A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit

The impact of COVID-19 on the provision of bereavement support in Australian intensive care units: A national survey

BACKGROUND

Bereavement support is a vital part of caring for families when a patient dies in the intensive care unit (ICU). Previous research has demonstrated that while many ICUs provide some informal aspects of bereavement care, formalised follow-up programmes are uncommon. The impacts of COVID-19 on ICU-based bereavement support are currently unknown.

OBJECTIVES

The objectives of this study were to explore the current provision of bereavement support in Australian ICUs and identify the impacts of the COVID-19 pandemic on these services.

METHODS

A cross-sectional exploratory web-based survey was used. The survey was distributed to one senior nurse in each public and private adult, paediatric, and neonatal ICU in Australia between April and July 2022. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Ethical approval was received from La Trobe University.

RESULTS

One hundred and four ICUs from 82 hospitals responded to the survey, with 36 units reporting a formal bereavement follow-up service. When compared to prepandemic levels, almost all of the common bereavement care practices explored in the survey were significantly reduced during the COVID-19 pandemic. Open-ended responses also demonstrated significant impacts of COVID-19 on bereavement care provision, particularly related to Restricted family togetherness, Logistical Challenges, and Impacts on Staff. Staff members reported adjusting care provision in response to these challenges by exploring Alternative family communications, Facilitation of family togetherness, and Increasing familysupports.

CONCLUSIONS

Many of the common elements of ICU-based bereavement care were significantly reduced during the COVID-19 pandemic. In addition, the number of formal bereavement follow-up services in Australian ICUs remains largely unchanged since 2015. Ongoing research is needed to explore the long-term effects of these changes on staff and family wellbeing and on ongoing provision of ICU-based bereavement support.

Futile life-sustaining treatment in the intensive care unit - nurse and physician experiences: meta-synthesis

BACKGROUND

Continuing futile life-sustaining treatment prolongs patients' suffering and family members' and medical staff's psychological distress. Additionally, continuing futile treatment is inefficient in healthcare resource distribution. Although the withdrawal of futile life-sustaining treatment is ideal, the prevalence is variable.

OBJECTIVE

To synthesise nurses' and physicians' experiences with continuing futile life-sustaining treatment in the intensive care unit.

DESIGN

This meta-synthesis was conducted following the thematic synthesis. The Preferred Reporting Items for Systematic Review and Meta-Analyses and Enhancing transparency in reporting the synthesis of qualitative research statement were used in reporting the synthesis of qualitative research statements.

METHODS AND DATA SOURCES

A systematic search was conducted following the inclusion and exclusion criteria in APA PsycINFO, CINAHL Plus, EMBASE, MEDLINE, PubMed and Web of Science in May 2023. Two reviewers independently screened and extracted the data. The extracted data were analysed using thematic analysis of qualitative research.

FINDINGS

A total of 16 studies were finally included, and 141 quotes were extracted and analysed. The main findings were categorised into four themes: (1) contextual and cultural diversity, (2) perceptions of futile treatment, (3) professional roles and responsibilities, and (4) emotional distress.

CONCLUSION

The study highlights the influence of culture, religion and family members, as well as perceptions of futile treatment among clinicians, on continuing futile life-sustaining treatment. Also, nurses' awareness of their roles and responsibilities in ensuring patients' comfort at end of life was revealed. This study informs future research to explore the experiences of futile life-sustaining treatment across various contexts.

Grief Support and Coping Mechanism Mediate the Effect of Grief on Burnout Among Intensive Care Unit Nurses: A Structural Equation Modeling Analysis

BACKGROUND

Patients' death caused the intensive care unit (ICU) nurses to grieve, which led to their burnout. Intensive care unit nurses use various coping mechanisms and need support to overcome grief.

OBJECTIVE

The aim of this study was to identify the mediation effects of coping mechanisms and grief support on the impact of grief on burnout.

METHOD

This cross-sectional study among 660 ICU nurses from 9 hospitals used 4 self-reported instruments to collect data, apart from the sociodemographic and employment-related variables. A final model was developed through structural equation modeling after establishing the construct validities of the measures through confirmatory factor analysis.

