The neuroscience ICU nurse's perceptions about end-of-life care

Moral distress in nurse leaders-A scoping review of the literature

Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles-2 quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures-the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress.

Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses

Moral sensitivity helps individuals resolve moral dilemmas as a precursor to moral decision-making. Intensive care unit (ICU) nurses are at high risk for encountering moral dilemmas and should have the moral sensitivity to recognize moral issues. The activities of ICU nurses in moral decision-making are guided by moral sensitivity but are also based on emotional intelligence (EI). EI, be recognized as an integral part of moral sensitivity with long-standing theoretical foundations. It is necessary to explicate the true role of EI in moral sensitivity through empirical research. To measure the level of moral sensitivity of ICU nurses and determine the relationship between moral sensitivity and EI. We recruited 467 ICU nurses of ten hospitals from March to June 2021 in Hunan Province, China for a cross-sectional questionnaire survey. The moral sensitivity and EI were measured using the Moral Sensitivity Questionnaire-Revised Version into Chinese (MSQ-R-CV) and the Wong and Law Emotional Intelligence Scale-Version into Chinese (WLEIS-C). A self-report questionnaire covered sociodemographic characteristics. The average moral sensitivity score of ICU nurses was 39.41 ± 7.21. The average EI score was significantly positively correlated with the moral sensitivity score (p < 0.001). This study demonstrated that the moral sensitivities of ICU nurses were at medium levels. EI of ICU nurses can indeed affect their moral sensitivity, and the impact of each element of EI should be clarified for practical application.

The differences in nurses' willingness to discuss palliative care with patients and their family members

BACKGROUND

This study aimed to evaluate the differences in nurses' willingness to discuss palliative care with terminally ill patients and their family members.

METHODS

The participants were randomly recruited from registered staff nurses ≥20 years of age who were responsible for clinical inpatient care in a tertiary hospital in northern Taiwan. A semi-structured questionnaire was administered to evaluate nurses' experiences of discussing do-not-resuscitate (DNR) decisions and their willingness to discuss palliative care with terminal patients and their family members. The differences in nurses' experiences regarding DNR and willingness to discuss palliative care with terminally ill patients and their family members were compared using the Chi-square test. Logistic regressions were used to analyze factors associated with nurses' willingness to discuss palliative care with patients and their families.

RESULTS

More participants had experienced initiating discussions about DNR with patients' families than with patients (72.2% vs 61.9%, p < 0.001). Unadjusted logistic regression analysis showed that the experiences of actively initiating DNR discussions with patients were a significant factor associated with palliative care discussion with patients (odds ratio [OR] = 2.91, 95% confidence interval [CI]: 1.09-7.79). On the other hand, the experiences of actively initiating DNR discussions with patients and with patients' families were significant factors associated with palliative care discussion with patients' families (OR = 3.84, 95% CI: 1.22-12.06 and OR = 3.60, 95% CI: 1.19-10.90, respectively). After adjusting for covariates, no significant factors were found to be independently associated with nurses' willingness to discuss palliative care with patients and their family members.

CONCLUSION

There are significant differences in nurses' willingness to discuss palliative care with patients and their family members. Further research is needed to evaluate factors associated with nurses' willingness to discuss palliative care with patients and their families to facilitate these discussions and protect patients' autonomy.

The Nurse as an Information Broker for Children with Terminal Illness: A Qualitative Study

Background:

Providing care for children with a terminal illness is a great challenge for nurses and might be very complex. Several roles can be performed while providing nursing care.

Objective:

The aim of this study was to identify the roles of nurses in providing nursing care to children with terminal illness and explore the nurse's perspective on how they perform their role in caring for children with terminal illness.

Methods:

This research was conducted qualitatively with a content analysis approach. In-depth interviews with 8 nurses and focus group discussion with 7 nurses were the data collection methods used in this study. The sampling technique in this research is purposive sampling with inclusion criteria for nurses who were willing to participate in this research with a minimum education of diploma degree in nursing, and having at least 3 years of working experience in the pediatric ward.

