Promoting peaceful death in the intensive care unit in Thailand

Quality of death and its related factors in terminally ill patients, as perceived by nurses

Background:

Little is known about the quality of death of terminally ill patients in hospitals in Thailand.

Aim:

To examine the quality of death of terminally ill patients and investigate correlations between the quality of death and the organisational climate; nurses' palliative care knowledge; nurses' palliative care practice; and nurses' perceptions of barriers in providing palliative care.

Methods:

A cross-sectional survey design was used. Data collected among 281 nurses were analysed by descriptive statistics, Pearson correlation and Spearman's rank correlation.

Results:

The overall quality of death of terminally ill patients in the hospital was moderate. Organisational climate and nurses' palliative care practice positively correlate with terminally ill patients' quality of death. Nurses' difficulty in providing palliative care negatively correlates with terminally ill patients' quality of death.

Conclusion:

Promoting an organisational climate and enhancing nurses' palliative care practice may improve the quality of death of terminally ill patients in this hospital.

The medical futility experience of nursing professionals in Greece

Background

Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear.

Methods

This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data.

Results

Importantly, many participants were half-hearted in their attitude towards accepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. The nursing professional’s role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient’s role in decisions on futile care was prioritized. The patient’s effort to keep themselves alive was also highlighted. This effort impacts nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized.

Conclusions

These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.

Death acceptance from a Thai Buddhist perspective: A qualitative study

PURPOSE

To have more in-depth understanding of death acceptance among patients with terminal cancer in Thailand.

METHODS

A qualitative descriptive research approach was used to capture the perspectives of patients with terminal cancer about death acceptance. Purposive sampling was used to recruit the participants. A semi-structured interview guide was used during data collection to obtain in-depth interviews with 12 patients diagnosed with terminal cancer. An interpretive descriptive method was used for analyzing data. Analysis of the data for this study was conducted by the analytic team beginning at initial data collection.

RESULTS

The findings of this study revealed six major themes relating to death acceptance: 1) perceiving death as a natural part of life; 2) perceiving that death cannot be controlled; 3) thinking that death can come at any time; 4) letting everything go before dying: finding a calmness; 5) additional Buddhist practices: clean living and making merit; and 6) additional means for attaining a peaceful death and peaceful life before death.

CONCLUSION

Understanding death acceptance is important for nurses providing care for patients with terminal cancer in order to find strategies and support for patients to accept death and live peacefully with their family in the time they have left.

Needs of patient with advanced stages of cancer in a Thai community

Purpose

The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.

Design/methodology/approach

A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.

Findings

The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.

Originality/value

The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.

Listening to How Experienced Nurses Care for the Dying Husband and His Spouse

BACKGROUND

Although most nurses in critical care settings provide nursing care for marital couples when 1 of the partners is dying, this is a relatively new area of research.

OBJECTIVE

The aim of this study is to describe the nature of nursing care provided for marital couples in the critical care unit when the husbands were dying.

METHOD

A qualitative interpretive description was used to construct this study. Data were collected by conducting semistructured individual interviews with 15 experienced critical care nurses in quiet conference rooms. The initial sample was recruited by invitation, and then followed by the snowball method. Institutional review board approval was obtained at the supporting institution. Interviews were recorded and transcribed to facilitate analysis. Data were analyzed line by line with constant comparison to formulate key ideas and then organized into themes.

RESULTS

Three themes were identified: (a) experienced nurses support the wife and husband, (b) experienced nurses connect spiritually with the wife and husband, and (c) experienced nurses provide skillful care for the wife and her husband who is dying. These themes form a description of the nature of nursing care needed by novice nurses. Emphasis for novice nurses includes focusing on the uniqueness of the marital couple as the patient, being less task oriented, and being more emotionally sensitive to the needs of the marital dyad. In this study, experienced nurses relay the importance of engaging self with these couples and being present at the end of life.

DISCUSSION

Future research directions are to explore innovative ways nurses may provide spiritual and emotional support to these marital couples and to measure what care activities the wife deems most beneficial for her and her husband at his end of life.

Experiences and needs of older people with end stage renal disease: bereaved carers perspective

BACKGROUND

There is a growing population of older patients with End Stage Renal Disease (ESRD) managed without dialysis in Thailand, and services have yet to be developed to specifically respond to the needs of this group. As a consequence this population are likely to have unmet needs with respect to health care and suffer from symptoms that could be better managed.

