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Pascual-Fernández MC. [Providing information to patient's families on the end of life process in the intensive care unit. Nursing evaluation]. ENFERMERIA CLINICA 2014; 24:168-74. [PMID: 24530045 DOI: 10.1016/j.enfcli.2013.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/04/2013] [Accepted: 09/07/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Informing is a process that includes many aspects and when it involves a family member at the end of life it becomes a complicated matter, not only for giving the information, but also for the mood of family members. Thus, the information should be adapted to the language and education of the patient and family. That information must be proper and suitable to the moment. OBJECTIVE To describe the aspects of information offered to relatives of patients in the end of life process in Intensive Care Units (ICU), and to determine the nursing evaluation in this process. To evaluate the professionals' attitude on this subject. MATERIAL AND METHOD An observational study conducted on nurses in pediatric and adult ICU nurses of a large public health hospital complexes in the city of Madrid. The data was collected using a questionnaire on the evaluation of care of children who died in pediatric ICU. RESULTS The majority of the nurses, 71% (159), said that the information was given in a place alone with the doctor. More than half (52.4%, 118) considered that the information was sufficient/insufficient depending on the day. Significant differences were found as regards the behavior of the staff at the time of a death in (P<.01), with pediatric ICU professionals being more empathetic. CONCLUSIONS ICU nurses believe that the information is appropriate for the prognosis and adapted to the patient situation. They also consider the place where the information is given and the attitude of the professionals in the end of life process are adequate.
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Affiliation(s)
- M Cristina Pascual-Fernández
- Supervisora de Urgencia Infantil, Hospital General Universitario Gregorio Marañón, Diplomado Universitario de Enfermería, Máster de Enfermería en Cuidados Críticos, Universidad Rey Juan Carlos, Doctora por la Universidad Rey Juan Carlos, Madrid, España.
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Obstacles and helpful behaviors in providing end-of-life care to dying patients in intensive care units. Dimens Crit Care Nurs 2013; 32:99-106. [PMID: 23388871 DOI: 10.1097/dcc.0b013e3182808429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Death can be difficult to accept, unimaginable, and unexpected. Critical care nurses are directly involved with patients and their families, and their experience can identify the best practices for end-of-life care. The purpose of this descriptive study was to identify the relative importance of helpful behaviors and obstacles that affect caring for dying patients and families in both adult and pediatric intensive care units as perceived by critical care nurses. The results show that for end-of-life care, nurses most strongly value factors that focus on the well-being of the family, and similar opinions were held by nurses from both adult and pediatric intensive care units.
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Attia AK, Abd-Elaziz WW, Kandeel NA. Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care. Am J Hosp Palliat Care 2012; 30:297-304. [DOI: 10.1177/1049909112450067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: To investigate critical care nurses' perceptions of barriers and supportive behaviors in providing end of life (EOL) care to dying patients and their families. Methods: The study involved a convenient sample of 70 nurses who were involved in caring for critically ill patients. Data were collected using a structured interview sheet. Results: Barriers to providing EOL care were related to intensive care environment, family members, nurses' knowledge and skills, physicians' attitudes and treatment policy. Possible help to providing EOL care involved nurses' support to each other, patient and family-centered care, and families' support. Conclusions: There is a need to allow the family unlimited access to the dying patient, involve them in patient care and provide them with a private place for grieving.
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Affiliation(s)
- Amal Kadry Attia
- Faculty of Nursing, Critical Care and Emergency Nursing, University of Alexandria, Alexandria, Egypt
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Kaldjian LC, Curtis AE, Shinkunas LA, Cannon KT. Review Article: Goals of Care Toward the End of Life: A Structured Literature Review. Am J Hosp Palliat Care 2008; 25:501-11. [DOI: 10.1177/1049909108328256] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Goals of care are often mentioned as an important component of end-of-life discussions, but there are diverse assessments regarding the type and number of goals that should be considered. To address this lack of consensus, we searched MEDLINE (1967—2007) for relevant articles and identified the number, phrasing, and type of goals they addressed. An iterative process of categorization resulted in a list of 6 practical, comprehensive goals: (1) be cured, (2) live longer, (3) improve or maintain function/quality of life/ independence, (4) be comfortable, (5) achieve life goals, and (6) provide support for family/caregiver. These goals can be used to articulate goal-oriented frameworks to guide decision making toward the end of life and thereby harmonize patients' treatment choices with their values and medical conditions.