Results:

Based on the nurses’ perspectives, their role as a communicator, counselor, collaborator, advocator, educator, and also as care provider make them an information broker for children with terminal illnesses and their families.

Conclusion:

In conclusion, while performing the roles, nurses must have good communication skills and knowledge related to the condition of the child as well as the ability to work with other healthcare teams with the purpose of providing holistic and comprehensive care for children with a terminal illness.

Management of the Patient with Malignant Hemispheric Stroke

Malignant hemispheric stroke occurs in 10% of ischemic strokes and has one of the highest mortality and morbidity rates. This stroke, also known as malignant middle cerebral artery stroke, may cause ischemia to an entire hemisphere causing edema, herniation, and death. A collaborative interdisciplinary team approach is needed to manage these complex stroke patients. The nurse plays a vital role in bedside management and support of the patient and family through this complex course of care. This article discusses malignant middle cerebral artery stroke pathophysiology, techniques to predict patients at risk for herniation, collaborative care strategies, and nursing care.

Registered nurses' provision of end-of-life care to hospitalised adults: A mixed studies review

OBJECTIVES

To describe, critically appraise and synthesise research regarding nurses' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives.

DESIGN

Mixed studies review.

DATA SOURCES

MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching.

REVIEW METHODS

Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically.

RESULTS

Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care.

CONCLUSIONS

Registered Nurses have aligned their end-of-life care with practice with the profession's expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.

Intensive care unit nurses' perceptions of the obstacles to the end of life care in Saudi Arabia

Objectives:

To explore nurses’ perceptions of obstacles to the provision of end of life care (EoLC) in the intensive care unit (ICU) in Saudi Arabia.

Methods:

A modified version of a questionnaire developed by Beckstrand and Kirchhoff was administered in one setting at Riyadh, Saudi Arabia between March and April 2015.

Results:

A total of 87 questionnaires were returned from 140 potential respondents, representing a 62% response rate. Findings highlighted concerns associated with patient’s family, physicians who differed in opinions, cultural differences and language barriers. The nurses also noted issues in awareness and involvement in education about EoLC and futile care.

Conclusion:

Findings highlight a number of key obstacles to the provision of quality EoLC in ICUs for nurses. Further development of both EoLC guidelines and education about EoLC in ICUs is recommended.

Predictors of Moral Distress in a US Sample of Critical Care Nurses

BACKGROUND

Moral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited.

OBJECTIVE

To explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses.

METHODS

Critical care nurses experienced in working with adults (> 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses' e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables.

RESULTS

Of a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant's age were statistically significant predictors of moral distress in this sample.

CONCLUSIONS

Modifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.

The role of emotion in clinical decision making: an integrative literature review

BACKGROUND

Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.

METHODS

A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.

RESULTS

Twenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour - responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.

CONCLUSIONS

Clinicians' experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.

Compassionate communication in acute healthcare: establishing the face and content validity of a questionnaire

The National Health Service is committed to measuring the quality of nursing care through adopting a number of indicators which are not nationally standardised. Compassionate communication is one indicator, but it is unclear how this is assessed or demonstrated in practice. This is primarily a methodological paper which aims to establish the face and content validity of a questionnaire to measure nurses’ non-verbal methods of compassionate communication with patients in acute healthcare. An existing questionnaire was amended to meet the study’s requirements. A ‘lay expert sample’ was used to rate the face validity and a ‘research expert sample’ to rate the content validity of the instrument. Modification of one response and adding instructions on how to complete the questionnaire meant that Version 2 potentially has high face validity. The questionnaire demonstrated excellent content validity (Scale-Content Validity Index = 0.85). Recommendations include pilot testing to further investigate the construct of non-verbal compassionate communication in an acute healthcare context. This research can be used to inform the measurement of compassionate communication and promote standardisation nationally.

