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Fernández-Gutiérrez MDC, Benavente-Fernández I, Jiménez-Luque N, Lubián-López S, López-Fernández C, Picardo-García JM. Nurses' Perception of Caring and Attitudes toward Caring for Dying Patients: Exploring the Relationship Using a Descriptive Cross-Sectional Design. Healthcare (Basel) 2024; 12:1331. [PMID: 38998865 PMCID: PMC11241302 DOI: 10.3390/healthcare12131331] [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: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
This study examines the association between nurses' perception of caring and attitudes toward caring for dying patients in end-of-life care units. We used a descriptive cross-sectional design with convenience sampling. Data were collected from May to June 2021 through self-reported questionnaires from 303 Spanish nurses (mean age = 48 years, 78.9% female). Participants completed the Caring Dimension Inventory (CDI-25) and the Frommelt Attitudes Toward Care of the Dying scale. Demographic and training information were collected. Data were analyzed using Stata 16.0. Attitudes toward Care of the Dying Patient were significantly higher in nurses with palliative care training (β = 2.829, p = 0.018) and those who scored higher on the psychosocial (β = 0.789, p = 0.0001) and technical dimensions (β = 0.487, p = 0.011) of the CDI-25. Multivariate analysis identified the psychosocial dimension of the CDI-25 scale (β = 0.783, p = 0.0001) and palliative care training (β = 2.686, p = 0.017) as the only significant variables associated with Attitudes toward Care of the Dying Patient. Overall, nurses exhibited a positive attitude toward caring for dying patients. Our results could potentially help nursing directors identify those with the necessary qualities and training for optimal end-of-life care and to further plan training courses to provide optimal care in end-of-life situations.
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Affiliation(s)
- María del Carmen Fernández-Gutiérrez
- Critical Care Unit, Puerta del Mar University Hospital, 11009 Cádiz, Spain;
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, 11009 Cádiz, Spain; (I.B.-F.); (S.L.-L.)
| | - Isabel Benavente-Fernández
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, 11009 Cádiz, Spain; (I.B.-F.); (S.L.-L.)
- Area of Pediatrics, Department of Child and Mother Health and Radiology, Medical School, University of Cádiz, 11003 Cádiz, Spain
- Division of Neonatology, Department of Pediatrics, Puerta del Mar University Hospital, 11009 Cádiz, Spain
| | - Natalia Jiménez-Luque
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, 11009 Cádiz, Spain; (I.B.-F.); (S.L.-L.)
| | - Simón Lubián-López
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University, 11009 Cádiz, Spain; (I.B.-F.); (S.L.-L.)
- Division of Neonatology, Department of Pediatrics, Puerta del Mar University Hospital, 11009 Cádiz, Spain
| | - Consuelo López-Fernández
- Department of Nursing, School of Nursing and Physiotherapy, University of Cadiz, 11009 Cádiz, Spain; (C.L.-F.); (J.M.P.-G.)
| | - Juan Manuel Picardo-García
- Department of Nursing, School of Nursing and Physiotherapy, University of Cadiz, 11009 Cádiz, Spain; (C.L.-F.); (J.M.P.-G.)
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Mrayyan MT, Al-Atiyyat N, Ashour A, Alshraifeen A, Algunmeeyn A, Al-Rawashdeh S, Sawalha M, Abu Khait A, Alfayoumi I, Sayaheen M, Odeh M. Nurses' perceptions of the obstacles and supportive behaviors of end-of-life care in intensive care units. ENFERMERIA INTENSIVA 2024; 35:23-34. [PMID: 37743169 DOI: 10.1016/j.enfie.2023.04.001] [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: 09/13/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE This study examined the Jordanian registered nurses' perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples' demographics. METHODS A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe's post hoc test. RESULTS The registered nurses' scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses' certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses' age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). CONCLUSIONS The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan.
| | - Nijmeh Al-Atiyyat
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Ala Ashour
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Ali Alshraifeen
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Abdullah Algunmeeyn
- Advanced Nursing Department, Faculty of Nursing, Isra University, P.O. Box 33, Amman 11622, Jordan
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Murad Sawalha
- Department of Maternal Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Abdallah Abu Khait
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Imad Alfayoumi
- Basic Nursing Department, Faculty of Nursing, Isra University, P.O. Box 33, Amman 11622, Jordan
| | - Mohammad Sayaheen
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Mohammad Odeh
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
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Mazzu MA, Campbell ML, Schwartzstein RM, White DB, Mitchell SL, Fehnel CR. Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review. J Pain Symptom Manage 2023; 66:e399-e426. [PMID: 37244527 PMCID: PMC10527530 DOI: 10.1016/j.jpainsymman.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Distress at the end of life in the intensive care unit (ICU) is common. We reviewed the evidence guiding symptom assessment, withdrawal of mechanical ventilation (WMV) process, support for the ICU team, and symptom management among adults, and specifically older adults, at end of life in the ICU. SETTING AND DESIGN Systematic search of published literature (January 1990-December 2021) pertaining to WMV at end of life among adults in the ICU setting using PubMed, Embase, and Web of Science. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. PARTICIPANTS Adults (age 18 and over) undergoing WMV in the ICU. MEASUREMENTS Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS Out of 574 articles screened, 130 underwent full text review, and 74 were reviewed and assessed for quality. The highest quality studies pertained to use of validated symptom scales during WMV. Studies of the WMV process itself were generally lower quality. Support for the ICU team best occurs via structured communication and social supports. Dyspnea is the most distressing symptom, and while high quality evidence supports the use of opiates, there is limited evidence to guide implementation of their use for specific patients. CONCLUSION High quality studies support some practices in palliative WMV, while gaps in evidence remain for the WMV process, supporting the ICU team, and medical management of distress. Future studies should rigorously compare WMV processes and symptom management to reduce distress at end of life.
