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Moran S, Bailey ME, Doody O. Role and contribution of the nurse in caring for patients with palliative care needs: A scoping review. PLoS One 2024; 19:e0307188. [PMID: 39178200 PMCID: PMC11343417 DOI: 10.1371/journal.pone.0307188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 07/01/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND The provision of high-quality palliative care is important to nursing practice. However, caring for palliative care patients and their families is challenging within a complex everchanging health environment. Nonetheless the caring, artistic role of the nurse is fundamental to the care of the patient and family. However, this role is currently being overshadowed by the technical and scientific elements of nursing. METHODS A scoping review was conducted utilising Arksey and O'Malley's framework to identify the role and contribution of nurses in caring for patients with palliative care needs. An open time period search of eight electronic databases (MEDLINE, CINAHL, Academic Search Complete, PsycINFO, EMBASE, Web of Science, Scopus and Cochrane Library) was conducted on the 8th of March 2023 and updated on the 30th of April 2024. Screening was performed independently by two reviewers against eligibility criteria with meetings between authors to discuss included papers and form a consensus. Data was extracted relating to palliative care nursing, methodology, key findings, and recommendations. The analysed and summarised data was mapped onto Oldland et al seven domains framework: (a) medical/nursing and technical competence, (b) person centred care, (c) positive interpersonal behaviours, (d) clinical leadership and governance, (e) promotion of safety, (f) management of the environment, and (g) evidence-based practice. RESULTS Fifty-five papers met the criteria for this review which describes the role and contribution of nurses in caring for palliative patients across all domains of professional practice. The review found the leading areas of nurse contribution were person centred, interpersonal and nursing care aspects, with leadership, managing the environment, patient safety and evidence-based practice evident but scoring lower. The contribution of the nurse in palliative care supports a biopsychosocial-educational approach to addressing the physical, emotional and social needs of patients with palliative care needs and their families across the care continuum. CONCLUSION Nurses in palliative care engage in a wide range of roles and responsibilities in caring for patients and their families with palliative care needs. However, there remains minimal evidence on the assessment, intervention, and evaluation strategies used by nurses to highlight the importance of their role in caring for patients and their families in this area. The findings of this review suggest that the artistic element of nursing care is being diluted and further research with a focus on evidencing the professional competence and artistic role of the nurse in the provision of palliative care is required. In addition, research is recommended that will highlight the impact of this care on patient and family care outcomes and experiences.
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Affiliation(s)
- Sue Moran
- Milford Care Centre, Castletroy, Limerick, Ireland
| | | | - Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
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Pettersson C, Forsén J, Joelsson-Alm E, Fridh I, Björling G, Mattsson J. Piloting and watch over in the end-of-life care of intensive care unit patients with COVID-19-A qualitative study. Nurs Crit Care 2024. [PMID: 39021308 DOI: 10.1111/nicc.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life. AIMS This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19. STUDY DESIGN A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed. RESULTS The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care. CONCLUSIONS Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient. RELEVANCE TO CLINICAL PRACTICE Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care.