RESULTS

The representation of ICU nurses from each hospital was greater than 50%, with the majority being female (90.8%) with a mean age of 27.27 years. Most nurses perceived the absence of grief, low burnout, and moderate to low grief support. The nurses use various coping mechanisms. Grief support significantly mediated the relationship between grief and burnout using a bootstrapping method with a mediation strength using the variance counted for (VAF) of 34.95%. The final model fit indices with acceptable values validated the direct and indirect relationships of grief, grief support, and coping mechanisms on burnout.

DISCUSSION

The significant influence of grief support in mediating the effect of grief on burnout is an important finding. The nursing and hospital management can use this finding to provide grief support to ICU nurses, enhance the grief support resources, and promote future studies to test the model's validity and applicability to health care professionals who frequently face patients' death.

Attitude of nurses caring critically ill patients admitted in the ICUs of AIIMS Hospital, Jodhpur

BACKGROUND

Nurses are internationally recognized to be largest group of registered and regulated practitioner in the health workforce of any country. There is an increase in number of critically ill patients seeking optimal care, and this rapidly increases the demand for the critical care nurses at the end of life. Caring for a critically ill patient creates anxiety and emotional exhaustion and may sometimes lead to burnout. So, it is imperative for the nurses to have an optimistic approach while caring patients in the ICU. The aim of the study was to assess the attitude of the nurses caring critically ill patients and to determine the association of the level of attitude with the selected personal variable. The study was conducted at ICUs of tertiary care hospital by using descriptive research design.

METHODS AND MATERIAL

A cross-sectional descriptive study was conducted in ICUs of tertiary care hospital from October to December 2018. The sample was selected by total enumeration technique. Data was collected from 60 critical care nurses with the help of self-structured five-point Likert scale to assess the attitude of nurses. Descriptive statistics and inferential statistics were used for data analysis such as mean, frequency, percentage, standard deviation, and Chi-square test.

RESULTS

Majority (81.7%) of the nurses were having favorable attitude toward caring the critically ill patients, and there was no significant association of the attitude score with the selected personal variable at P < 0.05.

CONCLUSIONS

Majority of critical care nurses have favorable attitude. If they have supportive environment at workplace, their willingness to work toward quality care will improve further.

Nurses' perceptions of supporting a 'good death' in intensive care units

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'.

Exploring societal perspectives on priorities at the end of life in South Korea using Q-methodology

AIM

To explore societal perspectives on priorities at the end of life in South Korea, an Asian country with high characteristics of Confucian culture. Based on this understanding, this study proposes strategies for establishing well-dying Confucian heritage cultures.

METHODS

Q-methodology, suitable for analyzing human subjectivity, was used in this study. Thirty-four Q-statements were extracted from the 170 Q population, which were gathered from literature reviews and online resources. Participants were 33 people expected to present diverse views of priorities at the end of their lives. The data were analyzed with principal component analysis and varimax rotations using the PQMethod software.

RESULTS

Four distinct perspectives on priorities at the end of life in South Korea were identified: "Emphasizing the right to self-determination," "Avoiding burdening the family," "Putting life first," and "Connotations with a complex perspective."

CONCLUSIONS

This study provides strategies for preparing various nursing interventions or policies for the establishment of a well-dying culture based on the four identified perspectives on priorities at the end of life, especially in countries with Confucian heritage cultures.

Effects of simulation problem-based learning based on Peplau's Interpersonal Relationship Model for cesarean section maternity nursing on communication skills, communication attitudes and team efficacy

BACKGROUND

In the coronavirus disease-impacted era, many medical institutions have not permitted clinical practice at hospitals or have operated their training on a restricted basis. The effective strategy for improving therapeutic communication and team cooperation as a nursing core competency is required.

OBJECTIVES

The study aimed to verify the effects of simulation problem-based learning on nursing students' communication skills, communication attitudes, and team efficacy.

DESIGN

Non-equivalent control group pretest-posttest design.

SETTINGS

A university in South Korea.

PARTICIPANTS

Nursing students who were classified as advanced beginners were randomly allocated to the control group (n = 46) or the experimental group (n = 47).

METHODS

The experimental group's students participated in the simulation problem-based learning for cesarean section maternity nursing. The control group's students participated in a conventional type of maternity nursing clinical practice. The communication skills, communication attitudes, and team efficacy were measured by using a self-reported questionnaire.