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Affiliation(s)
- Maria A Mazzu
- University of New England College of Osteopathic Medicine (M.A.M.), Biddeford, Maine, USA
| | | | - Richard M Schwartzstein
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Douglas B White
- University of Pittsburgh School of Medicine (D.B.W.), Pittsburgh, Pennsylvania, USA
| | - Susan L Mitchell
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA
| | - Corey R Fehnel
- Beth Israel Deaconess Medical Center (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Harvard Medical School (R.M.S., S.L.M., C.R.F.), Boston, Massachusetts, USA; Hebrew SeniorLife, Marcus Institute for Aging Research (S.L.M., C.R.F.), Boston, Massachusetts, USA.
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Beckstrand RL, Macintosh JLB, Drake J, Newman C, Rasmussen R, Luthy KE. Critical Access Hospital Nurses' Perceptions of Obstacles to End-of-Life Care: A Qualitative Study. Am J Crit Care 2023; 32:276-287. [PMID: 37391378 DOI: 10.4037/ajcc2023186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Critical care nurses working in urban settings have reported obstacles in caring for dying patients. However, the perceptions of such obstacles by nurses working in critical access hospitals (CAHs), which are located in rural areas, are unknown. OBJECTIVE To study stories and experiences related to obstacles in providing end-of-life care reported by CAH nurses. METHODS This exploratory, cross-sectional study presents the qualitative stories and experiences of nurses working in CAHs as reported on a questionnaire. Quantitative data have been previously reported. RESULTS Sixty-four CAH nurses provided 95 categorizable responses. Two major categories emerged: (1) family, physician, and ancillary staff issues and (2) nursing, environment, protocol, and miscellaneous issues. Issues with family behaviors were families' insistence on futile care, intrafamily disagreement about do-not-resuscitate and do-not-intubate orders, issues with out-of-town family members, and family members' desire to hasten the patient's death. Issues with physician behaviors were providing false hope, dishonest communication, continuation of futile treatments, and not ordering pain medications. Nursing-related issues were not having enough time to provide end-of-life care, already knowing the patient or family, and compassion for the dying patient and the family. CONCLUSION Family issues and physician behaviors are common obstacles in rural nurses' provision of end-of-life care. Education of family members on end-of-life care is challenging because it is most families' first experience with intensive care unit terminology and technology. Further research on end-of-life care in CAHs is needed.
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Affiliation(s)
- Renea L Beckstrand
- Renea L. Beckstrand is a professor, Brigham Young University College of Nursing, Provo, Utah
| | - Janelle L B Macintosh
- Janelle L. B. Macintosh is an associate professor, Brigham Young University College of Nursing, Provo, Utah
| | - Jeanette Drake
- Jeanette Drake is an assistant professor, Brigham Young University College of Nursing, Provo, Utah
| | - Con Newman
- Con Newman is a graduate family nurse practitioner student at Brigham Young University, Provo, Utah
| | - Ryan Rasmussen
- Ryan Rasmussen is an associate professor, Brigham Young University College of Nursing, Provo, Utah
| | - Karlen E Luthy
- Karlen E. Luthy is a professor, Brigham Young University College of Nursing, Provo, Utah
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Beckstrand RL, Lyman TM, Luthy KE, Macintosh JLB. Caring for Rural Patients at End of Life: Perceptions of Critical Access Hospital Nurses. Am J Crit Care 2022; 31:375-382. [PMID: 36045042 DOI: 10.4037/ajcc2022838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Critical access hospitals were created to bring health care to rural populations. These hospitals lack equipment and resources, but the nurses who work there still provide end-of-life care to critically ill and dying patients. OBJECTIVE To determine how nurses in critical access hospitals perceive the size of obstacles and helpful behaviors for the provision of end-of-life care. METHODS Questionnaires were sent to a cross-sectional, nationally representative sample of nurses working in 39 critical access hospitals. The nurses were asked to score obstacle and helpful behavior items on a scale of from 0 (not an obstacle or not a help, respectively) to 5 (extremely large obstacle or extremely large help, respectively). The items were then ranked from highest to lowest according to their mean scores. RESULTS Seven of the top 10 obstacles were directly related to family behaviors and attitudes, such as families not understanding what lifesaving measures entail and internal family disagreements about life support. Helpful behaviors ranked in the top 10 included interventions that were controlled by nurses and items that affected the nurses' having adequate time to deliver end-of-life care. Obstacles and helpful behavior items unique to critical access hospitals, such as a lack of resources and the nurse knowing the patient or the patient's family, ranked below the top 10 items. CONCLUSION Obstacles and helpful behaviors for providing end-of-life care remain consistent. Nurses in critical access hospitals are accustomed to working without the typical resources found in urban hospitals and thus did not perceive resource deficits to be among the greatest obstacles to providing end-of-life care. Family behaviors and attitudes remain the most dominant obstacle noted by nurses.
