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Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11020164. [PMID: 36673532 PMCID: PMC9859179 DOI: 10.3390/healthcare11020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece. METHODS A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software. RESULTS The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment. CONCLUSIONS The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.
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How nurses’ and physicians’ emotions, psychosocial factors, and professional roles influence the end-of-life decision making process: An interpretive description study. Intensive Crit Care Nurs 2022; 71:103249. [DOI: 10.1016/j.iccn.2022.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
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Lin YH, Lin MH, Chen CK, Yang C, Chuang YT, Shyu CH, Lin HJ, Chen HF, Yang WL, Chen YJ, Chen TJ, Hwang SJ, Chang HT. The differences in nurses' willingness to discuss palliative care with patients and their family members. J Chin Med Assoc 2021; 84:280-284. [PMID: 33433136 DOI: 10.1097/jcma.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
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.
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Affiliation(s)
- Yi-Hsuan Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Che Yang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ya-Ting Chuang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chuen-Huei Shyu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Huei-Jin Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Fang Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Ling Yang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ya-Jyun Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Peker Ş, Yıldırım S, Arıkan HC, Kocatepe V, Ünver V. Effect of Emotional State of Nurses Working in Intensive Care on Their Attitudes Toward Death. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:692-705. [PMID: 31342843 DOI: 10.1177/0030222819863913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to investigate the effect of the emotional state of the nurses working in intensive care unit on their attitudes toward death. The study was conducted with the participation of 100 nurses working in intensive care units between July and December 2017. A positive statistically significant correlation was found between the nurses' status of approaching emotions and subscales of Death Attitude Profile (p < .05). It was observed that there was a positive significant correlation between the emotional avoidance scores and neutral acceptance and approach acceptance (r = .281), escape acceptance (r = .335), and fear of death and death avoidance (r = .490) scores (p < .05).
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Affiliation(s)
- Şevval Peker
- Chemotherapy Unit, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Sinem Yıldırım
- Oncology Service, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | | | - Vildan Kocatepe
- Department of Nursing, School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Vesile Ünver
- Department of Nursing, School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Lomero-Martínez MM, Jiménez-Herrera MF, Bodí-Saera MA, Llaurado-Serra M, Masnou-Burrallo N, Oliver-Juan E, Sandiumenge-Camps A. Comment to «In reply to the question: Are we really playing together in the same team?». ENFERMERIA INTENSIVA 2019; 30:149-150. [PMID: 30691986 DOI: 10.1016/j.enfi.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
Affiliation(s)
- M M Lomero-Martínez
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España
| | - M F Jiménez-Herrera
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España.
| | - M A Bodí-Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, CIBERES, Tarragona, España
| | - M Llaurado-Serra
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | | | - E Oliver-Juan
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Libo-On ILM, Nashwan AJ. Oncology nurses' perceptions of end-of-life care in a tertiary cancer centre in Qatar. Int J Palliat Nurs 2017; 23:66-73. [PMID: 28245161 DOI: 10.12968/ijpn.2017.23.2.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nurses who work in oncology settings may lack the knowledge and skills required for end-of-life (EoL) care. A clear understanding of nurses' perceptions of EoL care is crucial for the successful improvement of care for terminally ill patients with cancer. Although many studies have underlined nurses' perspectives on EoL care, this is the first such study conducted on oncology nurses in Qatar. PURPOSE This study primarily sought to measure nurses' perceptions of EoL care at the National Center for Cancer Care and Research (NCCCR) in Qatar. METHODS A quantitative, cross-sectional, self-reported study. Nurses at the NCCCR reported their perceptions of EoL care using the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, which consisted of 30 items scored on a five-point Likert scale. Seventy-eight nurses working in oncology settings completed the tool. RESULTS Approximately one third (33-35%) of the participants had positive perceptions of EoL care. The majority (67%) of the participants were uncertain or ambivalent regarding EoL events and situations. There was no significant relationship between the participants' profiles and their perceptions of EoL care. However, very few of them had completed educational courses in death and dying. CONCLUSION Nurses have an important impact on EoL care, and continuous education is necessary to improve their confidence when they work with dying patients and their families. An in-house programme to help nurses cope with compassionate exhaustion and humanistic and relational care is highly recommended.