RESULTS

As compared with the pretest, the communication attitudes increased significantly (t = 2.41, p = .020) in the posttest for the experimental group. The communication skills (t = 1.47, p = .150) and team efficacy (F = 3.30, p = .073) were not statistically significant.

CONCLUSIONS

The simulation problem-based learning in clinical practice is recommended to improve communication attitudes for nursing students and to apply the learned knowledge in simulated nursing situations through experiential learning. Future research is particularly needed the standardized educational program to identify the long-term effects in various cases and settings.

Nursing students perceptions of death and dying: A descriptive quantitative study

BACKGROUND

Nurses are frequently present during the dying process as a support for the dying person and the family. Experiencing death in this capacity can cause emotional and psychological stress to the nursing staff as they work to help others. Nursing students as the upcoming generation of nurses, need the knowledge and self-awareness to support others through these often traumatic events. Many students may not have experience with death or dying and when combined with lack of knowledge will be a great barrier once students graduate.

OBJECTIVES

The purpose of this study is to determine how sophomore, junior, and senior undergraduate nursing students enrolled in one University setting perceive the concept of death and dying.

DESIGN

A descriptive quantitative study was designed to explore the various perceptions that sophomore, junior, and senior nursing students have about death and dying.

RESULTS

The Frommelt Attitudes Toward Care of the Dying scale showed students have a positive attitude toward caring for dying patients. The Death Attitudes Profile-Revised scale indicated the presence of all profiles, though most students identified with Neutral Acceptance profile.

CONCLUSIONS

Nursing students often fear caring for clients with death or dying. Additional targeted education along with end of life care simulations can improve students improve their attitudes and beliefs to better care for patients.

Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

AIM

To explore the association of organizational structures when integrating palliative care in intensive care units.

BACKGROUND

Palliative care within intensive care settings has been widely recognized as an area requiring improvement when caring for patients and their families. Despite this, intensive care units continue to struggle to integrate palliative care.

METHODS

A qualitative descriptive methodology was used. Data were collected through research interviews with 15 managers and 36 health care professionals working in intensive care. The data were analysed adopting constant comparative analysis.

RESULTS

This study provides insight into a diverse range of perspectives on organizational structure in the context of facilitation and the challenges posed. Three themes were identified: Do not resuscitate policy as a gateway to palliative care, facilitating family members to enable participation and support and barriers for palliative care in intensive care unit as a result of intensive care organization.

CONCLUSIONS

In fostering a sustainable organizational culture and practice development in intensive care, the findings indicate the need for specific palliative care policies and implementation strategies tailored according to context.

IMPLICATIONS FOR NURSING MANAGEMENT

Management has a responsibility to facilitate dialogue within any multidisciplinary team regarding palliative care and, in particular, to focus on 'do not resuscitate' policies as a gateway into this conversation.

Healthcare professionals' values about and experience with facilitating end-of-life care in the adult intensive care unit

OBJECTIVES

To evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.

RESEARCH DESIGN

Using a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.

SETTING

General adult intensive care unit at a tertiary referral hospital.

RESULTS

Compared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).

CONCLUSION

Findings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.

Mediating Effects of Role Perception of Life-sustaining Treatment in the Relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment among Nursing College Students

Purpose

This study examined the relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment among nursing college students, and attempted to identify the mediating effect of Role Perception on Life-sustaining Treatment in that relationship. It is hoped that the findings will ultimately contribute to the development of active nursing strategies.

Methods

The participants were 142 nursing college students in the third and fourth years of study who had experienced clinical practice at two universities in cities Y and C. Data were collected from November 1 to 30, 2019. For data analysis, SPSS for Windows version 22.0 was used to calculate descriptive statistics, the t-test, Pearson's correlation coefficients, and multiple regression. To analyze the mediating effect, the Baron and Kenny bootstrapping method was used.