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Affiliation(s)
- Renea L Beckstrand
- Renea L. Beckstrand is a professor, Brigham Young University College of Nursing, Provo, Utah
| | - Trissa M Lyman
- Trissa M. Lyman is a family nurse practitioner at the Center for Change, Orem, Utah
| | - Karlen E Luthy
- Karlen E. Luthy is a professor, Brigham Young University College of Nursing, Provo, Utah
| | - Janelle L B Macintosh
- Janelle L. B. Macintosh is an associate professor, Brigham Young University College of Nursing, Provo, Utah
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Xu DD, Luo D, Chen J, Zeng JL, Cheng XL, Li J, Pei JJ, Hu F. Nurses' perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study. Palliat Care 2022; 21:130. [PMID: 35854257 PMCID: PMC9294848 DOI: 10.1186/s12904-022-01020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIM Patient deaths are common in the intensive care unit, and a nurse's perception of barriers to and supportive behaviors in end-of-life care varies widely depending upon their cultural background. The aim of this study was to describe the perceptions of intensive care nurses regarding barriers to and supportive behaviors in providing end-of-life care in a Chinese cultural context. METHODS A cross-sectional survey was conducted among intensive care nurses in 20 intensive care units in 11 general hospitals in central and eastern China. Instruments used in this study were general survey and Beckstrand's questionnaire. Data were collected via online survey platform. Descriptive analysis was used to describe general characteristics of participants and mean and standard deviations of the barriers and supportive behaviors. The mean and standard deviation were used to describe the intensity and frequency of each barrier or supportive behavior following Beckstrand's method to calculate the score of barriers and supportive behaviors. Content analysis was used to analyze the responses to open-ended questions. RESULTS The response rate was 53% (n = 368/700). Five of the top six barriers related to families and the other was the nurse's lack of time. Supportive behaviors included three related to families and three related to healthcare providers. Nurses in the intensive care unit felt that families should be present at the bedside of a dying patient, there is a need to provide a quiet, independent environment and psychological support should be provided to the patient and family. Nurses believe that if possible, families can be given flexibility to visit dying patients, such as increasing the number of visits, rather than limiting visiting hours altogether. Families need to be given enough time to perform the final rites on the dying patient. Moreover, it is remarkable that nurses' supportive behaviors almost all concern care after death. CONCLUSIONS According to ICU-nurses family-related factors, such as accompany of the dying patients and acceptence of patient's imminent death, were found the major factors affecting the quality of end-of-life care. These findings identify the most prominent current barriers and supportive behaviors, which may provide a basis for addressing these issues in the future to improve the quality of end-of-life care.
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Affiliation(s)
- Dan-Dan Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Critical Care and Anesthesia Nursing Research Center, School of Nursing, Wuhan University, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Dan Luo
- Wuhan University School of Health Sciences, Wuhan, China
| | - Jie Chen
- University of Connecticut School of Nursing, Mansfield, USA
| | - Ji-Li Zeng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | | | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Juan-Juan Pei
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Critical Care and Anesthesia Nursing Research Center, School of Nursing, Wuhan University, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
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Elcelik UE, Ozcelik H, Muz G. The Effect on the Care Behaviors of Nurses Working in Intensive Care Clinics of Moral Distress Experienced During End of Life Patient Care. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221107195. [PMID: 35700116 DOI: 10.1177/00302228221107195] [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: 11/16/2022]
Abstract
This research was conducted as a descriptive study in order to examine the effects of the moral problems experienced by nurses working in intensive care clinics on their end of life care behaviors. The data were collected using the Moral Distress Scale and Caring Behaviors Inventory. It was found that 74.5% of the nurses were women and their mean age was 32.60 ± 6.6 years. The frequency of moral distress in the nurses was 44.27 ± 16.25 and total score was 111.02 ± 63.85. There were significant differences in the scores of the concept the use of futile treatment by nurses, the decision not to begin life-support treatment being made only by physicians, and moral distress and discomfort felt by pediatric intensive care nurses (p < .05). A statistically significant relationship was found between total scores of discomfort on moral distress and assurance, knowledge and skills, connectedness, and being respectful on the end of life care behaviors (p < .05).
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Affiliation(s)
| | - Hanife Ozcelik
- Zubeyde Hanim School of Health, Nigde Omer Halisdemir University, Niğde Üniversitesi, Nigde, Turkey
| | - Gamze Muz
- Semra-Vefa Küçük School of HealthNevsehir Haci Bektas Veli Universitesi, Nevsehir, Turkey
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Tipwong A, Ruamsook T, Hongkittiyanon T, Kgowsiri K. The perceptions on good death of the older adults in the semi-urban community: A qualitative study. Int J Nurs Sci 2022; 9:389-396. [PMID: 35891908 PMCID: PMC9305014 DOI: 10.1016/j.ijnss.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/19/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Araya Tipwong
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
- Corresponding author.
| | - Tanawat Ruamsook
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
| | | | - Kanit Kgowsiri
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
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Chapman AC, Lin JA, Cobert J, Marks A, Lin J, O'Riordan DL, Pantilat SZ. Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network. J Pain Symptom Manage 2022; 63:e611-e619. [PMID: 35595374 PMCID: PMC9303815 DOI: 10.1016/j.jpainsymman.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Palliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU. OBJECTIVES Compare characteristics of specialty PC consultations in the ICU to those on medical-surgical wards. METHODS Retrospective analysis of national Palliative Care Quality Network data for hospitalized patients receiving specialty PC consultation January 1, 2013 to December 31, 2019 in ICU or medical-surgical setting. 98 inpatient PC teams in 16 states contributed data. Measures and outcomes included patient characteristics, consultation features, process metrics and patient outcomes. Mixed effects multivariable logistic regression was used to compare ICU and medical-surgical units. RESULTS Of 102,597 patients 63,082 were in medical-surgical units and 39,515 ICU. ICU patients were younger and more likely to have non-cancer diagnoses (all P < 0.001). While fewer ICU patients were able to report symptoms, most patients in both groups reported improved symptoms. ICU patients were more likely to have consultation requests for GOC, comfort care, and withdrawal of interventions and less likely for pain and/or symptoms (OR-all P < 0.001). ICU patients were less often discharged alive. CONCLUSION ICU patients receiving PC consultation are more likely to have non-cancer diagnoses and less likely able to communicate. Although symptom management and GOC are standard parts of ICU care, specialty PC in the ICU is often engaged for these issues and results in improved symptoms, suggesting routine interventions and consultation targeting these needs could improve care.