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Affiliation(s)
- Izette Larraine M Libo-On
- Registered Nurse, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Qatar
| | - Abdulqadir J Nashwan
- Nurse Research Scientist, NCCCR, Hamad Medical Corporation, Qatar Adjunct Senior Instructor, University of Calgary (Qatar)
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Vallès-Fructuoso O, Ruiz-de Pablo B, Fernández-Plaza M, Fuentes-Milà V, Vallès-Fructuoso O, Martínez-Estalella G. [Perspective of intensive care nursing staff on the limitation of life support treatment]. ENFERMERIA INTENSIVA 2016; 27:138-145. [PMID: 27707532 DOI: 10.1016/j.enfi.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/20/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the perspective of intensive care nursing staff on the limitation of life support treatment (LLST) in the Intensive Care Units. METHOD An exploratory qualitative study was carried out by applying the theory of Strauss and Corbin as the analysis tool. Constructivist paradigm. POPULATION Nursing staff from three Intensive Care Units of Hospital Universitari de Bellvitge. Convenience sampling to reach theoretical saturation of data. Data collection through semi-structured interview recorded prior to informed consent. Rigor and quality criteria (reliability, credibility, transferability), and authenticity criteria: reflexivity. Demographic data was analysed using Excel. RESULTS A total of 28 interviews were conducted. The mean age of the nurses was 35.6 years, with a mean seniority of 11.46 years of working in ICU. A minority of nurses (21.46%) had received basic training in bioethics. The large majority (85.7%) believe that LLST is not a common practice due to therapeutic cruelty and poor management with it. There is a correlation with the technical concepts; but among the main ethical problems is the decision to apply LLST. Nurses recognise that the decision on applying LLST depends on medical consensus with relatives, and they believe that their opinion is not considered. Their objective is trying to avoid suffering, and assist in providing a dignified death and support to relatives. CONCLUSIONS There is still a paternalistic pattern between the doctor and patient relationship, where the doctor makes the decision and then agrees with the relatives to apply LLST. Organ failure and poor prognosis are the most important criteria for applying LLST. It is necessary to develop a guide for applying LLST, emphasising the involvement of nurses, patients, and their relatives.
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Affiliation(s)
- O Vallès-Fructuoso
- Enfermera, Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España; Profesora asociada, Departamento Enfermería Médico-Quirúrgica, Universidad de Barcelona, L' Hospitalet de Llobregat, Barcelona, España.
| | - B Ruiz-de Pablo
- Enfermera, Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - M Fernández-Plaza
- Enfermera, Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - V Fuentes-Milà
- Enfermera, Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - O Vallès-Fructuoso
- Técnico Curas Auxiliares de Enfermería, Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - G Martínez-Estalella
- Profesora asociada, Departamento Enfermería Médico-Quirúrgica, Universidad de Barcelona, L' Hospitalet de Llobregat, Barcelona, España; Adjunta enfermera, Unidad de Formación, Docencia e Investigación Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Rasoal D, Kihlgren A, James I, Svantesson M. What healthcare teams find ethically difficult. Nurs Ethics 2016; 23:825-837. [DOI: 10.1177/0969733015583928] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation. Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation. Findings: Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient’s/next-of-kin’s emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient’s autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have. Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders. Conclusion: MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.
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Affiliation(s)
| | | | | | - Mia Svantesson
- Faculty of Health and Medicine, Örebro University, Sweden
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9
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Johnstone MJ, Hutchinson AM, Redley B, Rawson H. Nursing Roles and Strategies in End-of-Life Decision Making Concerning Elderly Immigrants Admitted to Acute Care Hospitals. J Transcult Nurs 2016; 27:471-9. [DOI: 10.1177/1043659615582088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful sample of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by “doing the ground work,” “facilitating families,” “fostering trust,” and “allaying fear.” Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a “good death” at the end of their lives requires highly nuanced and culturally informed nursing care.
