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Rubbai YS, Chong MC, Tang LY, Abdullah KL, Mohammad WT, Mohajer S, Namazinia M. Barriers in providing quality end-of-life care as perceived by nurses working in critical care units: an integrative review. BMC Palliat Care 2024; 23:217. [PMID: 39210456 PMCID: PMC11363454 DOI: 10.1186/s12904-024-01543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
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.
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Affiliation(s)
- Yousef Saleh Rubbai
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Princess Aisha bint AL-Hussein College of Nursing and Health Science, Al-Hussein Bin Talal University, Maan, Jordan.
| | - Mei Chan Chong
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Li Yoong Tang
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing, School of Medical and Life Science, Sunway University, Bandar Sunway, 46200, Malaysia
| | | | - Samira Mohajer
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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Davis A, Dukart-Harrington K. Enhancing Care of Older Adults Through Standardizing Palliative Care Education. J Gerontol Nurs 2023; 49:6-12. [PMID: 37256761 DOI: 10.3928/00989134-20230512-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Nursing skill in caring for persons with serious chronic illness is increasingly in demand as the proportion of older adults in the United States increases. There is robust evidence that palliative care education among health care providers influences the reduction of death anxiety and avoidance behavior, while positively impacting self-efficacy and comfort, when caring for persons with serious illness or those nearing death. The international recognition of access to palliative care as a universal human right drives the need for education to adequately prepare nurses who have not been properly prepared for this work. The development of national competencies in palliative care education for nurses is an important step in synthesizing and disseminating available evidence in support of palliative care nursing education. These recently published competencies can lead to policy innovations at local, state, and national levels. Identifying competencies that lead to more clearly defined curricula will ultimately improve standardizing education and improve nursing practice in caring for older adults with serious chronic illness and their families. [Journal of Gerontological Nursing, 49(6), 6-12.].
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Tzenalis A, Papaemmanuel H, Kipourgos G, Elesnitsalis G. End-of-life Care in the Intesive Care Unit and Nursing Roles in Communicating with Families. J Crit Care Med (Targu Mures) 2023; 9:116-121. [PMID: 37593247 PMCID: PMC10429615 DOI: 10.2478/jccm-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - George Kipourgos
- General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
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Lovell T, Mitchell M, Powell M, Tonge A, Strube P, O'Neill K, Dunstan E, Bonnin-Trickett A, Miller E, Suliman A, Ownsworth T, Ranse K. Dying in intensive care: An analysis of the perspectives of families and clinicians on end-of-life care. Aust Crit Care 2022:S1036-7314(22)00094-7. [PMID: 36089461 DOI: 10.1016/j.aucc.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians. OBJECTIVE The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records. METHODS A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data. RESULTS Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient's death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted. CONCLUSIONS This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians' EOLC practices and education to improve clinician confidence with communication.
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Affiliation(s)
- Tania Lovell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia.
| | - Marion Mitchell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Madeleine Powell
- School of Population Health, University of New South Wales, NSW, Australia; National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Angela Tonge
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Petra Strube
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Kylie O'Neill
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Elspeth Dunstan
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Amity Bonnin-Trickett
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Elizabeth Miller
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Adam Suliman
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Kristen Ranse
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Zulueta Egea M, Prieto-Ursúa M, Bermejo Toro L, Jodar Anchía R. Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being. Palliat Support Care 2022; 21:1-9. [PMID: 35139982 DOI: 10.1017/s1478951521001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate. OBJECTIVE The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement. METHOD 176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018. RESULTS Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = -0.032, SE = 0.013, 95% CI: -0.064, -0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: -0.004, 0.032). SIGNIFICANCE OF RESULTS Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.