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Affiliation(s)
- Allyson Cook Chapman
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California; Critical Care Medicine, Department of Anesthesia (A.C.C., J.C.), University of California San Francisco, San Francisco, California.
| | - Joseph A Lin
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California
| | - Julien Cobert
- Anesthesia Service (J.C.), San Francisco VA Health Care System, San Francisco, California; Critical Care Medicine, Department of Anesthesia (A.C.C., J.C.), University of California San Francisco, San Francisco, California
| | - Angela Marks
- Department of Medicine (A.M.), University of California San Francisco, San Francisco, California
| | - Jessica Lin
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California
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10
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Zanin A, Brierley J, Latour JM, Gawronski O. End-of-life decisions and practices as viewed by health professionals in pediatric critical care: A European survey study. Front Pediatr 2022; 10:1067860. [PMID: 36704131 PMCID: PMC9872024 DOI: 10.3389/fped.2022.1067860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND AIM End-of-Life (EOL) decision-making in paediatric critical care can be complex and heterogeneous, reflecting national culture and law as well as the relative resources provided for healthcare. This study aimed to identify similarities and differences in the experiences and attitudes of European paediatric intensive care doctors, nurses and allied health professionals about end-of-life decision-making and care. METHODS This was a cross-sectional observational study in which we distributed an electronic survey to the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) members by email and social media. The survey had three sections: (i) 16 items about attitudes to EOL care, (ii) 14 items about EOL decisions, and (iii) 18 items about EOL care in practice. We used a 5-point Likert scale and performed descriptive statistical analysis. RESULTS Overall, 198 questionnaires were completed by physicians (62%), nurses (34%) and allied health professionals (4%). Nurses reported less active involvement in decision-making processes than doctors (64% vs. 95%; p < 0.001). As viewed by the child and family, the child's expected future quality of life was recognised as one of the most critical considerations in EOL decision-making. Sub-analysis of Northern, Central and Southern European regions revealed differences in the optimal timing of EOL decisions. Most respondents (n = 179; 90%) supported discussing organ donation with parents during EOL planning. In the sub-region analysis, differences were observed in the provision of deep sedation and nutritional support during EOL care. CONCLUSIONS This study has shown similar attitudes and experiences of EOL care among paediatric critical care professionals within European regions, but differences persist between European regions. Nurses are less involved in EOL decision-making than physicians. Further research should identify the key cultural, religious, legal and resource differences underlying these discrepancies. We recommend multi-professional ethics education to improve EOL care in European Paediatric Intensive Care.
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Affiliation(s)
- Anna Zanin
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Joe Brierley
- Critical Care Units, Great Ormond Street Hospital, London, United Kingdom
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Critical Care Nurses' Qualitative Reports of Experiences With Physician Behaviors, Nursing Issues, and Other Obstacles in End-of-Life Care. Dimens Crit Care Nurs 2021; 40:237-247. [PMID: 34033445 DOI: 10.1097/dcc.0000000000000479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Critical care nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Obstacles to EOL care in ICUs exist and have been previously published along with reports from CCNs. Further data exploring obstacles faced during ICU EOL care may increase awareness of common EOL obstacles. Research focusing on obstacles related to physician behaviors and nursing issues (and others) may provide improvement of care. OBJECTIVE The aim of this study was to gather first-hand data from CCNs regarding obstacles related to EOL care. METHODS A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from an item asking CCNs to tell us of the obstacles they experience providing EOL care to dying patients were analyzed. RESULTS There were 104 participants who provided 146 responses to this item reflecting EOL obstacles. These obstacles were divided into 11 themes; 6 physician-related obstacles and 5 nursing- and other related obstacles. Major EOL ICU barrier themes were inadequate physician communication, physicians giving false hope, poor nurse staffing, and inadequate EOL care education for nurses. DISCUSSION AND CONCLUSION Poor physician communication was the main obstacle noted by CCNs during ICU EOL care, followed by physicians giving false hope. Heavy patient workloads with inadequate staffing were also a major barrier in CCNs providing EOL care.
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Myers JC, Hyrkas K. End-of-Life Care: Improving Communication and Reducing Stress. Crit Care Nurs Q 2021; 44:235-247. [PMID: 33595970 DOI: 10.1097/cnq.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This quality improvement initiative originated in the cardiac intensive care unit (CICU) at a 637-bed licensed Magnet teaching hospital with the rating of level 1 trauma center. The CICU has 12 beds, with a staff of 59 nurses (RNs). The nursing staff expressed increased stress and discomfort when communicating with patients and their families when providing end-of-life care. Selected evidence-based techniques for stress reduction and active listening skills were taught in 4- to 5-minute mini sessions during the morning huddle 3 days per week for 4 weeks. The program was evaluated using pretest, posttest, and 2 follow-up surveys composed of 5 statements and 2 open-ended questions. The survey tool was developed by researchers in accordance with the relevant literature. The results showed improved communication as demonstrated by the surveys. Nurses also reported feeling more supported by their colleagues and supervisors. The project was conducted in 1 CICU, therefore limiting the generalizability of the results.
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Affiliation(s)
- Joan Carr Myers
- Spiritual Care Department Maine Medical Center, Portland, Maine (Ms Carr Myers); and Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine (Dr Hyrkas)
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MacKenzie AR, Lasota M. Bringing Life to Death: The Need for Honest, Compassionate, and Effective End-of-Life Conversations. Am Soc Clin Oncol Educ Book 2020; 40:1-9. [PMID: 32207670 DOI: 10.1200/edbk_279767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conversations about death and dying are a crucial part of all medical care and are particularly relevant in the field of oncology. Patients express a desire to have discussions about goals of care, and many patients have thought about their end-of-life (EOL) wishes but have not had an opportunity to openly talk with care providers about this. Deficiencies in medical training, lack of confidence, limited time, and cultural barriers all contribute to the paucity of these important discussions. Although physicians are often expected to lead these conversations, nurses and nurse practitioners also play a vital role in the identification of opportunities to address EOL goals and should be a resource for the care team in facilitating EOL conversations at all points on the care continuum. Public engagement is paramount in normalizing conversations about death and dying, and the health care system needs to partner with public health agencies and private groups to open dialogues about EOL. Providers at all levels need improved education in having these difficult but essential conversations.