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Affiliation(s)
- Charlotte Pettersson
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
| | - Johanna Forsén
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Anaesthesiology and Intensive Care, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Gunilla Björling
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Janet Mattsson
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Notodden, Norway
- Department of Health Science, Kristianstad University, Kristianstad, Sweden
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Xie P, Liu Z, Chen H, Wu Y, Xie P, Liu H, Ying W. Exploring the barriers and facilitators of palliative care in the adult intensive care unit from nurses' perspectives in China: A qualitative study. Nurs Crit Care 2024; 29:756-764. [PMID: 38311989 DOI: 10.1111/nicc.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Intensive care units (ICUs) in China primarily focus on active rescue efforts, and it is not common to provide palliative care services within the ICU. As nurses play a primary role as caregivers for end-of-life patients in the ICU, it is necessary to explore the factors that impede or facilitate palliative care from their perspective. AIM To explore the barriers and facilitators associated with implementing palliative care in Chinese adult ICUs from nurses' perspectives. STUDY DESIGN This study utilized a descriptive phenomenological research approach and purposive sampling to conduct face-to-face semi-structured interviews with nurses working in adult ICUs from three comprehensive hospitals in China during the period between February and May 2023. A total of 17 nurses were interviewed, and the collected data were transcribed, coded, and synthesized thematically. RESULTS Two themes of barriers and facilitators of palliative care in the Chinese adult ICU were extracted. The three sub-themes of hindering factors are as follows: (1) The influence of Chinese traditional culture. (2) The specificity of the ICU context. (3) Lacking sufficient attention in the ICU. The three sub-themes of the promoting factors are as follows: (1) Government and society value palliative care. (2) Patients and their families have palliative care needs. (3) Nurses view palliative care positively. CONCLUSION Currently, integrating palliative care into the ICU may face challenges such as cultural factors, the specificity of the ICU context, and insufficient attention. However, it is worth noting that as the government and society place more emphasis on palliative care, more and more people are gradually paying attention to the palliative care needs of critically ill patients and their families. RELEVANCE TO CLINICAL PRACTICE This study serves as a reference for exploring an ICU palliative care service model that is suitable for China's national conditions, such as education and training, resource allocation, service processes, and the palliative care environment, among others.
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Affiliation(s)
- Peiying Xie
- School of Nursing, Shantou University Medical College, Shantou, People's Republic of China
| | - Zhili Liu
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Huiyao Chen
- Intensive Care Unit, The First Peoples Hospital of Foshan, Foshan, People's Republic of China
| | - Yanchun Wu
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Peijie Xie
- Urology Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Hui Liu
- Orthopaedic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Wenjuan Ying
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
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Keskin Kızıltepe S, Koç Z. Intensive Care Nurses' Experiences Related to Dying Patients: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1016-1030. [PMID: 34873967 DOI: 10.1177/00302228211051856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe intensive care nurses' experiences of caring for dying patients. METHOD This study was carried out between July 15, 2019, and September 15, 2019, in a university hospital's intensive care unit. We conducted in-depth semi-structured interviews with a purposive sample of 14 intensive care nurses to describe their experiences related to patient deaths. Qualitative thematic analysis was used to identify, analyse and report the identified themes. RESULTS Four themes were identified: (I) Emotions experienced the first time their patient passed away; (II) feelings and thoughts on impact of death; (III) difficulties encountered when providing care and (IV) coping methods with this situation. CONCLUSION Despite the passage of time, nurses are unable to forget their death experiences when they first encountered. They oftentimes use ineffective methods of coping and were negatively affected physically and emotionally.
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Affiliation(s)
| | - Zeliha Koç
- Health Science Faculty, Ondokuz Mayıs University, Samsun, Turkey
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López-Panza ER, Pacheco-Roys VC, Fernández-Ahumada KJ, Díaz-Mass DC, Expósito-Concepción MY, Villarreal-Cantillo E, Aviles Gonzalez CI. Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review. Int J Nurs Sci 2024; 11:143-154. [PMID: 38352294 PMCID: PMC10859575 DOI: 10.1016/j.ijnss.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.
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Affiliation(s)
- Elvia R. López-Panza
- Nursing Department, Universidad del Norte, Barranquilla, Colombia
- Nursing Program, Faculty of Health Sciences, Universidad Popular del César, Valledupar, Colombia
| | - Vanessa C. Pacheco-Roys
- Nursing Department, Universidad del Norte, Barranquilla, Colombia
- Clínica Valledupar, Valledupar, Colombia
| | - Kelly J. Fernández-Ahumada
- Nursing Department, Universidad del Norte, Barranquilla, Colombia
- Hospital Universidad del Norte, Soledad, Colombia
| | | | | | | | - Cesar I. Aviles Gonzalez
- Nursing Program, Faculty of Health Sciences, Universidad Popular del César, Valledupar, Colombia
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Cagliari, Italy
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Efil S, Turen S, Demir G. Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes. Dimens Crit Care Nurs 2023; 42:325-332. [PMID: 37756505 DOI: 10.1097/dcc.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known. OBJECTIVES The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process. METHODS The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care. RESULTS The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98. CONCLUSION It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001). DISCUSSION It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.