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Affiliation(s)
| | | | | | - Helen Rawson
- Deakin University, Melbourne, Victoria, Australia
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10
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Nazari R, Vanaki Z, Kermanshahi S, Hajizadeh E. "Where Withstanding is Difficult, and Deserting Even More": Head Nurses' Phenomenological Description of Intensive Care Units. J Caring Sci 2016; 5:133-43. [PMID: 27354977 PMCID: PMC4923837 DOI: 10.15171/jcs.2016.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/15/2015] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The intensive care unit is one of the specialized units in hospitals where head nurses are responsible for both motivating the personnel and providing high quality care. Understanding of the lived experiences of head nurses could help develop new assumptions of the ICU. The present study was therefore conducted to describe the lived experiences of head nurses working in ICU. METHODS In this phenomenological study, data were collected through unstructured in-depth interviews with 5 ICU head nurses in Northern Iran and then analyzed using 7 steps Colaizzi's method. RESULTS Despite the "distressing atmosphere of the ICU", the "difficulty of managing the ICU" and the "difficulty of communication in the ICU", which encourages the "desire to leave the unit" among ICU head nurses, the "desire to stay in the unit" is stronger and head nurses are highly motivated to stay in the unit because the unit "develops a feeling of being extraordinary", "creates an interest in providing complicated care to special patients", "facilitates the spiritual bond", "develops a professional dynamism" and "creates an awareness about the nature of intensive care" among them. CONCLUSION According to the result, ICU head nurses are still inclined to work in the unit and achieve success in spite of the problems that persist in working in the ICU. As the individuals' motivation can be the backbone of organizations, and given that individuals with a high enthusiasm for success are productive, hospital managers can take advantage of this strength in choosing their head nurses.
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Affiliation(s)
- Roghieh Nazari
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zohre Vanaki
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sima Kermanshahi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Jerpseth H, Dahl V, Nortvedt P, Halvorsen K. Nurses' role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease. Nurs Ethics 2016; 24:821-832. [PMID: 26822302 DOI: 10.1177/0969733015626600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients' role in these processes. We applied a qualitative approach, with six focus-group interviews of nurses (n = 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained. FINDINGS The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation. DISCUSSION Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses' absence in participation in the decision about mechanical ventilation. CONCLUSION To be able to advocate for the patients' and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses' participation in decision-making processes.
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Affiliation(s)
- Heidi Jerpseth
- Oslo and Akershus University College of Applied Sciences, Norway
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12
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Kisvetrová H, Školoudík D, Joanovič E, Konečná J, Mikšová Z. Dying Care Interventions in the Intensive Care Unit. J Nurs Scholarsh 2016; 48:139-46. [PMID: 26756287 DOI: 10.1111/jnu.12191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Providing high-quality end-of-life care is a challenging area in intensive care practice. The aim of the current study was to assess the practice of registered nurses (RNs) with respect to dying care and spiritual support interventions in intensive care units (ICUs) in the Czech Republic (CR) and find correlations between particular factors or conditions and the frequency of NIC interventions usage. DESIGN AND METHODS A cross-sectional, descriptive study was designed. A questionnaire with Likert scales included the particular activities of dying care and spiritual support interventions and an evaluation of the factors influencing the implementation of the interventions in the ICU. The group of respondents consisted of 277 RNs working in 29 ICUs in four CR regions. The Mann-Whitney U test and Pearson correlation coefficient were used for statistical evaluation. FINDINGS The most and least frequently reported RN activities were "treat individuals with dignity and respect" and "facilitate discussion of funeral arrangements," respectively. The frequencies of the activities in the biological, social, psychological, and spiritual dimensions were negatively correlated with the frequency of providing care to dying patients. A larger number of activities were related to longer lengths of stay in the ICU, higher staffing, more positive opinions of the RNs regarding the importance of education in a palliative care setting, and attending a palliative care education course. CONCLUSIONS The psychosocial and spiritual activities in the care of dying patients are used infrequently by RNs in CR ICUs. The factors limiting the implementation of palliative care interventions and strategies improving implementation warrant further study. CLINICAL RELEVANCE Assessment of nursing activities implemented in the care of dying patients in the ICU may help identify issues specific to nursing practice.
