End-of-Life Care Obstacles and Facilitators in the Critical Care Units of a Community Hospital:

Social Context, Self-Efficacy, and Patient-Centered Service Behavior of Medical Professionals: The Moderating Role of Achievement Motivation

Patient-centered services are high-value, high-quality medical services that can improve patient satisfaction and safety. However, little is known about their driving mechanisms. This study examined whether external (social context) and internal (self-efficacy) motivation affects medical professionals' patient-centered service behavior, and explored the moderating role of medical professionals' achievement motivation. A cross-sectional survey was conducted with medical professionals at public hospitals in Hangzhou. Descriptive statistics, hierarchical linear regression analysis, and structural equation modeling were used to analyze the data. The final analysis included 1,612 medical professionals. Results indicated that perceived social context and self-efficacy had direct and positive effects (β = 0.578, β = 0.269) on medical professionals' patient-centered service behavior. Social context also indirectly influenced medical professionals' patient-centered service behavior mediated by self-efficacy (β = 0.149). Additionally, achievement motivation played a moderating role (β = -0.037) between the social context and self-efficacy. From the results it can be deduced that an excellent social environment and strong self-efficacy can promote the patient-centered service motivation of medical professionals. This promoting effect is even more significant under the moderating effect of high achievement motivation. Governments, health administrative departments, and hospital management should use internal and external motivation factors to promote medical professionals' patient-centered service behavior. Along with formulating relevant laws and regulations, efforts should also be made to guide medical professionals to improve their self-efficacy and achievement motivation, thereby encouraging patient-centered medical service behavior.

An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit

AIMS AND OBJECTIVES

To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit.

BACKGROUND

Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce.

DESIGN

An integrative literature review.

REVIEW METHOD

Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework.

RESULTS

In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment.

CONCLUSION

Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing.

RELEVANCE TO CLINICAL PRACTICE

Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.

Nursing Staff's Perception of Barriers in Providing End-of-Life Care to Terminally Ill Pediatric Patients in Southeast Iran

OBJECTIVE

To determine pediatric nurses' perceptions of intensity, frequency occurrence, and magnitude score of selected barriers in providing pediatric end-of-life (EOL) care.

METHOD

A translated modified version of National Survey of critical care Nurses' s Regarding End-of-Life Care questionnaire was used to assess 151 nurses' perceptions of intensity and frequency occurrence of barriers in caring for dying children.

RESULTS

The highest/lowest perceived barriers magnitude scores were "families not accepting poor child prognosis" (5.04) and "continuing to provide advanced treatment to dying child because of financial benefits to the hospital" (2.19).

CONCLUSION

More high perceived barriers by nurses were family-related issues. One of the possible causes of such deficiencies was lack of palliative care (PC) education/PC units in Iran. Thus, developing EOL/PC education may enhance nurses' knowledge/skill to face EOL care challenges.

Critical Care Nurses’ Perception of Barriers and Supportive Behaviors in End-of-Life Care

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.

A comfortable place to say goodbye

No death is easy, but we hope to die peacefully, with our loved ones surrounding us, comforted by each other's presence and the knowledge that the right decision has been made. The nurse's actions in the intensive care unit setting can promote hope for a comfortable place to say goodbye for the patient and his/her loved ones and the nursing staff and physicians. When nurses make the intensive care unit a comfortable place for the dying patients and their loved ones, we also make the patients' deaths comfortable for us. The problems encountered in implementing end-of-life care are explored in this article, as well as strategies to instill hope in families.

Oncology nurses' perceptions about palliative care

PURPOSE/OBJECTIVES

To explore oncology nurses' perceptions about palliative care.

RESEARCH APPROACH

Descriptive study with narrative data analysis.

SETTING

Oncology units in three midwestern hospitals.

PARTICIPANTS

33 actively practicing oncology nurses.

METHODOLOGIC APPROACH

Oncology nurses participated in focus groups that elicited concrete experiences and reflections about palliative care. Researchers identified subtexts by which to sort data, worked inductively in each subtext to identify categories, resorted the text according to the categories, carefully examined the category narratives, and established narrative descriptors that captured the essence of each category. Data matrices were constructed to examine the emerging categories more closely.

MAIN RESEARCH VARIABLE

Oncology nurses' perceptions about palliative care.

FINDINGS

Narratives revealed 14 descriptors about palliative care. Considerable agreement occurred in nurses' descriptions about the nature of palliative care. Divergent viewpoints were evident as nurses described how palliative care intersects with other practice areas. Three descriptors of the healthcare context in which palliative care occurs were identified: limited time for addressing complex palliative care issues, health care's emphasis on prolonging life, and the challenge of coordinating care across disciplines.

CONCLUSIONS

Participants clearly comprehend palliative care goals. However, divergent perspectives about the intersections of palliative care with oncology nursing may limit timely consultation with specialty palliative care teams. The current acute care context poses challenges to implementing palliative care.

INTERPRETATION

Palliative care teams and oncology nurses need to develop partnership models that clearly illustrate how both partners contribute to palliative care across the continuum of oncology care. Furthermore, the partnership models must address barriers that the acute care context poses to quality palliative care.

Workload and patient safety among critical care nurses

Several dimensions of workload experienced by nurses working in ICUs are described in this article, including the physical workload related to patient handling. The effects of workload on various outcomes, such as the health, safety, and quality of working life of nurses, and the safety of care provided by ICU nurses are discussed. A systemic approach to the assessment of workload is proposed that is aimed at identifying the work system factors that contribute to the different facets of workload and the interdependencies among the various dimensions of workload.

Performance obstacles of intensive care nurses

BACKGROUND

The work environment of intensive care nurses may have substantial impact on both nursing outcomes and patient safety. The factors in a nurse's immediate work environment, in the local work context, have not been studied in detail to provide useful, specific information for work redesign efforts to improve nurse's work and patient safety. Performance obstacles are the factors that hinder intensive care nurses' capacity to perform their jobs and that are associated closely with their immediate work environment.

OBJECTIVES

To identify the performance obstacles experienced by intensive care nurses in their work environment.

METHODS

A multisite, cross-sectional study was conducted. Data were collected using a 36-item questionnaire and analyzed using univariate statistical analysis. The frequencies of performance obstacles reported by intensive care nurses were computed.

RESULTS

Nurses (n = 272) from 17 intensive care units (ICUs) of seven hospitals in Wisconsin participated in the study. The most frequently experienced performance obstacles included noisy work environment (46%), distractions from families (42%), hectic (40%) and crowded work environments (37%), delay in getting medications from pharmacy (36%), spending considerable amount of time teaching families (34%), equipment not being available-someone else using it (32%), patient rooms not well-stocked (32%), insufficient workspace for completing paperwork (26%), seeking for supplies (24%) or patients' charts (23%), receiving many phone calls from families (23%), delay in seeing new medical orders (21%), and misplaced equipment (20%).

DISCUSSION

Intensive care nurses experience a variety of performance obstacles in their work environment. Future research should investigate the impact of various performance obstacles on nursing workload, nursing quality of working life, and quality and safety of care, as well as the impact of interventions aimed at redesigning the work system of ICU nurses to remove performance obstacles.