invite 15 parents who attended our pediatric tuina training program to participate voluntarily in three focus group interviews. The interviews were audio-recorded and transcribed verbatim. The data were analyzed through template analysis.

RESULTS

Two themes were identified: (1) facilitators of intervention implementation and (2) barriers to intervention implementation. The theme of the facilitators of intervention implementation included the subthemes of (a) perceived benefits to children and parents, (b) acceptability to children and parents, (c) professional support, and (d) parental expectations of the long-term effects of the intervention. The theme of barriers to intervention implementation included the subthemes of (a) limited benefits for children's inattention symptoms, (b) manipulation management difficulties, and (c) limitations of TCM pattern identification.

CONCLUSION

Perceived beneficial effects on the children's sleep quality and appetite and parent-child relationships, as well as timely and professional support, mainly facilitated the implementation of parent-administered pediatric tuina. Slow improvements in the children's inattention symptoms and the possible inaccuracies of online diagnosis were the dominant barriers of the intervention. Parents have high expectations for the provision of long-term professional support during their practice of pediatric tuina. The intervention presented here can be feasibly used by parents.

Exploring clinicians' decision-making processes about end-of-life care after burns: A qualitative interview study

INTRODUCTION

Little is known about treatment decision-making experiences and how/why particular attitudes exist amongst specialist burn clinicians when faced with patients with potentially non-survivable burn injuries. This exploratory qualitative study aimed to understand clinicians' decision-making processes regarding end-of-life (EoL) care after a severe and potentially non-survivable burn injury.

METHODS

Eleven clinicians experienced in EoL decision-making were interviewed via telephone or video conferencing in June-August 2021. A thematic analysis was undertaken using a framework approach.

RESULTS

Decision-making about initiating EoL care was described as complex and multifactorial. On occasions when people presented with 'unsurvivable' injuries, decision-making was clear. Most clinicians used a multidisciplinary team approach to initiate EoL; variations existed on which professions were included in the decision-making process. Many clinicians reported using protocols or guidelines that could be personalised to each patient. The use of pathways/protocols might explain why clinicians did not report routine involvement of palliative care clinicians in EoL discussions.

CONCLUSION

The process of EoL decision-making for a patient with a potentially non-survivable burn injury was layered, complex, and tailored. Processes and approaches varied, although most used protocols to guide EoL decisions. Despite the reported complexity of EoL decision-making, palliative care teams were rarely involved or consulted.

Grey area nursing: high-dependency nurses’ experiences of caring for patients approaching the transition from curative to palliative care

Background: Nurses in high-dependency units frequently facilitate the withdrawal of life-sustaining treatments and provide end-of-life care. Providing this care has been shown to cause distress, burnout and cumulative grief. There remains a lack of understanding of high dependency nurses’ experiences of caring for patients approaching withdrawal of life-sustaining treatments. Aim: To explore experiences of high dependency nurses caring for patients approaching withdrawal of life-sustaining treatment and highlight any support or needs they may have. Methods: Interviews were conducted and analysed using qualitative thematic analysis. Findings: Nurses experienced conflict in decision making, which was reported to prolong patient distress and cause nurses moral anguish. Nurses need time to talk and further education to support them to provide withdrawal of life-sustaining treatment. Conclusion: High-dependency nurses need time to talk following caring for this patient group and more extensive education to support them to provide quality end-of-life care.

Parent-administered pediatric Tuina for attention deficit/hyperactivity disorder symptoms in preschool children: A pilot randomized controlled trial embedded with a process evaluation

BACKGROUND

Beneficial effects of parent-administered pediatric tuina on ADHD in children have been reported in previous studies, but no rigorously designed randomized controlled trials (RCTs) have been conducted on it.

OBJECTIVE

To assess the feasibility and preliminary effects of parent-administered pediatric tuina for ADHD symptoms in preschoolers.