Results

Attitudes toward Withdrawal of Life-sustaining Treatment of nursing college students had a significant positive correlation with Knowledge of Life-sustaining Treatment Plans (r=0.34, P<0.001) and Role Perception on Life-sustaining Treatment (r=0.44, P<0.001). Role Perception on Life-sustaining Treatment partially mediated the relationship between Knowledge of Life-sustaining Treatment Plans and Attitudes toward Withdrawal of Life-sustaining Treatment (95% CI, 0.446~1.055).

Conclusion

Based on the results of this study, improving nursing college students' Role Perception on Life-sustaining Treatment could be used as a coping strategy to establish positive Attitudes toward Withdrawal of Life-sustaining Treatment.

Psychometric properties of the Chinese version of the End-of-Life Decision-Making and Staff Stress Questionnaire

Background/objective

The goal of this study is to establish a Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire to assess its reliability and validity.

Method

A sample of 119 Intensive Care Unit physicians and 485 nurses in China completed the questionnaire, along with questionnaires assessing motional exhaustion subscale, Stress Overload Scale, and other variables associated with end-of-life decision.

Results

Seven factors obtained via exploratory factor analysis could explain 70.61% of the total variance. Confirmatory factor analysis demonstrated an acceptable model fit with Root Mean Square Error of Approximation (RMSEA) being .078 and Standardized Root Mean Square Residual (SRMR) being .066. Validity evidence based on relationships with other variables was provided by positive or negative correlations between the questionnaire subscales and emotional exhaustion, stress overload, and other variables associated with end-of-life decision. The average content validity index was .96. The Cronbach’s α and test–retest reliability was outstanding.

Conclusions

The Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire is a reliable and valid instrument for measuring the facilitators and hinders to facilitate the end-of-life decision-making, communication and the associated pressure perceived by relevant Intensive Care Unit medical staff among the Chinese population.

Nurses' early and ongoing encounters with the dying and the dead: a scoping review of the international literature

BACKGROUND

End-of-life care is high on policy and political agendas in the UK and internationally. Nurses are at the forefront of this, caring for dying patients, 'managing' the dead body, and dealing with the corporeal, emotional and relational dimensions of death. Little is known about nurses' prior or early professional experiences of and reactions to death, dying and the corpse and how these might influence practice.

AIMS

To appraise the international literature on nurses' early experiences of death, dying and the dead body, to better understand how these might influence subsequent practice, and how this might inform our teaching of death, dying and last offices.

METHODS

A scoping review was undertaken of peer-reviewed publications between, 2000 and 2019, which included nurses working in hospital, care homes and the community. Medline, PubMed, PsychINFO and CINAHL databases were searched and 23 papers meeting the inclusion criteria were read. Arksey and O'Malley's (2005) five-stage approach was adopted to scope the relevant international literature, using where relevant the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Selected papers were independently reviewed and subjected to thematic analysis, leading to the generation of five overarching themes.

RESULTS

The five themes were: different philosophies of care; relationships; knowledge; impact of death; and giving care. The studies came from diverse geographical locations across different settings and were primarily qualitative in design.

CONCLUSIONS

Students and registered nurses are impacted both positively and negatively by their early encounters with death and dying. Good communication with patients, families and between professionals, understanding of what constitutes a 'good' death, and high-quality mentorship and support were of particular importance.

Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

Background

While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals.

Method

A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies.

Results

Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients’ involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication.

Conclusion

Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians’ perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.

The effectiveness of training interventions on nurses' communication skills: A systematic review

OBJECTIVES

The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice.

DESIGN

A systematic review of literature.

DATA SOURCES

Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures.

REVIEW METHODS

The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis.

RESULTS

Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills.

CONCLUSIONS

Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.

What are the challenges for nurses when providing end-of-life care in intensive care units?

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.

Nurses' perceptions of and barriers to the optimal end-of-life care in hospitals: A cross-sectional study

AIMS AND OBJECTIVES

To assess nurses' perceptions of what constitutes optimal end-of-life (EOL) care in hospital and evaluate nurses' perceived barriers to EOL care delivery.

BACKGROUND

Care of dying patients is common in hospitals. However, little is known about the important elements of and barriers to optimal EOL care from key service providers' perspective, which is crucial for quality EOL care in hospital settings.

METHOD

This is a cross-sectional survey. Nurses practising in hospitals recruited by convenience sampling completed self-report survey questionnaires. STROBE checklist was used in study reporting.