Limitation of therapeutic effort experienced by intensive care nurses

Background:

Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level.

Objectives:

To describe the experience of intensive care nurses practicing limitation of therapeutic effort.

Method:

A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ personal letters. The Giorgi proposal for data analysis was used on the data.

Ethical considerations:

This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality.

Results:

In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort.

Conclusion:

Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same.

End-of-life care provision: experiences of intensive care nurses in Iraq

BACKGROUND

Nurses play a key role in providing care for the critically ill in the intensive care unit (ICU). The physical, psychological, emotional and spiritual intimate care given by Kurdish nurses allows them to develop a therapeutic relationship with terminally ill patients in the ICU.

AIMS

This study sought to explore the meaning of caring for terminally ill patients from the perspective of Kurdish ICU nurses.

DESIGN

Van Manen's (1990) hermeneutic phenomenological design was adopted.

METHOD

The data were collected through in-depth semi-structured interviews with a purposive sample of 10 nurses working in ICUs. Interviews were transcribed and finally analysed according to Van Manen's method.

RESULTS

Four major themes including emotional labour, death as a positive dimension, optimistic rather than futile care and working within constraints emerged.

CONCLUSIONS

Kurdish nurses in their caring encounters with terminally ill patients experienced a range of feelings from emotional strain to being optimistic while working within limited resources in the ICU. Further research is needed to explore the experiences of nurses with other cultures of caring for terminally ill patients in ICUs.

RELEVANCE TO PRACTICE

End-of-life care in ICU is emotionally challenging, therefore, nurses in this setting require psychological and spiritual support to ensure optimal care provision.

Factors influencing the provision of end-of-life care in critical care settings: development and testing of a survey instrument

AIM

To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses.

BACKGROUND

Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses.

DESIGN

A cross-sectional survey of critical care nurses.

METHOD

An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics.

RESULTS

Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting.

CONCLUSION

This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.

Self-described nursing roles experienced during care of dying patients and their families: a phenomenological study

BACKGROUND

Critical care nurses frequently care for dying patients and their families. Little is known about the roles experienced and perceived by bedside nurses as they care for dying patients and their families.

OBJECTIVES

The purpose of this study was to understand the experiences of critical care nurses and to understand their perceptions of activities and roles that they performed while caring for patients and families during the transition from aggressive life-saving care to palliative and end-of-life care.

METHODS

A descriptive, phenomenological study was conducted and a purposive sampling strategy was used to recruit 19 critical care nurses with experience caring for dying patients and their families. Individual interviews were conducted and audio-recorded. Coliazzi's method of data analysis was utilised to inductively determine themes, clusters and categories. Data saturation was achieved and methodological rigour was established.

RESULTS

Categories that evolved from the data included educating the family, advocating for the patient, encouraging and supporting family presence, managing symptoms, protecting families and creating positive memories and family support. Participants also identified the importance of teaching and mentoring novice clinicians.

CONCLUSIONS

The results of this study have important implications for clinical practice, education and research for optimal preparation in providing end-of-life care.

Revealing the Meaning of the Mourning Process of Pediatric Nurses Facing the Death of Cancer Patients

Objetivo: develar el significado del duelo en enfermeras(os) que enfrentaron la muerte de niños con cáncer. La muerte de un niño(a) por cáncer genera un gran impacto en el equipo de enfermería, lo que produce impotencia, frustración y pena, que pueden llegar a causar Burnout. Método: se utilizó la investigación cualitativa fenomenológica basada en Husserl; se recogió la experiencia de diez enfermeras(o) oncológicas(os) pediátricas que enfrentaron la muerte de pacientes con cáncer bajo su cuidado. Los datos se obtuvieron de junio a noviembre del 2011 con entrevistas en profundidad grabadas y transcritas literalmente. El análisis fenomenológico se realizó según el método de Streubert. Resultado: los testimonios entregados develaron tres unidades de significado: las enfermeras vivencian la muerte de un paciente a través del transitar entre su propia forma de enfrentar la muerte y el cuidado profesional que otorgan. Con ello aparece un aprendizaje de vida dado por la comprensión de lo que es trabajar en oncología y los vínculos que establece en este ámbito. Esto permite desarrollar un cuidado con un sello particular. Conclusión: el estudio concluye que las enfermeras experimentan el duelo como un proceso dinámico al que atribuyen sentido a través de la entrega de un cuidado amoroso.