METHODS

This project was a two-arm, parallel, open-label, pilot RCT. Sixty-four participants were randomized into two groups at a 1:1 ratio. Parents in the parent-administered tuina group (n = 32) attended an online training program on pediatric tuina for ADHD and conduct this intervention on their children at home. Parents in the parent-child interaction group (n = 32) attended an online training about progressive muscle relaxation exercise and carried out parent-child interactive physical activities with their children at home. Both interventions were carried out every other day during a two-month intervention period, with each manipulation for at least 20 min. Feasibility outcomes included recruitment rate, consent rate, participants' adherence, retention rate, and adverse event. Outcomes were assessed at baseline, week 4, and week 8. The primary outcome measure was the Swanson, Nolan, and Pelham parent scale (SNAP); the secondary outcomes included preschool anxiety scale, children's sleep habits questionnaire, and parental stress scale. A mixed-method process evaluation embedded within the outcome evaluation was performed.

RESULTS

The recruitment rate was 12.8 per month. The consent rate was 98.5%. Good adherence was shown from the parent logbook. Four participants withdraw from the study. No severe adverse event was reported. For the SNAP total score, both groups showed improvement with moderate within-group effect size (Cohen's d > 0.5, all p < 0.001) and the between-group effect size was minimal (d_ppc2< 0.2, p > 0.05). Perceived improvements on children's appetite and sleep quality, and parent-child relationship was observed from the qualitative data.

CONCLUSIONS

The study design and the parent-administered pediatric tuina intervention were feasible. Parent-administered pediatric tuina provided beneficial effects on improving core hyperactivity/impulsivity symptoms in preschool children. Parents perceived improvements on children's appetite and sleep quality. Further large-scale are warranted.

Nurses' perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study

BACKGROUND AND AIM

Patient deaths are common in the intensive care unit, and a nurse's perception of barriers to and supportive behaviors in end-of-life care varies widely depending upon their cultural background. The aim of this study was to describe the perceptions of intensive care nurses regarding barriers to and supportive behaviors in providing end-of-life care in a Chinese cultural context.

METHODS

A cross-sectional survey was conducted among intensive care nurses in 20 intensive care units in 11 general hospitals in central and eastern China. Instruments used in this study were general survey and Beckstrand's questionnaire. Data were collected via online survey platform. Descriptive analysis was used to describe general characteristics of participants and mean and standard deviations of the barriers and supportive behaviors. The mean and standard deviation were used to describe the intensity and frequency of each barrier or supportive behavior following Beckstrand's method to calculate the score of barriers and supportive behaviors. Content analysis was used to analyze the responses to open-ended questions.

RESULTS

The response rate was 53% (n = 368/700). Five of the top six barriers related to families and the other was the nurse's lack of time. Supportive behaviors included three related to families and three related to healthcare providers. Nurses in the intensive care unit felt that families should be present at the bedside of a dying patient, there is a need to provide a quiet, independent environment and psychological support should be provided to the patient and family. Nurses believe that if possible, families can be given flexibility to visit dying patients, such as increasing the number of visits, rather than limiting visiting hours altogether. Families need to be given enough time to perform the final rites on the dying patient. Moreover, it is remarkable that nurses' supportive behaviors almost all concern care after death.

CONCLUSIONS

According to ICU-nurses family-related factors, such as accompany of the dying patients and acceptence of patient's imminent death, were found the major factors affecting the quality of end-of-life care. These findings identify the most prominent current barriers and supportive behaviors, which may provide a basis for addressing these issues in the future to improve the quality of end-of-life care.

Towards democratic institutions: Tronto's care ethics inspiring nursing actions in intensive care

Care as a concept has long been central to the nursing discipline, and care ethics have consequently found their place in nursing ethics discussions. This paper briefly revisits how care and care ethics have been theorized and applied in the discipline of nursing, with an emphasis on Tronto's political view of care. Adding to the works of other nurse scholars, we consider that Tronto's care ethics is useful to understand caring practices in a sociopolitical context. We also contend that this vision can be used specifically to politicize nurses, by encouraging them to think critically about the context in which they work and how they can participate to change the status quo, notably by prompting the democratization of care in institutional settings. We illustrate this by demonstrating how moral distress that can occur with aggressive or futile treatments in the intensive care unit can be reduced if nurses are systematically included in the decision-making process. By showing some ways in which nursing political actions can begin to change the status quo as it pertains to futile treatments at the end of life, we can help empower nurses to strive to be included in political spaces and voice their concerns to have their professional needs met.