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Johnson E, Jack B. Grey area nursing: high-dependency nurses’ experiences of caring for patients approaching the transition from curative to palliative care. Int J Palliat Nurs 2022; 28:515-521. [DOI: 10.12968/ijpn.2022.28.11.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Nurses in high-dependency units frequently facilitate the withdrawal of life-sustaining treatments and provide end-of-life care. Providing this care has been shown to cause distress, burnout and cumulative grief. There remains a lack of understanding of high dependency nurses’ experiences of caring for patients approaching withdrawal of life-sustaining treatments. Aim: To explore experiences of high dependency nurses caring for patients approaching withdrawal of life-sustaining treatment and highlight any support or needs they may have. Methods: Interviews were conducted and analysed using qualitative thematic analysis. Findings: Nurses experienced conflict in decision making, which was reported to prolong patient distress and cause nurses moral anguish. Nurses need time to talk and further education to support them to provide withdrawal of life-sustaining treatment. Conclusion: High-dependency nurses need time to talk following caring for this patient group and more extensive education to support them to provide quality end-of-life care.
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Affiliation(s)
- Emily Johnson
- Palliative Care Nurse, Liverpool Foundation Trust, UK
| | - Barbara Jack
- Professor of Palliative and End-of-Life Care; Academic Programme Lead (MSc/PG Cert Integrated), Queenscourt Hospice, Edge Hill University, UK
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Bennett FB, O'Conner-Von S. Continuous Commitment: Long-Term Care RNs' Experience Communicating With Residents and Their Families About End-of-Life Care Preferences. J Gerontol Nurs 2022; 48:29-36. [DOI: 10.3928/00989134-20221003-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stanzl N, Scammell J. Nurses' perceptions of supporting a 'good death' in intensive care units. Int J Palliat Nurs 2022; 28:357-364. [PMID: 36006787 DOI: 10.12968/ijpn.2022.28.8.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Death in the intensive care unit (ICU) is an unavoidable aspect of nursing practice. Nurses are the primary front-line healthcare professionals (HCPs) which care for dying patients in this setting. Facilitating 'good deaths' in the ICU has become increasingly debated due to the challenges involved, especially during the COVID-19 pandemic. Aim: To explore how nurses perceive a 'good death' for patients in the ICU. METHOD Literature published in English between 2005 and 2020 was rigorously searched and recorded using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources were: CINAHL Complete, MEDLINE complete, APA PsycInfo, ScienceDirect, SocINDEX, SwePub, SciELO, Complementary Index, Academic Search Ultimate, Supplemental Index, Education Source and Directory of Open Access Journals. Search terms included: nurses' perceptions, ICUs, 'good deaths', quality of death and dignified deaths. FINDINGS Seven articles met the search criteria, five used qualitative methods, one used a quantitative method and one used a mixed method design. Each of these were critically analysed. A process of thematic analysis identified three prevalent themes: ensuring physical comfort, providing an appropriate physical environment and the importance of relatives. CONCLUSION The review revealed that creating a less technical environment within the ICU can influence a 'good death', but further research is needed to establish how this can be enacted. More effective management of physical symptoms such as pain and dyspnoea are also recommended. Including care of relatives in care plans was also found to contribute toward a 'good death' and that this could be facilitated through improved staff education. Providing a private area for grieving relatives within the ICU has also had an impact in enabling a 'good death'.