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Affiliation(s)
- Amy R MacKenzie
- Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA
| | - Michelle Lasota
- Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA
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Huang J, Yang L, Qi H, Zhu Y, Zhang M. Psychometric properties of the Chinese version of the End-of-Life Decision-Making and Staff Stress Questionnaire. Int J Clin Health Psychol 2020; 20:271-281. [PMID: 32994800 PMCID: PMC7501447 DOI: 10.1016/j.ijchp.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jingying Huang
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
| | - Lili Yang
- Nursing Education Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
- Corresponding author at: Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, Zhejiang Province, 310016 China.
| | - Haiou Qi
- Nursing Education Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
| | - Yiting Zhu
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
| | - Minyan Zhang
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
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Jeong DI, Eun Y. Factors Affecting the End-of Life Care Competency of Tertiary Hospital Nurses. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:139-150. [PMID: 37497367 PMCID: PMC10332723 DOI: 10.14475/kjhpc.2020.23.3.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 07/28/2023]
Abstract
Purpose The purpose of this study was to investigate the levels of end-of-life care competency; knowledge, attitudes, and experiences regarding advance directives; perceptions of good death; and end-of-life care obstacles and supportive behaviors among tertiary care nurses. Methods The participants were 150 nurses at a tertiary hospital in Jinju, Korea. The data collected using a questionnaire were analyzed using descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and stepwise multiple regression in SPSS for Windows version 24.0. Results The mean (±SD) score of end-of-life care competency was 3.63 (±0.53) on a 5-point scale. A significant difference in end-of-life care competency was found according to whether nurses had experienced the death of a family member or acquaintance (P=0.029). According to stepwise multiple regression analysis, the factors affecting end-of-life care competency were the frequency of end-of-life care supportive behaviors (β=0.38, P<0.001), experience with advance directives (β=0.29, P<0.001), and marriage (β=0.15, P=0.039). This model had an explanatory power of 27.9% (F=18.87, P<0.001). Conclusion In order to improve nurses' end-of-life care competency, it is important to strengthen end-of-life care supportive behaviors by exposing nurses to those behaviors and providing frequent experience with advance directives.
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Affiliation(s)
- Da-In Jeong
- Department of Nursing, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Eun
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Gül Ş, Demir Karabulut S, Eren H, Durmuş İskender M, Göçmen Baykara Z, Keles Ş, Yıldız A, Yalim NY. Nursing Students' Experiences With Death and Terminal Patients During Clinical Education. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:628-649. [PMID: 32838653 DOI: 10.1177/0030222820950510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study is to explore nursing students' experiences with death and terminal patients during clinical education. A secondary analysis of qualitative data that were collected through 11 focus group interviews with nursing students was performed. Data obtained from the interviews were analyzed using thematic analysis. There were a total of 9 themes across 3 contexts. Data were grouped under the following themes: feelings experienced when encountering death for the first time, reactions to the first encounter with death, factors affecting the reactions to death, involvement in terminal patient care, being informed about the physical process that terminal patients are going through, students' approach toward terminal patients and their relatives, health professionals' approach toward terminal/dying patients/their relatives, changes in the ideas about death, and changes in the ideas about terminal/dying patients. The study shows a lack of guidance on the part of teachers who also avoid patients and families who are considered terminally ill.
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Affiliation(s)
- Şenay Gül
- Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Seyhan Demir Karabulut
- Department of Medical Ethics and History, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Handan Eren
- Department of Nursing, Health Sciences Faculty, Yalova University, Yalova, Turkey
| | | | | | - Şükrü Keles
- Department of Medical Ethics and History, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Abdullah Yıldız
- Department of Medical Ethics and History, Faculty of Medicine, Ankara University, Ankara, Turkey
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Blaževičienė A, Laurs L, Newland JA. Attitudes of registered nurses about the end - of - life care in multi-profile hospitals: a cross sectional survey. BMC Palliat Care 2020; 19:131. [PMID: 32814574 PMCID: PMC7439667 DOI: 10.1186/s12904-020-00637-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. METHODS A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. RESULTS Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. CONCLUSIONS Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.
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Affiliation(s)
- Aurelija Blaževičienė
- Department of Nursing and Care, Lithuanian University of Health Sciences, Eiveniu 4, 44307, Kaunas, LT, Lithuania.
| | - Lina Laurs
- Department of Nursing and Care, Lithuanian University of Health Sciences, Eiveniu 4, 44307, Kaunas, LT, Lithuania
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Beckstrand RL, Jenkins JB, Luthy KE, Macintosh JLB. Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data. Am J Crit Care 2020; 29:e81-e91. [PMID: 32607570 DOI: 10.4037/ajcc2020661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. OBJECTIVE To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. METHODS In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. RESULTS Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient's end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. CONCLUSIONS The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.
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Affiliation(s)
- Renea L. Beckstrand
- About the Authors: Renea L. Beckstrand and Karlen E. Luthy are professors and Janelle L. B. Macintosh is an associate professor at Brigham Young University College of Nursing, Provo, Utah
| | - Jasmine B. Jenkins
- Jasmine B. Jenkins, a former graduate student at Brigham Young University, is now a nurse practitioner in urgent care for Revere Health, Spanish Fork, Utah
| | - Karlen E. Luthy
- About the Authors: Renea L. Beckstrand and Karlen E. Luthy are professors and Janelle L. B. Macintosh is an associate professor at Brigham Young University College of Nursing, Provo, Utah
| | - Janelle L. B. Macintosh
- About the Authors: Renea L. Beckstrand and Karlen E. Luthy are professors and Janelle L. B. Macintosh is an associate professor at Brigham Young University College of Nursing, Provo, Utah
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19
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Guo Q, Zheng R. Assessing oncology nurses’ attitudes towards death and the prevalence of burnout: A cross-sectional study. Eur J Oncol Nurs 2019; 42:69-75. [DOI: 10.1016/j.ejon.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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Almansour I, Seymour JE, Aubeeluck A. Staff perception of obstacles and facilitators when providing end of life care in critical care units of two teaching hospitals: A survey design. Intensive Crit Care Nurs 2019; 53:8-14. [PMID: 31023516 DOI: 10.1016/j.iccn.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 01/10/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine perceptions of Jordanian critical care staff about obstacles and facilitators to end-of-life care. RESEARCH METHODOLOGY The "National Survey of Critical Care Nurses' Perceptions of End-of-Life Care" was adapted and distributed to 143 critical care nurses (n = 110) and physicians (n = 33) in two Jordanian hospitals. Nurses and physicians completed items about perceived obstacles to end-of-life care. Nurses only completed items about facilitators to end-of-life care. RESULTS The overall response rate was 72.7% (n = 104/143). Seventy-six nurses (69.1%) and 28 physicians (84.5%) responded. Nurses and physicians agreed that the highest scoring obstacles were: 'family members who do not understand what life-saving measures mean' and the 'poor design of critical care units'. Other highly scoring obstacles related to clinicians' behaviours, characteristics and attitudes. Nurses perceived the highest scoring facilitator was 'family members who accepted that the patient was dying'. CONCLUSION There is a need to further explore the issues underlying perceptions about clinicians' behaviours, which were perceived to be key barriers to quality end-of-life care and to find acceptable solutions that fit with Islamic culture. It is the first time that the survey has been used to gather perceptions of doctors and nurses in a non-western culture.