Knowledge of Critical Care Nurses about End-of-Life Care towards Terminal Illnesses: Levels and Correlating Factors

Introduction

The preparedness of nurses in relation to providing palliative care is not always adequate, indeed, it is sometimes unsatisfactory; this may be caused by lack of knowledge and limited experience in end-of-life care (EOLC). Thus, this study purposed to assess the levels of registered nurses' knowledge about EOLC, examine the relationships between EOLC knowledge and some demographic variables, and explore predictors of EOLC knowledge.

Methods

A cross-sectional design survey was conducted with Jordanian registered nurses in critical care units (N = 175) in different heath sectors in Jordan. The End-of Life Professional Caregiver Survey (EPCS) was used.

Results

Findings showed that nurses had moderate/quite a lot of knowledge (M (SD) = 2.58 (.48)) about EOLC. The cultural and ethical values was the highest subscale of knowledge about EOLC (M (SD) = 2.74 (.52)), while effective care delivery subscale was the lowest one ((M (SD) = 2.33 (.66). Knowledge about EOLC was correlated with age (r = .145, P < .05), work experience (r = .173, P < .05), and training course in palliative or EOLC (r = .217, P < .01). The main predictor of EPCS was training courses in palliative or EOLC (B = .190, P < .05).

Conclusion

The nurses need to enhance their knowledge about EOLC and correlating factors should be taken into consideration when developing any intervention program. Nurses need palliative care training courses; also more attention is required in palliative care education particularly in clinical skills in effective care delivery.

The medical futility experience of nursing professionals in Greece

Background

Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear.

Methods

This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data.

Results

Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. The nursing professional’s role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient’s role in decisions on futile care was prioritized. The patient’s effort to keep themselves alive was also highlighted. This effort impacts nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized.

Conclusions

These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.

Doživljanje umiranja z vidika medicinskih sester

Uvod: V enotah intenzivne terapije se medicinske sestrednevno soočajo z umiranjem. To jim predstavlja velike obremenitve, ki vodijo do stiske. Namen pregleda literature je ugotoviti, kaj doživljajo medicinske sestre ob umirajočih pacientih v enotah intenzivne terapije in kako se soočajo z umiranjem.Metode: Uporabljena je metoda pregleda literature. Iskanje je bilo izvedeno v bazah podatkov: PubMed, ScienceDirect, SAGE, Web of Science in CINAHL na osnovi vključitvenih in izključitvenih kriterijev. Proces iskanja literature je prikazan z diagramom PRISMA. Za analizo in sintezo podatkov je bila uporabljena metoda tematske analize.Rezultati: Od 1.886 zadetkov smo v končno analizo vključili 10 člankov. Na podlagi tematske analize smo oblikovali dve glavni temi: (1) doživljanje medicinskih sester ob hudo bolnih in umirajočih pacientih; (2) profesionalni odnos medicinskih sester.Diskusija in zaključek: Izvajanje zdravstvene nege v enotah intenzivne terapije je za medicinske sestre zelo stresno. Pri zdravstveni negi kritično bolnih pacientov se najpogosteje srečujejo s stalnimi fizičnimi obremenitvami, čustvenimi pretresi, pomanjkanjem čustvene podpore, žalostjo, izgorevanjem, depresijo, težavami v komunikaciji s pacientovimi sorodniki ter pomanjkljivim sodelovanjem in zagotavljanjem podpore v timu. Izpostavljene so številnim dejavnikom, ki prispevajo k doživljanju lastne stiske. Potrebni so ukrepi za zaščito, učinkovitejšo pomoč in podporo medicinskim sestram, ki se dnevno soočajo z umiranjem in zagotavljanjem podpore pacientovi družini oziroma svojcem. 