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Affiliation(s)
- Nicola Stanzl
- Adult Nursing Student, Department of Nursing and Clinical Sciences, Bournemouth University, UK
| | - Janet Scammell
- Associate Professor; Co-Director, Nursing Long-term Health Challenges Research Centre, Department of Nursing and Clinical Sciences, Bournemouth University, UK
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Muñoz Camargo JC, Hernández-Martínez A, Rodríguez-Almagro J, Parra-Fernández ML, Prado-Laguna MDC, Martín M. Perceptions of Patients and Their Families Regarding Limitation of Therapeutic Effort in the Intensive Care Unit. J Clin Med 2021; 10:4900. [PMID: 34768420 PMCID: PMC8584556 DOI: 10.3390/jcm10214900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to determine and describe the opinion and attitudes of patients and their families regarding the limitation of therapeutic effort and advanced directives in critical patients and whether end-of-life planning occurs. Religious affiliation, education level, and pre-admission quality of life were also evaluated to determine whether they may influence decisions regarding appropriate therapeutic effort. METHODS A prospective, observational and descriptive study, approved by the center's ethical committee, was carried out with 257 participants (94 patients and 163 family members) in the intensive care unit (ICU). A questionnaire regarding the opinions of patients and relatives about situations of therapeutic appropriateness in case of poor prognosis or poor quality of life was used. The questionnaire had three sections. In the first section, sociodemographic features were investigated. In the second section, information was collected on the quality of life and functional situation before ICU admission (taking as a reference the situation one month before admission) assessed by the Karnofsky scale, Barthel index, and the PAEEC scale (Project for the Epidemiological Analysis of Critical Care Patients). The third section aimed to determine whether the family knew the patient's opinion regarding his/her end of life. RESULTS Of those interviewed, 62.2% would agree to limit treatment in case of poor prognosis or poor quality of future life. In contrast, 37.7% considered that they should fight for life, even if it is irretrievable. Only 1.6% had advanced directives registered, 43.9% of the participants admitted deterioration in their quality of life before ICU admission, 18.2% with moderate-severe deterioration. Our study shows that the higher the educational level, the lower the desire to fight for life when it is irretrievable and the greater the agreement to limit treatment. Besides, those participants not affiliated with a religion were significantly less likely to fight for life, including when irretrievable, than Catholics and were more likely to agree to limit treatment. CONCLUSIONS More than half of the participants would agree to limit treatment in the case of a poor prognosis. Our results indicate that patients do not prepare for the dying process well in advance. Religion and educational level were determining factors for the choice of procedures at the end of life, both for patients and their families.
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Affiliation(s)
- Juan Carlos Muñoz Camargo
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain; (J.C.M.C.); (A.H.-M.); (J.R.-A.); (M.L.P.-F.); (M.d.C.P.-L.)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain; (J.C.M.C.); (A.H.-M.); (J.R.-A.); (M.L.P.-F.); (M.d.C.P.-L.)
| | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain; (J.C.M.C.); (A.H.-M.); (J.R.-A.); (M.L.P.-F.); (M.d.C.P.-L.)
| | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain; (J.C.M.C.); (A.H.-M.); (J.R.-A.); (M.L.P.-F.); (M.d.C.P.-L.)
| | - María del Carmen Prado-Laguna
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La Mancha, 13071 Ciudad Real, Spain; (J.C.M.C.); (A.H.-M.); (J.R.-A.); (M.L.P.-F.); (M.d.C.P.-L.)
| | - Mairena Martín
- Department of Inorganic, Organic Chemistry and Biochemistry, Faculty of Nursing of Ciudad Real, Regional Center of Biomedical Research (CRIB), Universidad de Castilla-La Mancha, 13091 Ciudad Real, Spain
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O'Conner-Von S, Bennett F. Long-Term Care Nurses and Their Experiences With Patients' and Families' End-of-Life Preferences: A Focus Group Study. J Gerontol Nurs 2021; 46:23-29. [PMID: 33232494 DOI: 10.3928/00989134-20201106-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
Long-term care (LTC) nurses are a critical nexus for patient communication and vital to advance care planning due to their professional role and breadth of patient relationships. The current study's aim was to explore the communication strategies Midwestern LTC nurses use to clarify patients' end-of-life (EOL) care preferences. Two focus groups used a phenomenological framework to elucidate the experiences of 14 RNs. Data analysis revealed two themes grounded in time: (a) nurses use time to assess patients' EOL situation and assist patients to discern care options; and (b) nurses educate patients about EOL care, adjust care plans, and develop trusting relationships. Two themes were grounded in clinical experience: (a) nurses become persistent advocates and educators to initiate and sustain EOL communication; and (b) nurses learn consistency in communication, including awareness of patients' nonverbal communication. Nurses shared that EOL communication is never "done"; time frames to assess, educate, and clarify are continuous. [Journal of Gerontological Nursing, 46(12), 23-29.].