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Affiliation(s)
- I Almansour
- School of Nursing, The University of Jordan, Amman, Jordan.
| | - J E Seymour
- School of Nursing and Midwifery, The University of Sheffield, Sheffield S10 2LA, UK
| | - A Aubeeluck
- School of Health Sciences, The University of Nottingham, Nottingham NG7 2HA, UK
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Critical Care Nurses' Qualitative Reports of Experiences With Family Behaviors as Obstacles in End-of-Life Care. Dimens Crit Care Nurs 2019; 37:251-258. [PMID: 30063520 DOI: 10.1097/dcc.0000000000000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care. OBJECTIVES We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care. METHODS A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed. RESULTS Sixty-seven EOL obstacle experiences surrounding issues with families' behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients. CONCLUSIONS In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
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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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Hassankhani H, Haririan H, Porter JE, Heaston S. Cultural aspects of death notification following cardiopulmonary resuscitation. J Adv Nurs 2018; 74:1564-1572. [PMID: 29495080 DOI: 10.1111/jan.13558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Abstract
AIMS To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context. BACKGROUND Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation. DESIGN A phenomenological study. METHOD Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran. FINDINGS There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation. CONCLUSIONS Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.
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Affiliation(s)
- Hadi Hassankhani
- Center of Qualitative Studies, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Joanne E Porter
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Australia
| | - Sondra Heaston
- Brigham Young University College of Nursing, Provo, UT, USA
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Kim HS, Yeom HA. The association between spiritual well-being and burnout in intensive care unit nurses: A descriptive study. Intensive Crit Care Nurs 2018; 46:92-97. [PMID: 29625870 DOI: 10.1016/j.iccn.2017.11.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/15/2017] [Accepted: 11/26/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To describe the spiritual well-being and burnout of intensive care unit nurses and examine the relationship between these factors. RESEARCH METHODOLOGY This was a cross-sectional descriptive study. The participants were 318 intensive care unit recruited from three university hospitals in South Korea. The survey questionnaire included demographic information, work-related characteristics and end-of-life care experience, along with the Spiritual Well-Being Scale and Burnout Questionnaire. The data were analysed using descriptive statistics, t-tests, ANOVA with Scheffé test and a multiple regression analysis. RESULTS The burnout level among intensive care unit nurses was 3.15 out of 5. A higher level of burnout was significantly associated with younger age, lower education level, single marital status, having no religion, less work experience and previous end-of-life care experience. Higher levels of spiritual well-being were associated with lower levels of burnout, even after controlling for the general characteristics in the regression model. CONCLUSION Intensive care unit nurses experience a high level of burnout in general. Increased spiritual well-being might reduce burnout among intensive care unit nurses. Younger and less experienced nurses should receive more attention as a vulnerable group with lower spirituality and greater burnout in intensive care unit settings.
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Affiliation(s)
- Hyun Sook Kim
- Department of Nursing, Yonsei University Health System, Yonsei Cancer Center, South Korea
| | - Hye-Ah Yeom
- The Catholic University of Korea College of Nursing, 222 Banpo-Daero, Seocho-Gu, Seoul 06591, South Korea.
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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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Browning ED, Cruz JS. Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:44-72. [PMID: 29488856 DOI: 10.1080/15524256.2018.1437588] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Health-care workers may experience moral distress when they are unable to act as they believe is ethically appropriate in their clinical work. A social worker-facilitated protocol called Reflective Debriefing was developed and tested for alleviating moral distress through regular debriefings with nursing staff on an intensive care unit (ICU). Forty-two ICU nurses completed a Moral Distress Scale-Revised (MDS-R) at the beginning and end of a 6-month period, during which time regular debriefings were offered. The overall level of moral distress on the ICU surveyed was found to be low to moderate. The top three most frequent situations causing moral distress reported by most nurses in this study were related to the provision of nonbeneficial care in the ICU. Participants reported gaining the most benefit from feeling empowered to constructively confront other staff members about truth-telling in giving a prognosis. Nurses' overall response to the intervention was positive, with 100% of participants requesting to continue the Reflective Debriefing sessions either on a monthly or on an as-needed basis. The response to the intervention emphasized the importance of interprofessional collaboration to successfully combat moral distress among health-care workers and may protect them from burnout, detachment, and even quitting their profession.