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Affiliation(s)
- Helena Kisvetrová
- Phi Gamma, Assistant Professor, Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - David Školoudík
- Professor, Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Eva Joanovič
- Doctoral Student, Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Jana Konečná
- Doctoral Student, Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Zdeňka Mikšová
- Associate Dean and Head of Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
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Scholtz S, Nel EW, Poggenpoel M, Myburgh CPH. The Culture of Nurses in a Critical Care Unit. Glob Qual Nurs Res 2016; 3:2333393615625996. [PMID: 28462324 PMCID: PMC5342286 DOI: 10.1177/2333393615625996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 01/12/2023] Open
Abstract
Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing.
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Affiliation(s)
| | - Elsabe W. Nel
- University of Johannesburg, Johannesburg, South Africa
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14
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Fridh I. Caring for the dying patient in the ICU – The past, the present and the future. Intensive Crit Care Nurs 2014; 30:306-11. [DOI: 10.1016/j.iccn.2014.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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15
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McLeod A. Nurses’ views of the causes of ethical dilemmas during treatment cessation in the ICU: a qualitative study. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjnn.2014.10.3.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne McLeod
- Senior Lecturer in Critical Care, School of Health Sciences, City University, Northampton Square, London, England
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16
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Guay D, Michaud C, Mathieu L. Conditions facilitant les « bons soins » palliatifs aux soins intensifs selon la perspective infirmière. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.112.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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17
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Bridges J, Nicholson C, Maben J, Pope C, Flatley M, Wilkinson C, Meyer J, Tziggili M. Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship. J Adv Nurs 2012; 69:760-72. [PMID: 23163719 PMCID: PMC3617468 DOI: 10.1111/jan.12050] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/30/2022]
Abstract
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.
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Lind R, Lorem GF, Nortvedt P, Hevrøy O. Intensive care nurses’ involvement in the end-of-life process – perspectives of relatives. Nurs Ethics 2012; 19:666-76. [DOI: 10.1177/0969733011433925] [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]
Abstract
In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed a long-term perspective in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process.
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Affiliation(s)
| | | | - Per Nortvedt
- University of Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Norway
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19
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Carnevale FA, Farrell C, Cremer R, Canoui P, Séguret S, Gaudreault J, de Bérail B, Lacroix J, Leclerc F, Hubert P. Struggling to do what is right for the child: pediatric life-support decisions among physicians and nurses in France and Quebec. J Child Health Care 2012; 16:109-23. [PMID: 22247181 DOI: 10.1177/1367493511420184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined (a) how physicians and nurses in France and Quebec make decisions about life-sustaining therapies (LSTs) for critically ill children and (b) corresponding ethical challenges. A focus groups design was used. A total of 21 physicians and 24 nurses participated (plus 9 physicians and 13 nurses from a prior secondary analysis). Principal differences related to roles: French participants regarded physicians as responsible for LST decisions, whereas Quebec participants recognized parents as formal decision-makers. Physicians stated they welcomed nurses' input but found they often did not participate, while nurses said they wanted to contribute but felt excluded. The LST limitations were based on conditions resulting in long-term consequences, irreversibility, continued deterioration, inability to engage in relationships and loss of autonomy. Ethical challenges related to: the fear of making errors in the face of uncertainty; struggling with patient/family consequences of one's actions; questioning the parental role and dealing with relational difficulties between physicians and nurses.
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Gysels M, Evans N, Meñaca A, Andrew E, Toscani F, Finetti S, Pasman HR, Higginson I, Harding R, Pool R. Culture and end of life care: a scoping exercise in seven European countries. PLoS One 2012; 7:e34188. [PMID: 22509278 PMCID: PMC3317929 DOI: 10.1371/journal.pone.0034188] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
AIM Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
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Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain.
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21
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Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature. Nurs Res Pract 2011; 2011:527834. [PMID: 21994831 PMCID: PMC3184494 DOI: 10.1155/2011/527834] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 07/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022] Open
Abstract
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.