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Affiliation(s)
- Lauris C. Kaldjian
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center,
| | - Ann E. Curtis
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
| | - Laura A. Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine
| | - Katrina T. Cannon
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
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Van Horn JM. A Case Study of Right Ventricular Rupture in an Elderly Victim of Motor Vehicle Crash. J Trauma Nurs 2007; 14:136-43. [DOI: 10.1097/01.jtn.0000292114.80647.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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del Barrio Linares M, Jimeno San Martín L, López Alfaro P, Ezenarro Muruamendiaraz A, Margall Coscojuela MA, Asiain Erro MC. [Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses]. ENFERMERIA INTENSIVA 2007; 18:3-14. [PMID: 17397608 DOI: 10.1016/s1130-2399(07)74384-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. AIMS To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. METHOD A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand and Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. FINDINGS Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x = 4.46); whereas ethics committee constantly involved in the unit as the least supportive one (x = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant differences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. CONCLUSIONS Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority.
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Affiliation(s)
- M del Barrio Linares
- Unidad de Cuidados Intensivos, Clínica Universitaria, Universidad de Navarra, Pamplona, España.
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Rodriguez KL, Barnato AE, Arnold RM. Perceptions and utilization of palliative care services in acute care hospitals. J Palliat Med 2007; 10:99-110. [PMID: 17298258 PMCID: PMC4070316 DOI: 10.1089/jpm.2006.0155] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To understand perceptions of palliative care in acute care hospitals and identify barriers to earlier use of palliative care in the illness trajectory. METHODS In Pennsylvania hospitals, we completed semistructured interviews with 131 providers involved in decision making or discharge planning. We used qualitative methods to analyze transcripts. RESULTS Most interviewees characterized palliative care as end-of-life or hospice care that is initiated after the decision to limit curative treatment is made. Few recognized the role of palliative care in managing symptoms and addressing psychosocial needs of patients with chronic illnesses other than cancer. Interviewees viewed earlier and broader palliative care consultations less in terms of clinical benefits than in terms of cost savings accrued from shorter terminal hospitalizations. In general, they thought nurses were most likely to facilitate these consultations, surgeons were most likely to resist them, and intensive care specialists were most likely to view palliative care as within their own scope of practice. Suggestions for broadening palliative care utilization included providing education and training, improving financial reimbursement and sustainability for palliative care, and fostering a hospital culture that turns to high-intensity care only if it meets individual needs and goals of chronically ill patients. CONCLUSIONS In acute care hospitals, palliative care is primarily perceived as a means to limit life-sustaining treatment or allow death. Moving consultation earlier in the hospitalization of "dying" patients is a greater preoccupation than increasing palliative service use earlier in the illness trajectory. Any move short of far upstream will require palliative care specialists to market benefits to patients and referring providers in ways that emphasize compatibility with parallel treatment plans and do not threaten provider autonomy.
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Affiliation(s)
- Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
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Abstract
PURPOSE/OBJECTIVES To explore the topic of moral distress in nurses related to witnessing futile care. DATA SOURCES Literature related to moral distress and futility; analysis of narratives written by 108 nurses attending one of two national continuing education courses on end-of-life care regarding their experiences in the area. DATA SYNTHESIS Nurses were invited to share a clinical situation in which they experienced moral distress related to a patient receiving care that they considered futile. Nurses described clinical situations across care settings, with the most common conflict being that aggressive care denies palliative care. Conflicts regarding code status, life support, and nutrition also were common. Patients with cancer were involved quite often, second only to geriatric patients and patients with dementia. The instances created strong emotional responses from nurses, including feeling the need for patient advocacy and that futile care was violent and cruel. Important spiritual and religious factors were cited as influencing the clinical experiences. CONCLUSIONS Instances of futile care evoke strong emotional responses from nurses, and nurses require support in dealing with their distress. IMPLICATIONS FOR NURSING The ethical dilemma of futile care is complex. Additional research and support are needed for patients, families, and nurses.
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Affiliation(s)
- Betty R Ferrell
- Department of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA.