RESULTS

One hundred and-seventy-five nurses participated in the survey. The majority (70%) had experience in caring for dying patients. The five most highly perceived factors constituting optimal EOL care included the following: "families know and follow patient's EOL wishes"; "patients emotional concerns identified and managed well"; "patients participating in decision-making"; "EOL care documents stored well and easily accessed"; and "provide private rooms and unlimited visiting hours for families of dying patients". Top five barriers were "doctors are too busy"; "nurses are too busy"; "insufficient private room/space"; "nurses have limited training in EOL care"; and "families have unrealistic expectations of patient's prognosis." Multivariate regression analysis identified that nurses without experience in caring for dying patients reported a significantly higher number of perceived barriers towards EOL care (p = .012). Those with postgraduate degree training reported significantly fewer perceived barriers (p = .007).

CONCLUSION

Findings identified essential elements for optimal hospital EOL care not only involving patients and families in EOL decision and care, but also documentation and environmental issues in the healthcare system level and the needs for strengthening manpower and expertise at palliative care policy level.

RELEVANCE TO CLINICAL PRACTICE

This study revealed quantitative data to inform health service managers and policy makers in terms of training and service development/ re-design for EOL care in hospital settings.

Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study

AIMS AND OBJECTIVES

The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness?

BACKGROUND

Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession.

DESIGN

A qualitative descriptive design was used.

METHODS

Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study.

RESULTS

In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families.

CONCLUSIONS

Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions.

RELEVANCE TO CLINICAL PRACTICE

Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.

Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study

A majority of nurses struggled with a negative emotion of anger, doubt, fear, or anxious, uncomfortable in the face of death and dying. However, little was known about community health care providers' in China. Therefore, we conducted a study to investigate their knowledge and attitudes toward end-of-life care and analyze its influencing factors. To provide reference for developing effective strategies to promote end-of-life care in China.A total of 132 community health care providers of 10 community health care centers in Changzhi city were investigated by a Questionnaire of Knowledge and Attitudes toward Caring for the Dying from May, 2017 to December, 2017, and data was analyzed by SPSS 22.0 software.Of the 132 community health care providers who were under investigation, 70 knew about hospice care, but they rated their overall content on end-of-life care as inadequacy, especially in communication skills and knowledge of pain management. The average score of attitudes was 3.47 (SD = 0.44), the lowest score was in the subscale of nurse-patient communication, which was 2.91 (SD = 0.65). Health care providers who had worked for more than 11 years, who had experiences of the death of relatives or friends, and who had previous experiences of caring for terminal patients had more positive attitudes toward caring for the dying (P < .05 for all). There was a significant relationship between community health care providers' attitudes toward death and their attitudes toward end-of-life care (r = -0.282, P < .01). The significant predictors of attitudes toward end-of-life care were attitudes toward death (β = -0.342), experiences of the death of relatives (β=-0.207), experiences of caring for the dying (β = 0.185), and working experience (β = 0.171).Community health care providers had positive attitudes toward end-of-life care, but they lacked systematic and professional knowledge and skills of caring for the terminal patients. Education is the top priority. It is imperative to set up palliative care courses and life-death education courses, establish an indigenous end-of-life care model, and improve policies, systems, and laws to promote end-of-life care.

End-of-life care content in postgraduate critical care nursing programs: Structured telephone interviews to evaluate content-informing practice

BACKGROUND

The provision of end-of-life care remains a significant component of work for clinicians in critical care settings. Critical care nurses report that this area of practice receives limited attention in education and training.

OBJECTIVES

The objective of this study was to identify and describe the end-of-life care content in postgraduate critical care nursing programs in Australia.

METHODS

Using a descriptive exploratory research design, an Internet search was undertaken in August 2015, identifying 17 education providers offering postgraduate critical care nursing programs. Thirteen individuals agreed to participate in a structured telephone interview regarding end-of-life content in their postgraduate program. Descriptive statistics were calculated to summarise the data obtained.