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Efstathiou N, Clifford C. The critical care nurse's role in end-of-life care: issues and challenges. Nurs Crit Care 2011; 16:116-23. [PMID: 21481113 DOI: 10.1111/j.1478-5153.2010.00438.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Nikolaos Efstathiou
- University of Birmingham, College of Medical and Dental Sciences, School of Health and Population Sciences, Nursing and Physiotherapy, Birmingham, UK.
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23
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Kinoshita S, Miyashita M. Development of a scale for “difficulties felt by ICU nurses providing end-of-life care” (DFINE): A survey study. Intensive Crit Care Nurs 2011; 27:202-10. [DOI: 10.1016/j.iccn.2011.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/14/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
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Saevareid TJ, Balandin S. Nurses’ perceptions of attempting cardiopulmonary resuscitation on oldest old patients. J Adv Nurs 2011; 67:1739-48. [DOI: 10.1111/j.1365-2648.2011.05622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guay D, Michaud C, Mathieu L. De « bons soins » palliatifs aux soins intensifs : une perspective infirmière. Rech Soins Infirm 2011. [DOI: 10.3917/rsi.105.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
AIM This paper is a report of a study exploring intensive care nurses' experiences of conflicts related to practical situations when they encounter culturally diverse families of critically ill patients. BACKGROUND Conflicts can arise in critical care settings as a result of differing cultural and professional values. Nurses and families with diverse cultural backgrounds bring beliefs and understandings to the care situation that can have an impact on the care process. Such families are challenged in their efforts to maintain traditions, while some nurses are not sufficiently culturally aware. A limited number of studies have focused on such conflicts. METHOD Sixteen critical care nurses took part in multistage focus group interviews conducted from October 2005 to June 2006. The data were analysed using qualitative content analysis. FINDINGS The main theme, 'conflict between professional nursing practice and family cultural traditions', was based on three pairs of conflicting themes: 'culturally based need to participate actively in the care vs. nurses' professional perceptions of themselves as total care providers'; 'nurses' professional obligation to provide comprehensible information vs. culturally based communication difficulties and responses to illness'; and 'families' needs for cultural norms and self-determination vs. nurses' professional responsibility for the clinical environment'. In addition, each pair of themes contained several sub-themes. CONCLUSION Nurses need to negotiate with culturally diverse family members to address conflicts. In their encounters with such families, they should establish a balance between ethnocentricity and cultural sensitivity. An implication for practice is to increase nurses' competence in assessment of diversity.
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Affiliation(s)
- Sevald Høye
- Department of Nursing, Hedmark University College, Elverum, Norway.
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Wåhlin I, Ek AC, Idvall E. Staff empowerment in intensive care: nurses' and physicians' lived experiences. Intensive Crit Care Nurs 2010; 26:262-9. [PMID: 20674363 DOI: 10.1016/j.iccn.2010.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 04/09/2010] [Accepted: 06/23/2010] [Indexed: 11/30/2022]
Abstract
AIM The purpose of the study was to describe empowerment from the perspective of intensive care staff. What makes intensive care staff experience inner strength and power? BACKGROUND Intensive care staff are repeatedly exposed to traumatic situations and demanding events, which could result in stress and burnout symptoms. A higher level of psychological empowerment at the workplace is associated with increased work satisfaction and mental health, fewer burnout symptoms and a decreased number of sick leave days. METHOD Open-ended interviews were conducted with 12 intensive care unit (ICU) staff (four registered nurses, four enrolled nurses and four physicians) in southern Sweden. Data were analysed using a phenomenological method. FINDINGS Intensive care staff were found to be empowered both by internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, well functioning teamwork and a good atmosphere. CONCLUSION Findings show that not only personal knowledge and skills, but also a supporting atmosphere and a good teamwork, has to be focused and encouraged by supervisors in order to increase staff's experiences of empowerment. Staff also need a chance to feel that they do something good for patients, next of kin and other staff members.
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Affiliation(s)
- Ingrid Wåhlin
- Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Sweden.
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28
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Abstract
AIM This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies. BACKGROUND The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief. METHOD This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework. FINDINGS Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients. CONCLUSION There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.