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

This descriptive qualitative study was planned to determine the views of intern nursing students about death and end-of-life care. The study was completed with 12 intern students based on the criterion of data saturation. As a result of the study, the categories of 'end,' 'uncertainty,' 'fear,' 'beginning,' 'helplessness' under the theme of death, 'ensuring peace,' 'continuing communication' 'providing psychosocial/spiritual support,' 'acting in conformity with principles of ethics/morality,' 'continuing to provide physical care,' 'supporting the family,' 'making the best use of the limited remaining time or helping the patient's last wishes come true' under the theme of end-of-life care emerged.

Health Care at the End of Life: Experience of Nurses at the Adult Intensive Care Unit

The objective of this study was to determine the experience of the nurses who provide health care in the final stages of life in the intensive care unit for adults. The authors report the results of their study, which used a qualitative design with a phenomenological approach. Eighteen adults participated by being interviewed using semistructured questions. The nurses expressed that health care at the end of life represents an emotional and psychological burden for them. They also recognized that health care was given based on the empiricism achieved through clinical experience. In this regard, they emphasize the importance of having the proper education in this area to provide comprehensive care to the patient, the family, and the nurse.

A genealogy of what nurses know about 'the good death': A socio-materialist perspective

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.

Clinical staff perceptions on the quality of end-of-life care in an Australian acute private hospital: a cross-sectional survey

ObjectiveTo explore the perceptions of clinical staff on the quality of end-of-life care in an acute private hospital.MethodsA descriptive cross-sectional study with a convenience sample of clinical staff in an acute private hospital were surveyed using a validated end-of-life survey. Data from the surveys were analysed using descriptive statistics for quantitative responses and inductive content analysis for the open-ended responses.ResultsOverall, 133 staff completed the survey. Of these, 107 had cared for a dying patient in the hospital. In total, 87.6% of participants felt confident in their ability to recognise a dying patient and 66.7% felt confident in their ability to talk to the patient and family. Almost one-third had not received specific training in the area.ConclusionsHospitals need to take the lead in ensuring end-of-life care processes are embedded across clinical areas. This includes providing staff with end-of-life care education and support in the delivery of end-of-life care. These strategies will facilitate safe and quality end-of-life care, including better collaboration between patients, families and staff.What is known about the topic?Key to providing quality end-of-life care in hospitals are strategic guidelines that support good clinical governance and adequately trained staff to deliver the care.What does the paper add?This study highlights the importance of clinical staff in all areas having skills and confidence in providing care to dying patients and their families.What are the implications for practitioners?It is important that all health practitioners implement strategies to overcome gaps in staff education and support, to ensure all patients and families receive quality end-of-life care.

Evaluation of a training program for community-based end-of-life care of older people toward aging in place: A mixed methods study

AIMS

To evaluate a training program that supports community-based service staff in implementing aging-in-place and end-of-life care programs.

BACKGROUND

Globally, as the population ages, the need for end-of-life care has never been greater. Since Japan is facing the issues of a super-aged population sooner than most countries, there is a particularly urgent need to enhance end-of-life care for older people. Most Japan's older people wish to spend their final days at home, however, only 11-13% end their lives at home, while 73% die in hospitals. As part of care system, small-scale community-based service for aging-in-place established across Japan in 2006 managed locally. These are flexible services using home or facility care or both for the individual to live long term at their preferred place. We developed the end-of-life care educational training program to encourage behavioral changes in community-based service staff of various readiness levels.

DESIGN

Mixed methods study design.

METHODS

A pre-post evaluation of knowledge, confidence and attitude toward end-of-life care, combining quantitative and qualitative data from 53 community-based service staff members who participated in the training program from September 2017 to September 2019. Participants were informed of the end-of-life care process using focus group discussions about end-of-life care and completed surveys evaluating the program before, immediately following and three months after the training. We used the four-level Kirkpatrick model as the evaluation indicator.

RESULTS

Quantitative analysis results indicated that participants were satisfied with the training program. Their knowledge scores regarding end-of-life care significantly improved; they also experienced confidence gains and changes in attitudes, becoming more approving of end-of-life care. Qualitative data revealed details of participants' satisfaction and what was learned. Through the focus group discussions, they created action plans for implementing end-of-life care programs, which some had accomplished in their local centers by the three-month follow-up.