The provision of emotional support to the families of traumatic brain injury patients: perspectives of Finnish nurses

AIMS AND OBJECTIVES

To examine nursing staff's perceptions about how often they provide interventions of emotional support and the level of competence needed on neurosurgical wards to support traumatic brain injury patients' family members.

BACKGROUND

Traumatic brain injury in one individual affects the health of their whole family. Studying the emotional support provided by nursing staff is important because such support is crucial for the family members of a traumatic brain injury patient during the acute phase of treatment. Members of the nursing staff provide emotional support to family members by consoling them; this alleviates insecurity, anxiety, hopelessness and depression.

DESIGN

A structured self-reported questionnaire presented to 172 nurses working on neurosurgical wards. The response rate was 67% (n = 115).

METHODS

Descriptive statistics were used to determine how often nurses provided emotional support to the traumatic brain injury patients family members and one-way anova to examine the relationships between the background variables and the respondents' evaluations of how often they gave emotional support to brain injury patients' family members.

RESULTS

Thirty-seven percentage of nurses stated that they always took account of family members' individuality and 65% that they were always respectful. All registered nurses and staff members with long work experience (21 years or more) on a neurosurgical ward reported that they took family members' feelings of anger and guilt into consideration slightly more often than other nursing staff did. Most nurses considered these skills to represent basic competencies.

CONCLUSION

Further service training on dealing with difficult emotions of traumatic brain injury patients' family members could help nurses to face these situations. Both education and work experience affected the frequency at which nursing staff provided emotional support to traumatic brain injury patients' family members.

RELEVANCE TO CLINICAL PRACTICE

The results are relevant for example when planning specialised studies or in-service training for neuro-nurses, as well as when selecting the subjects to be addressed during the orientation of a new staff member. In addition, the results should help nursing staff to understand their role in the emotional support of family members.

Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship

Aims

To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings.

Background

While primary research on nurses' experiences has been reported, it has not been previously synthesized.

Design

Meta-ethnography.

Data sources

Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.

Review methods

Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method.

Results

Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.

Conclusion

The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.

Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study

BACKGROUND

A challenge for intensive care nurses is providing the best possible care to patients in an end-of-life stage. The fact that some patients will die despite the efforts of the health care team can affect the psychological state of the nurses and families. Lack of attention to such an issue can bring about unpleasant consequences for both patients and nurses.

AIM

Using a qualitative design, the aim is this article explores the experiences of intensive care nurses providing care for end-of-life patients.

METHODS

The data were collected through in-depth interviews with a purposive sample of 10 nurses working at intensive care units (ICUs). Interviews were transcribed and finally analysed through the conventional content analysis.

FINDINGS

Two themes emerged out of the experience of providing care to the end-of-life patients. The findings revealed that for Iranian intensive care nurses providing care to such patients was accompanied by emotional burden and values and beliefs.

CONCLUSION

The results of the study have increased the current knowledge over the experience of providing care to end-of-life patients at ICUs. It also has revealed the need for providing the nurses with psychological support, accommodating the possibility for offering a complete care, attending to and managing the conditions of the patient and their families and engaging nurses in decision making about end-of-life patients.

RELEVANCE TO PRACTICE

Managers ought to provide specialized units for providing care to end-of-life patients. Nurses working on these units will require emotional support.