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A national Position Statement on adult end-of-life care in critical care. Aust Crit Care 2021; 35:480-487. [PMID: 34384650 DOI: 10.1016/j.aucc.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
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Al-Shamaly HS. A focused ethnography of the culture of inclusive caring practice in the intensive care unit. Nurs Open 2021; 8:2973-2985. [PMID: 34318598 PMCID: PMC8510735 DOI: 10.1002/nop2.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To explore and understand the culture of nurses' multidimensional “caring‐for” practice in intensive care unit (ICU). Design A focused ethnography. Methods Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used. Findings Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring‐for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.
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Bennett FB, Hadidi NN, O'Conner-Von SK. End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research. J Gerontol Nurs 2021; 47:43-49. [PMID: 34191654 DOI: 10.3928/00989134-20210604-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].
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Stokes F, Zoucha R. Nurses' Participation in Limited Resuscitation: Gray Areas in End of Life Decision-Making. AJOB Empir Bioeth 2021; 12:239-252. [PMID: 33871322 DOI: 10.1080/23294515.2021.1907477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Historically nurses have lacked significant input in end-of-life decision-making, despite being an integral part of care. Nurses experience negative feelings and moral conflict when forced to aggressively deliver care to patients at the EOL. As a result, nurses participate in slow codes, described as a limited resuscitation effort with no intended benefit of patient survival. The purpose of this study was to explore and understand the process nurses followed when making decisions about participation in limited resuscitation. Five core categories emerged that describe this theory: (1) recognition of patient and family values at the EOL; (2) stretching time and reluctance in decision-making; (3) harm and suffering caused by the physical components of CPR; (4) nurse's emotional and moral response to delivering aggressive care, and; (5) choosing limited resuscitation with or without a physician order. Several factors in end-of-life disputes contribute to negative feelings and moral distress driving some nurses to perform slow codes in order to preserve their own moral conflict, while other nurses refrain unless specifically ordered by physicians to provide limited care through tailored orders.
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Affiliation(s)
- Felicia Stokes
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Rick Zoucha
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania, USA
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Walker W, Efstathiou N. What's in this Special Issue. Nurs Crit Care 2020; 25:263-265. [PMID: 32815294 DOI: 10.1111/nicc.12535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Vanderspank-Wright B, Wright DK, McMillan K. Thinking about strengths in end-of-life nursing practice: the case of intensive care unit nurses. Int J Palliat Nurs 2020; 25:378-385. [PMID: 31437107 DOI: 10.12968/ijpn.2019.25.8.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context. AIM To stimulate a reflective examination of intensive care nursing practice with respect to end-of-life care. METHODS The work of contemporary nursing scholar Laurie Gottlieb is used to perform a strengths-based relational ethical examination of previously published literature that describes critical care nurses' experiences of providing end-of-life care in the ICU. FINDINGS This literature suggests that the relational ethical value of authentic engagement, which is fundamental to the disciplinary ethos of expert palliative care nursing, is reflected in the everyday practice of intensive care nurses whose patients die while under their care. CONCLUSION A strengths-based approach can make visible the relational ethical practice of critical care nurses who care for dying patients and their families in the ICU.