CONCLUSIONS

These results suggest that the training program is effective for promoting end-of-life care through community-based services in Japan. Conducting follow-up training could effectively strengthen participants' commitment to end-of-life care at community-based services. Use of the training program is expected to promote services to support aging-in-place.

Nurses' Participation in Limited Resuscitation: Gray Areas in End of Life Decision-Making

Historically nurses have lacked significant input in end-of-life decision-making, despite being an integral part of care. Nurses experience negative feelings and moral conflict when forced to aggressively deliver care to patients at the EOL. As a result, nurses participate in slow codes, described as a limited resuscitation effort with no intended benefit of patient survival. The purpose of this study was to explore and understand the process nurses followed when making decisions about participation in limited resuscitation. Five core categories emerged that describe this theory: (1) recognition of patient and family values at the EOL; (2) stretching time and reluctance in decision-making; (3) harm and suffering caused by the physical components of CPR; (4) nurse's emotional and moral response to delivering aggressive care, and; (5) choosing limited resuscitation with or without a physician order. Several factors in end-of-life disputes contribute to negative feelings and moral distress driving some nurses to perform slow codes in order to preserve their own moral conflict, while other nurses refrain unless specifically ordered by physicians to provide limited care through tailored orders.

End-of-Life Care: Improving Communication and Reducing Stress

This quality improvement initiative originated in the cardiac intensive care unit (CICU) at a 637-bed licensed Magnet teaching hospital with the rating of level 1 trauma center. The CICU has 12 beds, with a staff of 59 nurses (RNs). The nursing staff expressed increased stress and discomfort when communicating with patients and their families when providing end-of-life care. Selected evidence-based techniques for stress reduction and active listening skills were taught in 4- to 5-minute mini sessions during the morning huddle 3 days per week for 4 weeks. The program was evaluated using pretest, posttest, and 2 follow-up surveys composed of 5 statements and 2 open-ended questions. The survey tool was developed by researchers in accordance with the relevant literature. The results showed improved communication as demonstrated by the surveys. Nurses also reported feeling more supported by their colleagues and supervisors. The project was conducted in 1 CICU, therefore limiting the generalizability of the results.

End-of-Life Care Mobile App for Intensive-Care Unit Nurses: A Quasi-Experimental Study

Intensive-care unit nurses may experience difficulties in end-of-life care because of frustration or lethargy. The purpose of this study was to develop a mobile end-of-life care program for intensive-care unit nurses and evaluate the effects on competence factors such as knowledge, self-efficacy, and compassion. A quasi-experimental design was used. The participants included 44 nurses who had less than three years of experience in the intensive-care unit, divided into the experimental group and control group. After the intervention, the experimental group showed a significant improvement in self-efficacy in end-of-life care and compassion in end-of-life care. Based on the results of this study, the end-of-life care mobile app was an effective educational method for nurses with experience of less than 3 years in an intensive-care unit. To improve the quality of end-of-life care, it is necessary to develop various educational programs considering the greater role of the fourth industrial revolution in the future.

Nurses' perceptions of caring activities in nursing

Aim

This study aimed to determine nurses' perceptions of caring activities in nursing.

Design

A descriptive study design.

Methods

A Turkish translation of the 25-item version of the Caring Dimensions Inventory was completed by 260 nurses working in one university hospital. Data were analysed using Mokken scaling.

Results

Technical aspects of nursing were highly endorsed items such as "observing the effects of a medication on a patient, measuring vital signs, being technically competent with a clinical procedure, consulting with the doctor" except for the item "providing privacy for a patient" which is a psychosocial item. The range of items included in the Mokken scale with "providing privacy for a patient" (mean = 4.31) as the most endorsed, and "exploring the patient's lifestyle" (mean = 2.60) being the least endorsed item. Listening to patients and involving them in their care are not considered as caring.

Midwives holding the space for women undergoing termination of pregnancy: A qualitative inquiry

PROBLEM

Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives' role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood.