OBJECTIVE

This qualitative study explored experiences and health care needs during the last year of life among older people with ESRD, managed without dialysis, from the perspective of bereaved carers.

METHODS

A retrospective post-bereavement approach was adopted to collect qualitative interview data. Purposive sampling was used to select 12 bereaved relatives of older patients with ESRD, managed without dialysis, who had died in the previous 5-10 months. Semi-structured interviews were conducted. Data were digitally recorded, transcribed and analysed through framework analysis.

RESULTS

Four main themes were identified: symptom experiences, impacts of being managed without dialysis, symptom management, and health care needs and utilisation of services.

CONCLUSIONS

Findings confirmed patients' needs were not being met and identified the need to develop approaches to symptom management at home, health education, and psychological and spiritual support at the end of life.

Dying Care Interventions in the Intensive Care Unit

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.

Lived experience of caring for dying patients in emergency room

BACKGROUND

Dying often occurs in hospitals and frequently in emergency rooms. Understanding caring for critical and dying patients is necessary for quality nursing.

PURPOSE

This study described the meaning of nurses' lived experience of caring for critical and dying patients in the emergency rooms.

METHODS

This study was conducted in three emergency rooms of tertiary hospitals in southern Thailand. Twelve nurses met the inclusion criteria: nurses working in emergency room for at least 2 years, and experienced caring for critical and dying patients in an emergency department. Data were collected using in-depth individual interviews. Data transcription and analysis used van Manen's hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria.

FINDINGS

Experiences of caring for critical and dying patients revealed four thematic categories: defying death; no time for palliative care; lacking support for family; and privacy for peaceful deaths. These thematic categories reflected van Manen's four lived worlds of body, time, relations and space.

CONCLUSIONS

The study described the meaning of the experience of caring for critical and dying patients while supporting the development of nursing knowledge for palliative and end-of-life care in emergent settings.

IMPLICATIONS FOR NURSING POLICY

Findings of the study influence nursing policies toward enhancing education of nurses regarding palliative and end-of-life care in emergency settings. These findings can also influence the value of caring-healing environments for critical and dying patients and their families. Policies can focus on practice and education of families particularly about end-of-life care for critical and dying patients.

Supporting families of dying patients in the intensive care units

Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.

Commitment to care: a qualitative study of intensive care nurses' perspectives of end-of-life care in an Islamic context

BACKGROUND

Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking.

AIM

The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran.

METHODS

A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach.

RESULTS

Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews.

LIMITATION

Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context.

CONCLUSIONS

This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.

Palliative care nursing interventions in Thailand

PURPOSE

This study aimed to describe the nursing interventions that nurses in Thailand identify as most important in promoting dignified dying.

DESIGN

This study used a cross-sectional descriptive design.

METHOD

A total of 247 Thai nurses completed a paper-and-pencil survey written in Thai. The survey included both demographic questions and palliative care interventions, listed with summative rating scales, from the International Classification for Nursing Practice (ICNP) catalogue Palliative Care for Dignified Dying. Descriptive statistics were used to analyze the data.

FINDINGS

The five most important nursing interventions to promote dignified dying, ranked by average importance rating, were (a) maintain dignity and privacy, (b) establish trust, (c) manage pain, (d) establish rapport, and (e) manage dyspnea.

CONCLUSIONS

This research identified the palliative care nursing interventions considered most important by nurses in Thailand to promote dignified dying.

IMPLICATIONS

The ICNP catalogue Palliative Care for Dignified Dying can be used for planning and managing palliative nursing care in Thailand.

Thai Buddhist families' perspective of a peaceful death in ICUs

AIM

To describe the concept of a peaceful death in intensive care units (ICUs) from the perspective of Thai Buddhist family members.

METHODS

This descriptive qualitative study was based on data generated from individual in-depth interviews of nine Thai Buddhist family members from the southern region of Thailand whose loved ones died in adult ICUs. Colaizzi's phenomenological approach was used to analyse the data. Rigour for the study was established by Lincoln and Guga's guidelines for qualitative research studies.