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Høye S, Severinsson E. Multicultural family members' experiences with nurses and the intensive care context: a hermeneutic study. Intensive Crit Care Nurs 2009; 26:24-32. [PMID: 20036542 DOI: 10.1016/j.iccn.2009.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 10/10/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to illuminate the experiences of multicultural family members in intensive care units in hospitals, when a loved one was critically ill. An increasing migration from non-Western countries to Norway and potential double-stress for multicultural families experiencing critical illness are pre-understandings. METHODS The study utilised a Gadamerian hermeneutic design. Data were collected through in-depth-interviews (n=5) and interpreted, inspired by Lindseth and Norberg's phenomenological hermeneutical method. FINDINGS Multicultural family members' experiences of their encounters with nurses were understood as: 'Struggling to preserve the families' cultural belonging within the health care system', based on four themes: (a) filtering information to reduce concern; (b) understanding and being understood; (c) protecting cultural traditions and (d) interaction between roles, rules and expectations. CONCLUSION Family members with a non-Western ethnic background experienced several challenges within the complex ICU environment. Multicultural family members had distinct strategies to deal with the hospitalisation of a critically ill loved one. Interaction difficulties and cultural traditions were not influenced by the environment alone, however the challenges seemed to deal with universal human interaction independent of the context. Nurses need to be sensitive to the families' cultural customs in order to meet their expectations in a respectful way.
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Affiliation(s)
- Sevald Høye
- Department of Nursing, Hedmark University College, Kirkeveien 47, Elverum, Norway.
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Hov R, Athlin E, Hedelin B. Being a nurse in nursing home for patients on the edge of life. Scand J Caring Sci 2009; 23:651-9. [DOI: 10.1111/j.1471-6712.2008.00656.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Doing one's utmost: Nurses’ descriptions of caring for dying patients in an intensive care environment. Intensive Crit Care Nurs 2009; 25:233-41. [DOI: 10.1016/j.iccn.2009.06.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/18/2009] [Accepted: 06/22/2009] [Indexed: 11/23/2022]
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Silén M, Tang PF, Ahlström G. Swedish and Chinese nurses' conceptions of ethical problems: a comparative study. J Clin Nurs 2009; 18:1470-9. [PMID: 19416099 DOI: 10.1111/j.1365-2702.2008.02422.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To investigate Swedish and Chinese nurses' conceptions of ethical problems and workplace stress and ascertain whether there are differences between the nurses in the two countries and between types of clinics. BACKGROUND Nursing can be regarded as an ethical practice and ethical problems are one type of problems nurses have to deal with. DESIGN The research design was comparative and quantitative. METHODS A questionnaire was used. The study was carried out at one hospital in China and two hospitals in Sweden. One hundred and thirty-six Chinese nurses and 137 Swedish nurses participated. RESULTS There was a statistical difference between nurses working in the different countries regarding commonest stated ethical problem. The Swedish nurses indicated a greater number of ethical problems than the Chinese nurses. The latter felt irritated, dissatisfied or sad at work or after work more often than the Swedish nurses. Forty-one per cent of the nurses in both countries thought there was a modest or rather big difference between the current and the desired quality of nursing. CONCLUSIONS The findings were partially the same in the two countries and this underlines the importance of looking at ethical problems from an organisational perspective. RELEVANCE TO CLINICAL PRACTICE The findings also show the need for a reduction of nurses' workload as well as the importance of assuring that nurses have the knowledge they need to carry out their work. The communication between nurses and other members of the health-care team, patients and relatives also needs to be improved.
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Affiliation(s)
- Marit Silén
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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The cardiovascular intensive care unit nurse's experience with end-of-life care: a qualitative descriptive study. Intensive Crit Care Nurs 2009; 25:214-20. [PMID: 19524441 DOI: 10.1016/j.iccn.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/30/2009] [Accepted: 05/03/2009] [Indexed: 11/23/2022]
Abstract
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.
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Life support decision making in critical care: Identifying and appraising the qualitative research evidence. Crit Care Med 2009; 37:1475-82. [PMID: 19242328 DOI: 10.1097/ccm.0b013e31819d6495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. DATA SOURCES In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. STUDY SELECTION Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. DATA EXTRACTION We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). DATA SYNTHESIS Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. CONCLUSIONS Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and stress). Both designs can provide useful reflections for improving care. Given the diversity of qualitative research in critical care, room for improvement exists regarding both the quality and transparency of reported methodology.