SETTING

New Zealand.

BACKGROUND

TOP after 20 weeks may be performed to save a woman's life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women's complex psychological and clinical needs.

OBJECTIVE

To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them.

METHODS

Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens.

FINDINGS

Three themes emerged: "A different kind of midwife", "Staying true to oneself" and "Melting an Iceberg". TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women's emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief.

CONCLUSION

Midwives' experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported.

The practices and attitudes of nurses regarding palliative sedation: A scoping review

BACKGROUND

Palliative sedation is used as a last-resort option to treat refractory symptoms of dying patients. Nurses are important participants in the process of sedation. However, little is known about palliative sedation from a nursing perspective.

OBJECTIVES

To analyze the practices and attitudes of nurses concerning palliative sedation.

DATA SOURCES AND REVIEW METHODS

A scoping review guided by Arksey and O`Malley`s methodological framework was used to analyze existing peer-reviewed empirical research on the topic of the practices and attitudes of nurses related to the palliative sedation of patients aged 18 years and older. Of the 316 publications identified from the PubMed, CINAHL and Cochrane Library, 17 full-text articles were included in this review. The data of the included articles were charted (author(s), year of publication, country, objectives, study design, data collection, setting, respondents, definition of palliative sedation, focus of the study and key findings), and the results were summarized with inductive content analysis. The PRISMA-ScR checklist was used as a guideline for the reporting in this review.

RESULTS

During the decision-making concerning the start of palliative sedation, nurses usually have an advocatory and supportive role, although the role varies between different countries. This role then changes to a relatively independent performance of sedation; including administration of the medication, monitoring the effectiveness of sedation, and in some cases taking decisions concerning the medication and dosage policy. Further, nurses provide information and compassionate care to both the patient and the family during the process of palliative sedation. Most nurses view palliative sedation as a positive and sometimes necessary last resort therapy to relieve refractory suffering of dying patients. However, sedation poses ethical problems for many nurses. These problems especially concern the essential elements of deciding to use palliative sedation, the depth of sedation, the potential for shortening life, and the loss of social interaction.

CONCLUSIONS

Nurses play a key role in palliative sedation, as they often perform sedation independently and have important information about the needs and wishes of both patients and their families due to their unique position at the bedside of the patient. Although nurses generally see palliative sedation as a positive practice for selected patients, many of them feel it is ethically controversial. This scoping review reveals a great need for further research and discussion on the practices and attitudes of nurses regarding palliative sedation.

Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out.Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC.Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes.Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions. Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.

Critical Care Registered Nurses' Preparedness in the Provision of End-of-Life Care

BACKGROUND

The number of deaths in critical care units continues to rise as patients are living longer with chronic illnesses; however, critical care registered nurses report feelings of unpreparedness in the provision of end-of-life (EOL) care.

OBJECTIVES

To understand and find meaning of critical care registered nurses' preparedness in the provision of EOL care.

METHODS

A qualitative interpretive description study was conducted to allow for rich, descriptive detail through the participants' eyes. Semistructured one-on-one interviews were conducted with 12 participants. Constant comparative method was used to analyze the data.

RESULTS

According to the participants, to be prepared to provide EOL care, the nurses need to understand their personal beliefs about death and dying; be able to provide care to both patient and family; combine knowledge based on education, personal and professional experience, and support resources; balance the ongoing dialogue between their professional and personal role as a registered nurse; and find ways to make sense of the dying experience, specifically through closure.

DISCUSSION

Ultimately, the provision of EOL is contextual and will vary, requiring the critical care registered nurse to adapt to each situation utilizing the tools learned and experienced to promote patient, family, and nurse comfort. Improvements to nursing education and nursing practice are warranted to expose students and nurses to more EOL care experiences while also providing the tools and support resources during the provision of EOL care.

Italian Nurses' Attitudes Towards Neonatal Palliative Care: A Cross-Sectional Survey

PURPOSE

Neonatal palliative care becomes an option for critically ill neonates when death is inevitable. Assessing nurses' attitudes towards, barriers to, and facilitators of neonatal palliative care is essential to delivering effective nursing care.