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Affiliation(s)
- Brandi Vanderspank-Wright
- Associate Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa Canada
| | - David Kenneth Wright
- Associate Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa Canada
| | - Kim McMillan
- School of Health and Community Studies, Algonquin College, Ottawa Canada
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Intensive care nurses’ experiences of withdrawal of life-sustaining treatments in intensive care patients: A qualitative study. Intensive Crit Care Nurs 2020; 56:102768. [DOI: 10.1016/j.iccn.2019.102768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
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Griffiths I. What are the challenges for nurses when providing end-of-life care in intensive care units? ACTA ACUST UNITED AC 2020; 28:1047-1052. [PMID: 31518542 DOI: 10.12968/bjon.2019.28.16.1047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM this literature review aimed to explore qualitative studies in which nurses discussed the challenges they face when delivering end-of-life care in intensive care units (ICUs). Analysis and discussion of the studies' findings aimed to contribute to the current evidence base surrounding the subject. METHOD a systematic search of academic databases was conducted to source relevant studies. An inductive process using grounded theory was undertaken to elicit suitable themes to address the review question. FINDINGS six relevant studies were identified with four main themes emerging from analysis. The themes were a lack of nurse involvement in end-of-life care decision-making, a lack of nursing knowledge in providing end-of-life care, the dilemma of prioritising care between the patient and family, and the nature of providing end-of-life care within an ICU environment. CONCLUSION the provision of end-of-life care in ICUs requires nurses to be involved in interdisciplinary communication. ICU-specific end-of-life care education, training and guidelines need to be implemented to ensure patients receive high-quality, patient-centred care.
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Affiliation(s)
- Ian Griffiths
- Staff Nurse, Critical Care, London North West University Healthcare NHS Trust
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Temelli G, Cerit B. Perceptions of Palliative Care Nurses Related to Death and Palliative Care Practices. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:378-398. [PMID: 31841067 DOI: 10.1177/0030222819890457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study has been conducted with the purpose of identifying the perceptions of palliative nurses about death and determining palliative care practices. We conducted qualitative interviews with 23 palliative care nurses in Turkey. Content analysis was used in the evaluation of the data. Three themes have been identified about perception of death. Furthermore, three themes have been identified about palliative care practices. It was concluded that the palliative nurses perceive death as a natural and inevitable process and that as long as their working period increases, they become desensitized. It was identified that the participants generally perform the following procedures in palliative care practices.
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Affiliation(s)
- Gülnur Temelli
- Fundamentals of Nursing Department, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Turkey
| | - Birgül Cerit
- Fundamentals of Nursing Department, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Turkey
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Stokes H, Vanderspank-Wright B, Fothergill Bourbonnais F, Wright DK. Meaningful experiences and end-of-life care in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2019; 53:1-7. [DOI: 10.1016/j.iccn.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/14/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
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Dreher BS. All the Comforts of Home: Transformation to a Comfort Environment in Critical Care. Crit Care Nurse 2019; 37:78-80. [PMID: 28148619 DOI: 10.4037/ccn2017350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Betsey S Dreher
- Betsey Dreher is the clinical education coordinator of the intensive care unit at Bristol Hospital, Bristol, Connecticut.
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Exploring nurses’ end-of-life care for dying patients in the ICU using focus group interviews. Intensive Crit Care Nurs 2019; 52:3-8. [DOI: 10.1016/j.iccn.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/19/2022]
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Karbasi C, Pacheco E, Bull C, Evanson A, Chaboyer W. Registered nurses' provision of end-of-life care to hospitalised adults: A mixed studies review. NURSE EDUCATION TODAY 2018; 71:60-74. [PMID: 30245257 DOI: 10.1016/j.nedt.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/04/2018] [Accepted: 09/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe, critically appraise and synthesise research regarding nurses' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives. DESIGN Mixed studies review. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching. REVIEW METHODS Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically. RESULTS Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care. CONCLUSIONS Registered Nurses have aligned their end-of-life care with practice with the profession's expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.
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Affiliation(s)
- C Karbasi
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - E Pacheco
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - C Bull
- Centre for Applied Health Economics (CAHE), Griffith University, Nathan Campus, 4111 QLD, Australia.
| | - A Evanson
- North West Hospital and Health Service, Mount Isa Hospital, 30 Camooweal Street, QLD 4825, Australia.
| | - W Chaboyer
- Menzies Health Institute Queensland, Griffith University, 4215 QLD, Australia.
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Wiegand DL, Cheon J, Netzer G. Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU. Am J Hosp Palliat Care 2018; 36:13-23. [DOI: 10.1177/1049909118801011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.