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36
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Latour JM, Fulbrook P, Albarran JW. EfCCNa survey: European intensive care nurses’ attitudes and beliefs towards end-of-life care. Nurs Crit Care 2009; 14:110-21. [DOI: 10.1111/j.1478-5153.2008.00328.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McMillen RE. End of life decisions: Nurses perceptions, feelings and experiences. Intensive Crit Care Nurs 2008; 24:251-9. [DOI: 10.1016/j.iccn.2007.11.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 10/18/2007] [Accepted: 11/08/2007] [Indexed: 10/22/2022]
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Devictor D, Latour JM, Tissières P. Forgoing life-sustaining or death-prolonging therapy in the pediatric ICU. Pediatr Clin North Am 2008; 55:791-804, xiii. [PMID: 18501766 DOI: 10.1016/j.pcl.2008.02.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most deaths in the pediatric intensive care unit occur after a decision to withhold or withdraw life-sustaining treatments. The management of children at the end of life can be divided into three steps. The first concerns the decision-making process. The second concerns the actions taken once a decision has been made to forego life-sustaining treatments. The third regards the evaluation of the decision and its implementation. The mission of pediatric intensive care has expanded to provide the best possible care to dying children and their families. Improving the quality of care received by dying children remains an ongoing challenge for every pediatric intensive care unit team member.
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Affiliation(s)
- Denis Devictor
- Pediatric Intensive Care, Hôpital de Bicêtre, AP-HP, Department of Research on Ethics, Paris-Sud 11 University, Bicêtre 94275, France.
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Silén M, Svantesson M, Ahlström G. Nurses' conceptions of decision making concerning life-sustaining treatment. Nurs Ethics 2008; 15:160-73. [PMID: 18272607 DOI: 10.1177/0969733007086014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.
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Affiliation(s)
- Marit Silén
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Ramcharan P. Commentary on Hov R, Hedelin B & Athlin E (2007) Being an intensive care nurse related to questions of withholding or withdrawing curative treatment. Journal of Clinical Nursing 16, 203-211. J Clin Nurs 2008; 16:2365-7, discussion 2367-8. [PMID: 18036126 DOI: 10.1111/j.1365-2702.2006.01674.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul Ramcharan
- Department of Mental Health and Learning Disabilities, University of Sheffield, Sheffield, UK.
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Hov R, Hedelin B, Athlin E. RESPONSE. J Clin Nurs 2007. [DOI: 10.1111/j.1365-2702.2006.01735.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Hov R, Hedelin B, Athlin E. Good nursing care to ICU patients on the edge of life. Intensive Crit Care Nurs 2007; 23:331-41. [PMID: 17689250 DOI: 10.1016/j.iccn.2007.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 03/13/2007] [Accepted: 03/17/2007] [Indexed: 11/18/2022]
Abstract
Critically ill patients are admitted to intensive care units (ICUs) to receive advanced technological and medical treatment. Some patients seem not to benefit from the treatment, and sometimes questions are raised as to whether treatment should be withheld or withdrawn. This study was conducted using ICU nurses' experiences with the aim of acquiring a deepened understanding of what good nursing care is for these patients. The study was performed at an adult ICU in Norway, where 14 ICU female nurses were included as participants. The research design was based on interpretative phenomenology and data was collected by group interviews inspired by focus-group methodology. The participants were divided into two groups and each group was interviewed four times. Colaizzi's model was used in the process of analysis. The results show that good nursing care depended on several basic conditions: continuity, knowledge, competence and cooperation, and included clear goals to give appropriate life-saving -- or end-of-life treatment and care. Cornerstones in good nursing care were nurses' verbal communication and nurses' use of their hands. The study emphasises several consequences for future ICU nursing practice and education to enhance good nursing care to patients on the edge of life.
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Affiliation(s)
- Reidun Hov
- Hedmark University College, Faculty of Health Studies, Elverum, Norway.
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