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Affiliation(s)
- Emily D Browning
- a Palliative Care Department , Temple University Hospital , Philadelphia , Pennsylvania , USA
| | - Jourdan S Cruz
- a Palliative Care Department , Temple University Hospital , Philadelphia , Pennsylvania , USA
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Omar Daw Hussin E, Wong LP, Chong MC, Subramanian P. Nurses’ perceptions of barriers and facilitators and their associations with the quality of end‐of‐life care. J Clin Nurs 2017; 27:e688-e702. [DOI: 10.1111/jocn.14130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emni Omar Daw Hussin
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mei Chan Chong
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Pathmawathi Subramanian
- Pathmawathi Subramanian Nursing Synergy Ptd Ltd. 18.USJ 1/3K, USJ 1 Subang Jaya 47100 Malaysia
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Oncology nurses' perceptions of obstacles and role at the end-of-life care: cross sectional survey. BMC Palliat Care 2017; 16:74. [PMID: 29258492 PMCID: PMC5735910 DOI: 10.1186/s12904-017-0257-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/30/2017] [Indexed: 01/09/2023] Open
Abstract
Background Major obstacles exist in the care of patients at the end of life: lack of time, poor or inadequate communication, and lack of knowledge in providing care. Three possible nursing roles in care decision-making were investigated: Information Broker, Supporter, and Advocate. The purpose of this study was to examine obstacles faced by oncology nurses in providing end-of-life (EOL) care and to examine roles of nurses in providing care. Methods A descriptive, cross-sectional, correlational design was applied. The study was conducted at two major University Hospitals of Oncology in Lithuania that have a combined total of 2365 beds. The study sample consisted of 239 oncology registered nurses. Data collection tool included a questionnaire about assessment of obstacles and supportive behaviors, nursing roles, and socio-demographic characteristics. Results The two items perceived by respondents as the most intense obstacles to providing EOL care were The nurse’s opinion on immediate patient care is not welcome, valued or discussed and. Family has no access to psychological help after being informed about the patient’s diagnosis. The majority of respondents self-assigned the role of Supporter. Conclusions Major obstacles in providing care included the nurse’s opinion that immediate patient care was not valued, lack of nursing knowledge on how to treat the patient’s grieving family, and physicians who avoided conversations with the patient and family members about diagnoses and prospects. In EOL care nurses most frequently acted as Supporters and less frequently as Advocates.
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Beckstrand RL, Hadley KH, Luthy KE, Macintosh JLB. Critical Care Nurses’ Suggestions to Improve End-of-Life Care Obstacles. Dimens Crit Care Nurs 2017; 36:264-270. [DOI: 10.1097/dcc.0000000000000252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Azzizadeh Forouzi M, Banazadeh M, Ahmadi JS, Razban F. Barriers of Palliative Care in Neonatal Intensive Care Units. Am J Hosp Palliat Care 2016; 34:205-211. [DOI: 10.1177/1049909115616597] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses’ attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses’ attitude toward barriers in providing NPC in Southeast Iran. Method: In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran. Results: Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of “insufficient resources” (3.42 ± 0.65) and “inappropriate personal and social attitudes” (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of “inappropriate organizational culture” and/or “inadequate nursing proficiency.” Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62). Conclusion: The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants’ EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.
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Affiliation(s)
| | - Marjan Banazadeh
- Razi Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran
| | - Jila Soltan Ahmadi
- Razi Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran
| | - Farideh Razban
- Razi Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran
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Abstract
Health care professionals believe that futile care must not be provided; however, there is no clear agreement over the definition and the manifestations of futile care. The aim of this study was to explore Iranian nurses' perceptions of futile care. In this qualitative exploratory study, the conventional content analysis approach was used for collecting and analyzing the study data. Three main themes were extracted from the data: nonfutility of care: care tantamount with outcome; sense of burnout; and subjectivity and relativity of medical futility concept.
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Ayeh DD, Tak HJ, Yoon JD, Curlin FA. U.S. Physicians' Opinions About Accommodating Religiously Based Requests for Continued Life-Sustaining Treatment. J Pain Symptom Manage 2016; 51:971-8. [PMID: 27039013 DOI: 10.1016/j.jpainsymman.2015.12.337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/19/2015] [Accepted: 12/24/2015] [Indexed: 11/22/2022]
Abstract
CONTEXT Families of critically ill patients occasionally request that physicians continue life-sustaining treatment (LST), sometimes giving religious reasons. OBJECTIVES To examine whether U.S. physicians are more likely to accommodate requests for LST that are based on religious reasons. METHODS In 2010, we surveyed 1156 practicing U.S. physicians from specialties likely to care for adult patients with advanced illness. The questionnaire included two randomized experimental vignettes: one where a family asked that LST be continued for a patient that met brain death criteria and a second where the son of an elderly patient with cancer insists on continuing LST. In both, we experimentally varied the reasons that the family member gave to justify the request, to see if physicians are more likely to accommodate a request based on a religious requirement or hope for a miracle, compared to no mention of either. For physicians' religious characteristics, we assessed their religious affiliation and level of religiosity. RESULTS For the patient meeting brain death criteria, physicians were more likely to accommodate the request to continue LST when the family mentioned their Orthodox Jewish community (85% vs. 70%, P < 0.001). For the patient with metastatic cancer, physicians were more likely to accommodate the request when the son said his religious faith does not permit discontinuing LST (65% vs. 46%, P < 0.001), but not when he said he expected divine healing (50% vs. 46%). CONCLUSION Physicians appear more willing to accommodate requests to continue LST when those requests are based on particular religious communities or traditions, but not when based on expectations of divine healing.
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Affiliation(s)
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - John D Yoon
- Department of Medicine and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - Farr A Curlin
- Trent Center for Bioethics, Humanities & History of Medicine, Duke University, Durham, North Carolina, USA.