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Affiliation(s)
| | - Jooyoung Cheon
- Department of Nursing Science, College of Nursing, Sungshin Women’s University, Seoul, South Korea
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
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Yáñez Dabdoub M, Vargas Celus IE. Cuidado humanizado en pacientes con limitación del esfuerzo terapéutico en cuidados intensivos, desafíos para enfermería. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.21.1.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
En las unidades de cuidados intensivos (UCI) el equipo de salud utiliza todas las medidas posibles para preservar la vida de sus pacientes. No obstante, cuando las terapias son fútiles, se decide limitar el esfuerzo terapéutico (LET). Este artículo tiene como objetivo describir los factores que pueden llevar a enfermería a deshumanizar sus cuidados en pacientes en LET en UCI. Revisión de la literatura en bases de datos, con las palabras clave: critical care, intensive care unit, limitation of therapeutic effort, end of life care, humanized/human care, nursing. Los hallazgos fueron agrupados en seis categorías que pueden influir en la deshumanización del cuidado en UCI. Se concluye que en el cuidado humanizado se destacan los roles de enfermería como defensora de los intereses del paciente y como agente comunicador.
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Lyu C, Zhang L. Who decides in withdrawal of treatment in a critical care setting? A case study on ethical dilemma. Int J Nurs Sci 2018; 5:310-314. [PMID: 31406841 PMCID: PMC6626226 DOI: 10.1016/j.ijnss.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
Case description Withdrawal of treatment is a common practice in critical care settings, perticularly when treatment is considered futile. The case study demonstrates an ethical dilemma, in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes. Under such a circumstance, withdrawal of treatment will inevitably be considered, although his family refused to do so. Consequently, acritical question must be answered: Who should make the decision? Ethical dilemma identification Danny decided to withdraw the use of life-support, whilst his wife and adult children refused to do so. The ethical dilemma is illustrated by the following question: Who decides the withdrawal of treatment in a critical care setting? Analysis To provide an opotional solution to this case and make the best moral decision, the current study will critically discuss this issue in conjunction with ethical principles, philosophical theories and the values statement of the European and Chinese nurses’ codes of ethics. Additionally, the associated literature relative to this case are analysed before the decision-making. Ethical decision-making The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment. If his family is involved in the discussion, the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients. Results In Danny’s case, health professionals opted to respect his decision to withdraw treatment. The medical staff maintained an effective communication with the family involved, and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.
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Affiliation(s)
- Chunmei Lyu
- The First People's Hospital of Foshan, Affiliated with Sun Yat-Sen University, China
| | - Li Zhang
- Department of Nursing, The First People's Hospital of Foshan, Affiliated with Sun Yat-Sen University, China
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Listening to How Experienced Nurses Care for the Dying Husband and His Spouse. Dimens Crit Care Nurs 2018; 36:193-201. [PMID: 28375996 DOI: 10.1097/dcc.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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.
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Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence. Int J Nurs Stud 2018; 77:15-26. [DOI: 10.1016/j.ijnurstu.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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Luckett A. End-of-life care guidelines and care plans in the intensive care unit. ACTA ACUST UNITED AC 2017; 26:287-293. [DOI: 10.12968/bjon.2017.26.5.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Luckett
- Nurse, Lecturer Pre-registration Nursing, University of Central Lancashire
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[End of life care difficulties in intensive care units. The nurses' perspective]. GACETA SANITARIA 2017; 31:299-304. [PMID: 28188012 DOI: 10.1016/j.gaceta.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). METHOD A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. RESULTS Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. CONCLUSIONS Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support.
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Becker CA, Wright G, Schmit K. Perceptions of dying well and distressing death by acute care nurses. Appl Nurs Res 2017; 33:149-154. [DOI: 10.1016/j.apnr.2016.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/15/2016] [Accepted: 11/10/2016] [Indexed: 11/25/2022]
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Efstathiou N, Ives J. Compassionate care during withdrawal of treatment: A secondary analysis of ICU nurses' experiences. Nurs Ethics 2017; 25:1075-1086. [PMID: 28116962 DOI: 10.1177/0969733016687159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. OBJECTIVES: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. DESIGN: The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. ETHICAL CONSIDERATIONS: The primary study was approved by the local Research Ethics Committee and the hospital's Research and Development services. FINDINGS: Compassionate care was mostly directed to the patient's family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient's dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. CONCLUSION: This study's findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians' roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.