RESULTS

Twelve participants reported that end-of-life care content was explicitly addressed in their postgraduate critical care nursing programs, yet variation in actual content areas covered was evident. The majority of programs addressed content related to organ donation (92%) and legal and ethical issues (77%). However, content least commonly identified as covered pertained to the work of the nurse in providing direct clinical care to the patient at the end of life and his or her family, including the physical changes experienced by the dying patient (31%), respiratory management encompassing withdrawal of ventilation and symptom management (23%), emotional support of family (23%), care of the body after death (23%), and the process of withdrawing life-sustaining treatment (15%). Participants (92%) agreed that end-of-life content was important in postgraduate critical care nursing programs, with 77% of participants agreeing that more time should be allocated to end-of-life content.

CONCLUSIONS

This study provides preliminary evidence of the variation in end-of-life content in postgraduate critical care nursing programs in Australia. Addressing gaps in end-of-life care content in formal education, including clinical care of the dying patient, is urgently needed to address the complexity of this phase of care that is so frequently provided in critical care units.

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

OBJECTIVES

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

DESIGN

Mixed studies review.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

Nurses' perceptions of intensive care unit palliative care at end of life

BACKGROUND

Significant barriers can block the provision of palliative care at the end of life in the intensive care unit (ICU). However, the relationship between perceptions of ICU quality palliative care and barriers to palliative care at the end of life is not well documented.

AIMS AND OBJECTIVES

To describe ICU nurses' perceptions of quality palliative end-of-life care, barrier intensity and frequency to palliative care and their association with one another.

DESIGN

This was a descriptive, correlational, cross-sectional design.

METHODS

A convenience sample of 126 ICU nurses from two hospitals in Israel was recruited for the study. Participants completed three pencil-and-paper questionnaires (a personal characteristics questionnaire, the Quality of Palliative Care in the ICU and a revised Survey of Oncology Nurses' Perceptions of End-of-Life Care). Respondents were recruited during staff meetings or while on duty in the ICU. Ethical approval was obtained for the study from participating hospitals.

RESULTS

The item mean score of the quality of palliative end-of-life care was 7·5/10 (SD = 1·23). The item mean barrier intensity and frequency scores were 3·05/5 (SD = 0·76) and 3·30/5 (SD = 0·61), respectively. A correlation of r = 0·46, p < 0·001 was found between barrier frequency and intensity and r = -0·19, p = 0·04 between barrier frequency and quality palliative end-of-life care.

CONCLUSIONS

ICU nurses perceived the quality of palliative care at the end of life as moderate despite reports of moderate barrier levels. The frequency of barriers was weakly associated with quality palliative end-of-life care. However, barrier intensity did not correlate with quality palliative end-of-life care at a statistically significant level. Further research that investigates other factors associated with quality ICU palliative care is recommended.

RELEVANCE TO CLINICAL PRACTICE

Barriers to palliative care are still common in the ICU. Increased training and education are recommended to decrease barriers and improve the quality of ICU palliative care.

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

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.

Arts-based palliative care training, education and staff development: A scoping review

BACKGROUND

The experience of art offers an emerging field in healthcare staff development, much of which is appropriate to the practice of palliative care. The workings of aesthetic learning interventions such as interactive theatre in relation to palliative and end-of-life care staff development programmes are widely uncharted.

AIM

To investigate the use of aesthetic learning interventions used in palliative and end-of-life care staff development programmes.

DESIGN

Scoping review.

DATA SOURCES

Published literature from 1997 to 2015, MEDLINE, CINAHL and Applied Social Sciences Index and Abstracts, key journals and citation tracking.

RESULTS

The review included 138 studies containing 60 types of art. Studies explored palliative care scenarios from a safe distance. Learning from art as experience involved the amalgamation of action, emotion and meaning. Art forms were used to transport healthcare professionals into an aesthetic learning experience that could be reflected in the lived experience of healthcare practice. The proposed learning included the development of practical and technical skills; empathy and compassion; awareness of self; awareness of others and the wider narrative of illness; and personal development.

CONCLUSION

Aesthetic learning interventions might be helpful in the delivery of palliative care staff development programmes by offering another dimension to the learning experience. As researchers continue to find solutions to understanding the efficacy of such interventions, we argue that evaluating the contextual factors, including the interplay between the experience of the programme and its impact on the healthcare professional, will help identify how the programmes work and thus how they can contribute to improvements in palliative care.

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.