This article has been retracted and is available online only: Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study

RETRACTION: The following article from Nursing in Critical Care, 'Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study' by Sina Valiee, Reza Negarandeh and Nahid Dehghan Nayeri, published online on 9 May 2012 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors and the journal Editors. The retraction has been agreed due to errors in the manuscript handling process which meant that an early version of the article was published that did not include all the amendments made as part of the peer review process. John Albarran and Julie Scholes Editors Nursing in Critical Care REFERENCE Valiee, S., Negarandeh, R. and Dehghan Nayeri, N. (2012), Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study. Nursing in Critical Care. doi: 10.1111/j.1478-5153.2012.00505.x.

Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature

The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research.

The critical care nurse's role in end-of-life care: issues and challenges

AIM

The purpose of this article is to discuss the challenges critical care nurses face when looking after patients needing End-of-Life (EoL) care in critical care environments.

BACKGROUND

Critical care nurses frequently provide care to patients who fail to respond to treatments offered to support and prolong life. The dying phase for individuals in critical care settings, commonly after withholding/withdrawing treatment, is very short posing great demands on critical care nurses to provide physical and emotional support to both patients and their families. Despite the existence of recognized care planning frameworks that may help nurses in providing EoL care, these are not used by all units and many nurses rely on experience to inform practice. A number of aspects such as communication, patient/family-centred decision-making, continuity of care, emotional/spiritual support and support for health professionals have been indicated as contributing factors towards the provision of effective EoL care. These are considered from the perspective of critical care nursing.

CONCLUSION

Skills development in key aspects of care provision may improve the provision of EoL care for critical care patients and their families.

RELEVANCE TO CLINICAL PRACTICE

Critical care nurses have an essential role in the provision of effective EoL care; however, this dimension of their role needs further exploration. It is noted that educational opportunities need to be provided for critical care nurses to increase the knowledge on planning and delivering EoL care. To inform this evaluation of current EoL care provision in critical care is necessary to address a knowledge deficit of the needs of nurses who seek to support patients and their families at a critical time.

The cardiovascular intensive care unit nurse's experience with end-of-life care: a qualitative descriptive study

PURPOSE

Nurses in the cardiovascular intensive care unit (CVICU) informally expressed moral angst when caring for patients who are approaching the end of life. The purpose of this study was to better understand CVICU nurses' perceptions about their roles and responsibilities in the decision-making process about change in intensity of care and end-of-life care for patients within the CVICU setting.

PARTICIPANTS AND METHODS

Nineteen nurses from one CVICU consented to being interviewed individually regarding their experiences caring for patients approaching the end of life, and specifically regarding the initiation of a change in code status. Investigators used a qualitative descriptive approach to collect and analyse the data. Transcript data were analysed and as concepts emerged they were compared with those from earlier interviews to establish similarities and differences. Investigators reached consensus about the major themes.

FINDINGS

Analysis revealed four major themes: (a) exhausting patient treatments; (b) promoting family presence; (c) acknowledging physician authority; and (d) walking a fine line.

CONCLUSIONS

This research adds to the limited body of knowledge concerning CVICU nurses' experiences with end-of-life care. Results of this study provide a basis for putting in place support systems for CVICU nurses.

Barriers to intensive care unit nurses providing terminal care: an integrated literature review

Traditional goals of critical care center on curative interventions for patients with acute illness. However, death is a common occurrence in critical care, which means a shift from curative care to comfort care. For a number of reasons, the transition in care is often not a smooth one. An integrated literature review was completed on 22 studies related to provision of terminal care. These 13 quantitative studies along with 9 qualitative studies identified specific barriers to effective terminal care provision including (a) lack of involvement in the plan of care and comfort, (b) disagreement among physicians and other healthcare team members, (c) inadequacy of pain relief, (d) unrealistic expectations of families, (e) nurses' difficulty coping, (f) lack of experience and education, (g) staffing levels, and (h) environmental circumstances. Recommendations address strategies to improve terminal care and suggest future research needed.