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Velarde-García JF, Luengo-González R, González-Hervías R, Cardenete-Reyes C, Álvarez-Embarba B, Palacios-Ceña D. Limitation of therapeutic effort experienced by intensive care nurses. Nurs Ethics 2016; 25:867-879. [PMID: 28027690 PMCID: PMC6238171 DOI: 10.1177/0969733016679471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level. Objectives: To describe the experience of intensive care nurses practicing limitation of therapeutic effort. Method: A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ personal letters. The Giorgi proposal for data analysis was used on the data. Ethical considerations: This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality. Results: In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort. Conclusion: Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same.
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Affiliation(s)
- Juan Francisco Velarde-García
- Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
| | - Raquel Luengo-González
- Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
| | - Raquel González-Hervías
- Escuela de Enfermería de Cruz Roja de Madrid, Spain.,Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
| | - César Cardenete-Reyes
- Universidad Europea de Madrid, Spain.,Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
| | - Beatriz Álvarez-Embarba
- Universidad Autónoma de Madrid, Spain.,Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
| | - Domingo Palacios-Ceña
- Universidad Rey Juan Carlos, Spain.,Juan Francisco Velarde-García, Red Cross Nursing College, Universidad Autónoma de Madrid, Avenida Reina Victoria 28, 4a planta, 28003 Madrid, Spain
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Bloomer MJ, Endacott R, Ranse K, Coombs MA. Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand. J Clin Nurs 2016; 26:690-697. [DOI: 10.1111/jocn.13585] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research; Deakin University; Geelong Vic. Australia
| | - Ruth Endacott
- Plymouth University; Plymouth UK
- School of Nursing and Midwifery; Monash University; Frankston Vic. Australia
| | - Kristen Ranse
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - Maureen A Coombs
- Graduate School of Nursing Midwifery and Health; Victoria University of Wellington; Wellington New Zealand
- Capital and Coast District Health Board; Wellington New Zealand
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End-of-life care practices of critical care nurses: A national cross-sectional survey. Aust Crit Care 2016; 29:83-9. [DOI: 10.1016/j.aucc.2015.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/22/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022] Open
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Ranse K, Yates P, Coyer F. Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision. Intensive Crit Care Nurs 2016; 33:48-55. [DOI: 10.1016/j.iccn.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/29/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
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Kisorio LC, Langley GC. Intensive care nurses' experiences of end-of-life care. Intensive Crit Care Nurs 2016; 33:30-8. [PMID: 26791353 DOI: 10.1016/j.iccn.2015.11.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 09/25/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore intensive care nurses' experiences of end-of-life care in adult intensive care units. DESIGN AND METHODS An exploratory, descriptive qualitative approach was utilised. Purposive sampling method was used to select nurse participants (n=24) working at the selected intensive care units in the three academic affiliated, tertiary specialist hospitals in the Johannesburg and Pretoria regions, South Africa. Using a focus group guide, three focus group discussions were conducted. Data were analysed using the long-table approach (Krueger and Casey, 2000). Trustworthiness of the study was ensured by following the criteria set out by Lincoln and Guba (1985). FINDINGS Five major themes related to nurses' experiences of end-of-life care emerged. These included: "difficulties we experience", "discussion and decision making", "support for patients", "support for families" and "support for nurses". CONCLUSION End-of-life care can be difficult and a challenging process. Nevertheless, this study has highlighted some of the interventions and support systems that could be incorporated for improved caring process. Whereas the dying patients and their families need to be continuously supported, critical care nurses too need to be taken care of for them to continue providing the best possible end-of-life care.
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Affiliation(s)
- Leah C Kisorio
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Park Town 2193, Johannesburg, South Africa.
| | - Gayle C Langley
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Park Town 2193, Johannesburg, South Africa.
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