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Affiliation(s)
- Mar Zulueta Egea
- Nursing, Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Madrid, Spain
| | - María Prieto-Ursúa
- Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
| | - Laura Bermejo Toro
- Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
| | - Rafa Jodar Anchía
- Psychology Department and Clinical Unit of Psychology (UNINPSI), Comillas Pontifical University - Cantoblanco Campus, Comunidad de Madrid, Spain
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A national Position Statement on adult end-of-life care in critical care. Aust Crit Care 2021; 35:480-487. [PMID: 34384650 DOI: 10.1016/j.aucc.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
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Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study. NURSE MEDIA JOURNAL OF NURSING 2020. [DOI: 10.14710/nmjn.v10i3.31302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Eltaybani S, Igarashi A, Yamamoto-Mitani N. Palliative care in adult intensive care units: A nationwide survey. Nurs Crit Care 2020; 26:315-325. [PMID: 33107206 DOI: 10.1111/nicc.12565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are no data on the provision of palliative nursing care in Egyptian adult intensive care units (ICUs). The Palliative and End-Of-Life (PEOL) Care Index is reliable and content valid; however, its construct and criterion validities have not been examined. AIMS AND OBJECTIVES First, to assess palliative care education, practice, and perceived competence among adult ICU nurses in Egypt. Second, to explore factors related to palliative care nursing practice and perceived competence. Third, to assess the construct and criterion validities of the PEOL Care Index. DESIGN A cross-sectional survey. METHODS Nurse managers and staff nurses in 33 adult ICUs completed self-administered questionnaires. The questionnaires assessed nurses' palliative care practice and perceived competence. A multilevel regression analysis was used to determine the best predictors of palliative care practice and perceived competence. Theory evidence construct validity and predictive criterion validity of the PEOL Care Index were examined. RESULTS Thirty-three nurse managers and 403 staff nurses participated in the study-response rate = 100% and 72.5%, respectively. On a 0-100 scale, the mean scores of undergraduate education, practice, and perceived competence were 54.0 ± 18.7, 49.7 ± 18.1, and 54.5 ± 17.0, respectively. Palliative care practice was significantly related to receiving in-service training on palliative care or end-of-life care (regression coefficients: 3.39), higher job satisfaction (0.97), and higher organizational support (1.85). Palliative care perceived competence was significantly related to older nurses' age (0.20), higher job satisfaction (0.97), and higher palliative care undergraduate education (0.63). CONCLUSIONS Palliative care education, practice, and perceived competence among adult ICU nurses in Egypt are inadequate, especially in terms of spiritual and cultural care. The PEOL Care Index is construct and criterion valid. RELEVANCE TO CLINICAL PRACTICE Palliative care education should begin in nursing schools and extend through clinical in-services. Guidelines should be developed to maximize staff collaboration and the utilization of chaplains in ICUs.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan.,Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan
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Ganz FD, Ben Nun M, Raanan O. Introducing palliative care into the intensive care unit: An interventional study. Heart Lung 2020; 49:915-921. [PMID: 32723616 DOI: 10.1016/j.hrtlng.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Intensive Care Unit (ICU) deaths include patient and family suffering. While there is a need to include palliative care in the ICU, such care is often unavailable. OBJECTIVES To determine whether a course in ICU Palliative Care was associated with changes in participants' palliative care knowledge, attitudes and practices. METHODS Four cohorts of a national Israeli course in ICU palliative care (N = 122) were followed. Data were collected on the first and last day of a six-month course and 2-5 years later. RESULTS Statistically significant differences were found in palliative care attitudes and practices, with knowledge levels and quality of death and dying stable after course completion. Participants reported obtaining knowledge and skills necessary to introduce palliative care but were thwarted by organizational barriers. CONCLUSIONS The course was successful in building participants capacity to provide palliative care however; barriers made introduction of palliative care into the ICU difficult.
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Affiliation(s)
- Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Kiryat Hadassah, PO Box 12000, Jerusalem 91120, Israel and Jerusalem College of Technology, Jerusalem, Israel.
| | - Maureen Ben Nun
- Belinson Medical Center, Surgical Intensive Care Unit, Petach Tikva, Israel.
| | - Ofra Raanan
- Sheba Medical Center, School of Nursing, Tel Hashomer, Israel.