METHODS

This study was conducted from January to September 2015 and involved Italian nurses employed in Level III neonatal intensive care units in 14 hospitals in northern, central, and southern Italy. A modified version of the Neonatal Palliative Care Attitudes Scale (NiPCAS) was adopted to assess nurses' attitudes.

FINDINGS

A total of 347 neonatal nurses filled out the questionnaire. The majority were female (87.6%), with a mean age of 40.38 (±8.3) years. The mean score in the "organization" factor was 2.71 (±0.96). The "resources" factor had a mean score of 2.44 (±1.00), while the "clinician" factor had a mean score of 3.36 (±0.90), indicating the main barriers to and facilitators of implementing palliative nursing care.

CONCLUSIONS

Italian neonatal nurses may face different obstacles to delivering neonatal palliative care and to improve their attitudes in this field. In the Italian context, no facilitators of, only barriers to, palliative care delivery were identified.

CLINICAL RELEVANCE

Nurses' attitudes towards neonatal palliative care are essential to supporting nurses, who are constantly exposed to the emotional and moral distress connected with this field of end-of-life nursing care.

Ethical conflicts in nursing: An interview study

BACKGROUND

A growing body of evidence about nurses' ethical conflicts has been added to nursing science in recent decades, but no research has been done in Estonia. Ethical conflicts are a cultural and context sensitive phenomenon, so the historical, legal, social, economic and political backgrounds and position of nursing have had an impact on ethical conflict experiences.

AIM

Describe nurses' experiences of ethical conflicts.

METHOD

A qualitative, descriptive study was conducted among nurses (n = 21) in May-October 2018 in Estonia. The data were collected in the form of semi-structured individual interviews and analysed using the inductive content analysis method.

ETHICAL CONSIDERATIONS

Due to the sensitive nature of the research topic, only individual interviews were carried out.

FINDINGS

Nurses' ethical conflicts were related to situations that violated the rights, safety or well-being of the patient or relatives, caused them suffering, were against their will or threatened nurses' dignity and professionalism through a variety of practices, attitudes and relationships. The insufficiency of patient care and professional collaboration emerged as important sources of nurses' ethical conflicts and were connected to historical and societal factors.

CONCLUSIONS

In order to achieve good quality of care, nurses need to have appropriate education and organisational support to carry out ethical daily care. More research is needed to understand the multidimensional cultural and contextual knowledge of ethics and nurses' ethical conflicts.

Hospice Employees' Perceptions of Their Work Environment: A Focus Group Perspective

Burnout in healthcare professionals can lead to adverse effects on physical and mental health, lower quality of care, and workforce shortages as employees leave the profession. Hospice professionals are thought to be at particularly high risk for burnout. The purpose of the study was to evaluate workplace perceptions of interdisciplinary hospice care workers who provide care to patients at end of life. Six focus groups and one semi-structured interview were conducted with mixed group of social workers, managers, nurses, hospice aides, chaplains, support staff, and a physician (n = 19). Findings from the groups depicted both rewards and challenges of hospice caregiving. Benefits included intrinsic satisfaction from the work, receiving positive patient and family feedback, and teamwork. Challenges reflected issues with workload, technology issues, administrative demands, travel-related problems, communication and interruptions, difficulties with taking time off from work and maintaining work-life integration, and coping with witnessing grief/loss. Hospice workers glean satisfaction from making meaningful differences in the lives of patients with terminal illness and their family members. It is an expected part of the job that certain patients and situations are particularly distressing; team support and targeted grief support is available for those times. Participants indicated that workload and administrative demands rather than dealing with death and dying were the biggest contributors to burnout. Participants reported episodic symptoms of burnout followed by deliberate steps to alleviate these symptoms. Notably, for all except one of the participants, burnout was cyclical. Symptoms would begin, they would take steps to deal with it (e.g., taking a mental health day), and they recovered. At an organizational level, a multipronged approach that includes both personal and occupational strategies is needed to support professional caregivers and help mitigate the stressors associated with hospice work.