FINDINGS

Five core qualities emerged that made-up the concept of a peaceful death as described by Thai Buddhist family members who cared for their loved ones while they were dying in ICUs. These core qualities were 'knowing death was impending, preparing for a peaceful state of mind, not suffering, being with family members and not alone, and family members were not mourning'.

CONCLUSION

Thai Buddhist family members described what they meant by a peaceful death. 'This was: preparing for a peaceful state of mind in knowing that one's impending death is not a situation of suffering or being alone, but rather a time of being with family members who are not yet mourning one's death.' The findings support that family members should participate in promoting a peaceful death for their loved ones dying in ICUs.

IMPLICATIONS FOR PRACTICE

The five core qualities of a peaceful death reported in this study could be used as a framework for nurses to create nursing practice interventions for quality end-of-life care for Thai Buddhists.

Thai Nurses’ Experience of Caring for Persons Who Had a Peaceful Death in Intensive Care Units

This phenomenological study describes the lived experience of caring for persons who had a peaceful death in the intensive care units. Ten intensive care nurses in south Thailand participated in individual interviews. Van Manen’s approach was utilized to synthesize data. The lived experience of Thai nurses caring for persons who had a peaceful death is: understanding the other through valuing experience and enhancing relationships with others by recognizing time is short and is a priority. Boykin and Schoenhofer’s theory of nursing as caring provided the theoretical lens for interpreting the meaning of the phenomenon.

Thai Buddhists' experiences caring for family members who died a peaceful death in intensive care

AIM

To describe the meaning of Thai Buddhists' lived experiences caring for family members who died a peaceful death in intensive care units.

METHODS

The study made use of hermeneutic phenomenology. The participants were nine family caregivers from the southern Thailand region. Data was generated from individual interviews, and Van Manen's approach was used to analyse and interpret the data.

FINDINGS

Nine themes structured the experiences and were reflected within the four lived worlds of relationality, corporeality, temporality, and spatiality. The participants struggled when making decisions about their family member's life in the context of changing hope. Feelings of stress and exhaustion were common. The participants valued empathetic understanding as a means for maintaining relationships with others in giving and receiving compassionate care. Caring for the self in order to give mindful care and doing one's best in the moment also significantly contributed to achieving a peaceful death.

CONCLUSION

The findings suggest nursing practice guidelines for models of family-centred care and family participation in end-of-life care in intensive care units.

Knowing the occasion of a peaceful death in intensive care units in Thailand

The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit.

EvaIuating the "good death" concept from Iranian bereaved family members' perspective

Improving end-of-life care demands that first you define what constitutes a good death for different cultures. This study was conducted to evaluate a good death concept from the Iranian bereaved family members' perspective. A descriptive, cross-sectional study was designed using a Good Death Inventory (GDI) questionnaire to evaluate 150 bereaved family members. Data were analyzed by SPSS. Based on the results, the highest scores belonged to the domains "being respected as an individual," "natural death," "religious and spiritual comfort," and "control over the future." The domain perceived by family members as less important was "unawareness of death." Providing a good death requires professional caregivers to be sensitive and pay attention to the preferences of each unique person's perceptions. In order to implement holistic care, caregivers must be aware of patients' spiritual needs. Establishing a specific unit in a hospital and individually treating each patient as a valued family member could be the best way to improve the quality of end-of-life care that is missing in Iran.

Thai Buddhist intensive care unit nurses' perspective of a peaceful death: an empirical study

AIM

To describe the concept of a peaceful death from Thai Buddhist intensive care unit (ICU) nurses' perspectives.

METHOD

A descriptive qualitative study of data generated from individual in-depth interviews of ten intensive care nurses who practiced in adult ICUs in the southern region of Thailand. Content analysis was used to analyse the data.

FINDINGS

Four core qualities of a peaceful death emerged as described by Thai Buddhist nurses who practised in the ICUs. These core qualities are: peaceful mind; no suffering; family's acceptance of patient's death; and being with others and not alone.

CONCLUSION

Thai Buddhist nurses described a peaceful death as 'a situation in which persons who are dying have peace of mind, and do not show signs and symptoms of suffering. Peaceful death occurs when family members declare acceptance of their loved one's dying and eventual death. Such a death is witnessed by relatives and friends and the dying person is not alone.' The findings encourage nurses to be with, and provide palliative care for, dying patients and families.