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Scherer Y, Jezewski MA, Graves B, Wu YWB, Bu X. Advance Directives and End-of-Life Decision Making. Crit Care Nurse 2006. [DOI: 10.4037/ccn2006.26.4.30] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yvonne Scherer
- Yvonne K. Scherer is an associate professor in the School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY. She is area director of the Adult Health Graduate Program, which includes specialties in adult, critical care, and geriatric nurse practitioner and clinical nurse specialist programs
| | - Mary Ann Jezewski
- Mary Ann Jezewski is an associate professor in the School of Nursing, University at Buffalo, The State University of New York. She is the director of the Center for Nursing Research and has been the recipient of research grants to study advance directives and end-of-life decision making
| | - Brian Graves
- Brian T. Graves is a clinical assistant professor in the School of Nursing, University of Rochester, Rochester, New York. He is responsible for coordinating the acute care nurse practitioner specialty core courses
| | - Yow-Wu Bill Wu
- Yow-Wu Bill Wu is an associate professor in the School of Nursing, University at Buffalo, The State University of New York. One of his roles is to serve as a statistical consultant to faculty and students
| | - Xiaoyan Bu
- Xiaoyan Bu is an assistant professor in the School of Nursing at the University of South Carolina, Columbia, SC. She teaches pediatric content
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Fischer SM, Gozansky WS, Sauaia A, Min SJ, Kutner JS, Kramer A. A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria. J Pain Symptom Manage 2006; 31:285-92. [PMID: 16632076 DOI: 10.1016/j.jpainsymman.2005.08.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2005] [Indexed: 11/19/2022]
Abstract
Palliative care is often offered only late in the course of disease after curative measures have been exhausted. To provide timelier symptom management, advance care planning, and spiritual support, we propose a simple set of prognostic criteria that identifies persons near the end of life. In this retrospective cohort study of five prognostic indicators, the CARING criteria (Cancer, Admissions > or = 2, Residence in a nursing home, Intensive care unit admit with multiorgan failure, > or = 2 Noncancer hospice Guidelines), logistic regression modeling demonstrated high sensitivity and specificity for mortality at 1 year (c statistic > 0.8). A simple set of clinically relevant criteria applied at the time of hospital admission can identify seriously ill persons who have a high likelihood of death in 1 year and, therefore, may benefit the most from incorporating palliative measures into the plan of care.
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Affiliation(s)
- Stacy M Fischer
- Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA.
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Abstract
There is a critical mismatch between available organs for transplant and acutely or critically ill patients with end-stage organ disease. Patients who may benefit from organ transplantation far outnumber available organs. The causes for this imbalance are multiple. One cause is family refusal to donate. A second cause is nonrecognition or delay in determination of brain death. A third cause is donor loss due to profound cardiopulmonary and metabolic instability consequent to brain-stem herniation and brain death. Family refusal may be addressed by education, public awareness, as well as close attention to social, cultural and ethical issues, and optimal communication with donor families. Brain death may be consequent to traumatic brain injury, ischemic versus hemorrhagic stroke, as well as massive cerebral anoxia/ischemic following cardiac arrest. Nonrecognition or delay in brain death determination may be addressed by clinician education and frequent clinical assessment to detect early stages of brain-stem herniation refractory to aggressive measures for control of intracranial pressure. Donor loss due to profound cardiopulmonary and metabolic instability may be addressed by aggressive, mechanism-based treatment for clinical instability based on affected body system, as well as measures to support metabolic activity at the cellular and tissue level in the brain-dead organ donor. This article explores cerebral physiology related to impending brain death and catastrophic intracranial pressure elevations. In addition, physiologic consequences of brain death are correlated with affected body systems and mechanism-based therapies to support organ function pending transplantation. Ethical/legal issues are explored as related to patient autonomy and optimal family outcomes. Effective family communication, astute clinical assessment, and optimal clinical management of the organ donor are illustrated using a case study approach, highlighting the role of the advanced practice nurse in donor management.
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Affiliation(s)
- Richard Arbour
- Medical Intensive Care Unit, Albert Einstein Healthcare Network, Philadelphia, PA 19141-3211, USA.
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Beckstrand RL, Kirchhoff KT. Providing End-of-Life Care to Patients: Critical Care Nurses’ Perceived Obstacles and Supportive Behaviors. Am J Crit Care 2005. [DOI: 10.4037/ajcc2005.14.5.395] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited.
• Objective To measure critical care nurses’ perceptions of the intensity and frequency of occurrence of (1) obstacles to providing end-of-life care and (2) supportive behaviors that help in providing end-of-life care in the intensive care unit.
• Methods An experimental, posttest-only, control-group design was used. A national, geographically dispersed, random sample of members of the American Association of Critical-Care Nurses was surveyed.
• Results The response rate was 61.3%, 864 usable responses from 1409 eligible respondents. The highest scoring obstacles were frequent telephone calls from patients’ family members for information, patients’ families who did not understand the term lifesaving measures, and physicians disagreeing about the direction of a dying patient’s care. The highest scoring supportive behaviors were allowing patients’ family members adequate time alone with patients after death, providing peaceful and dignified bedside scenes after death, and teaching patients’ families how to act around a dying patient.
• Conclusions The biggest obstacles to appropriate end-of-life care in the intensive care unit are behaviors of patients’ families that remove nurses from caring for patients, behaviors that prolong patients’ suffering or cause patients pain, and physicians’ disagreement about the plan of care.
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Affiliation(s)
- Renea L. Beckstrand
- Brigham Young University, Provo, Utah (rlb), and University of Wisconsin, Madison, Wis (ktk)
| | - Karin T. Kirchhoff
- Brigham Young University, Provo, Utah (rlb), and University of Wisconsin, Madison, Wis (ktk)
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