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Ozga D, Woźniak K, Gurowiec PJ. Difficulties Perceived by ICU Nurses Providing End-of-Life Care: A Qualitative Study. Glob Adv Health Med 2020; 9:2164956120916176. [PMID: 32284910 PMCID: PMC7139169 DOI: 10.1177/2164956120916176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background With advances in medicine and technology, intensive care units (ICUs) have the capacity to treat patients who would have previously not been expected to survive and would therefore not have been managed in ICUs. When an individual is not expected to survive, doctors and nurses face the modern ethical dilemma of death associated with withdrawal of life-supporting strategies. The aim of this study was to identify difficulties perceived by ICU nurses providing end-of-life care (EOLC) in Poland. Methods The qualitative study was designed to investigate the difficulties, and the related barriers, to EOLC provided in ICUs in Poland. We conducted individual telephone interviews with ICU nurses from across Poland. Results The main issues raised during the interviews included (1) barriers attributable to the hospital, (2) barriers related to the patient's family, and (3) barriers related to the ICU personnel providing direct EOLC. The interviewed nurses considered the lack of support from managers to be the main barrier. We found that ICU nurses in Poland dealt with end-of-life aspects that were emotionally and psychologically taxing. In addition, they lacked specialized training in this area, especially with regard to family care and care provision. Conclusions A pressing need exists to improve facilities and make equipment ensuring a desirable standard of care more available. Specialized palliative care training programs should be incorporated into compulsory nursing curricula for ICU nurses.
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Affiliation(s)
- Dorota Ozga
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Rzeszow, Poland
| | - Krystyna Woźniak
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Rzeszow, Poland
| | - Piotr Jerzy Gurowiec
- Faculty of Medical Sciences, Public Higher Medical Professional School in Opole, Opole, Poland
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Ganz FD. Improving Family Intensive Care Unit Experiences at the End of Life: Barriers and Facilitators. Crit Care Nurse 2020; 39:52-58. [PMID: 31154331 DOI: 10.4037/ccn2019721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Experiencing the end of life of a family member in the intensive care unit is clearly difficult. An important role of critical care nurses is to help family members through this challenging period. This article highlights a few clinically significant barriers and facilitators related to improving family experiences at the patient's end of life that have received less attention in the literature thus far. Facilitators include specific aspects of communication, the nurse's role as the coordinator of care, bereavement care, promoting a "good death," and caring for health care providers. Barriers include medical uncertainty and differences in values and culture.
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Affiliation(s)
- Freda DeKeyser Ganz
- Freda DeKeyser Ganz is Department Chair, Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
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End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content-informing practice. Aust Crit Care 2019; 33:181-186. [PMID: 31182250 DOI: 10.1016/j.aucc.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/31/2019] [Accepted: 04/13/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training. OBJECTIVES The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia. METHODS Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen individuals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained. RESULTS Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content. CONCLUSIONS This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units.
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Exploring nurses’ end-of-life care for dying patients in the ICU using focus group interviews. Intensive Crit Care Nurs 2019; 52:3-8. [DOI: 10.1016/j.iccn.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/19/2022]
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Brooks LA, Manias E, Nicholson P. Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Aust Crit Care 2017; 30:161-166. [DOI: 10.1016/j.aucc.2016.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022] Open
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Bloomer MJ, Endacott R, Ranse K, Coombs MA. Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand. J Clin Nurs 2016; 26:690-697. [DOI: 10.1111/jocn.13585] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research; Deakin University; Geelong Vic. Australia
| | - Ruth Endacott
- Plymouth University; Plymouth UK
- School of Nursing and Midwifery; Monash University; Frankston Vic. Australia
| | - Kristen Ranse
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - Maureen A Coombs
- Graduate School of Nursing Midwifery and Health; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
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Ranse K, Bloomer M, Coombs M, Endacott R. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses. Aust Crit Care 2016; 29:210-216. [DOI: 10.1016/j.aucc.2016.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/03/2016] [Accepted: 08/26/2016] [Indexed: 11/27/2022] Open
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