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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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Noome M, Beneken genaamd Kolmer DM, van Leeuwen E, Dijkstra BM, Vloet LCM. The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review. Scand J Caring Sci 2016; 30:645-661. [DOI: 10.1111/scs.12315] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Marijke Noome
- Bachelor of Nursing; The Hague University of Applied Sciences; The Hague The Netherlands
- Research Department of Emergency and Critical Care; HAN University of Applied Sciences; Nijmegen The Netherlands
- Research Department Informal Care; The Hague University of Applied Sciences; The Hague The Netherlands
| | - Deirdre M. Beneken genaamd Kolmer
- Research Department Informal Care; The Hague University of Applied Sciences; The Hague The Netherlands
- Tranzo; School of Social and Behavioral Sciences; Tilburg University; Tilburg The Netherlands
| | - Evert van Leeuwen
- Section Ethics, Philosophy and the History of Medicine; Scientific Institute for Quality of Healthcare; Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Boukje M. Dijkstra
- Research Department of Emergency and Critical Care; HAN University of Applied Sciences; Nijmegen The Netherlands
- Intensive Care Unit; Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Lilian C. M. Vloet
- Research Department of Emergency and Critical Care; HAN University of Applied Sciences; Nijmegen The Netherlands
- Scientific Institute for Quality of Healthcare; Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
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O’Neill CS, Yaqoob M, Faraj S, O’Neill CL. Nurses’ care practices at the end of life in intensive care units in Bahrain. Nurs Ethics 2016; 24:950-961. [DOI: 10.1177/0969733016629771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. Objectives: This study explored nurses’ care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. Findings: A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Discussion: Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Conclusion: Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.
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Affiliation(s)
| | | | - Sumaya Faraj
- Royal College of Surgeons in Ireland – Medical University of Bahrain, Bahrain
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Ka-Ming Ho J. Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Appl Nurs Res 2016; 29:e7-13. [DOI: 10.1016/j.apnr.2015.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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Haase B, Bos M, Boffa C, Lewis P, Rudge C, Valero R, Wind T, Wright L. Ethical, legal, and societal issues and recommendations for controlled and uncontrolled DCD. Transpl Int 2016; 29:771-9. [DOI: 10.1111/tri.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/04/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - Michael Bos
- Health Council of the Netherlands; The Hague The Netherlands
| | - Catherine Boffa
- Nuffield Department of Surgery; Oxford Transplant Center; University of Oxford; Oxford UK
| | | | - Chris Rudge
- Former Clinical Director for transplantation DoH; London UK
| | | | - Tineke Wind
- Maastricht University Medical Centre; Maastricht The Netherlands
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Heo KS, Park EJ. Clinical Nurses' Perceived or Experienced Obstacles and Supportive Behaviors in Providing Care for Terminally Ill Cancer Patients. ASIAN ONCOLOGY NURSING 2016. [DOI: 10.5388/aon.2016.16.3.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Eun-Jun Park
- Department of Nursing, Konkuk University, Chungju, Korea
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Family Experiences During the Dying Process After Withdrawal of Life-Sustaining Therapy. Dimens Crit Care Nurs 2016; 35:160-6. [DOI: 10.1097/dcc.0000000000000174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rafii F, Nikbakht Nasrabadi A, Karim MA. End-of-life care provision: experiences of intensive care nurses in Iraq. Nurs Crit Care 2015; 21:105-12. [PMID: 26487503 DOI: 10.1111/nicc.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurses play a key role in providing care for the critically ill in the intensive care unit (ICU). The physical, psychological, emotional and spiritual intimate care given by Kurdish nurses allows them to develop a therapeutic relationship with terminally ill patients in the ICU. AIMS This study sought to explore the meaning of caring for terminally ill patients from the perspective of Kurdish ICU nurses. DESIGN Van Manen's (1990) hermeneutic phenomenological design was adopted. METHOD The data were collected through in-depth semi-structured interviews with a purposive sample of 10 nurses working in ICUs. Interviews were transcribed and finally analysed according to Van Manen's method. RESULTS Four major themes including emotional labour, death as a positive dimension, optimistic rather than futile care and working within constraints emerged. CONCLUSIONS Kurdish nurses in their caring encounters with terminally ill patients experienced a range of feelings from emotional strain to being optimistic while working within limited resources in the ICU. Further research is needed to explore the experiences of nurses with other cultures of caring for terminally ill patients in ICUs. RELEVANCE TO PRACTICE End-of-life care in ICU is emotionally challenging, therefore, nurses in this setting require psychological and spiritual support to ensure optimal care provision.
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Affiliation(s)
- Forough Rafii
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, International Campus (IUMS-IC), Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | - Muaf Abdulla Karim
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
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Piedrafita-Susín AB, Yoldi-Arzoz E, Sánchez-Fernández M, Zuazua-Ros E, Vázquez-Calatayud M. [Nurses' perception, experience and knowledge of palliative care in intensive care units]. ENFERMERIA INTENSIVA 2015; 26:153-65. [PMID: 26242205 DOI: 10.1016/j.enfi.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. RESULTS Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. CONCLUSION This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making.
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Affiliation(s)
- A B Piedrafita-Susín
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
| | - E Yoldi-Arzoz
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - M Sánchez-Fernández
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - E Zuazua-Ros
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - M Vázquez-Calatayud
- Área de Investigación, Formación y Desarrollo en Enfermería, Clínica Universidad de Navarra, Pamplona, España
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Dillworth J, Dickson VV, Mueller A, Shuluk J, Yoon HW, Capezuti E. Nurses' perspectives: hospitalized older patients and end-of-life decision-making. Nurs Crit Care 2015; 21:e1-e11. [PMID: 25892177 DOI: 10.1111/nicc.12125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/18/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
AIMS To explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues. BACKGROUND Critical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life. DESIGN It is a mixed method study. METHODS A secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics. RESULTS Comments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals (x‾ age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations. CONCLUSIONS Nurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services. RELEVANCE TO PRACTICE Palliative care and EOL decision-making will remain a nursing priority as people age and require increased care.
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Affiliation(s)
- Judy Dillworth
- New York University, College of Nursing, New York, NY, USA
| | | | - Anna Mueller
- New York University, College of Nursing, New York, NY, USA
| | - Joseph Shuluk
- New York University, College of Nursing, New York, NY, USA
| | - Hye W Yoon
- New York University, College of Nursing, New York, NY, USA
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The Relationship between Nurses' Perception of Barriers Magnitude and their Demographic Characteristics. ACTA ACUST UNITED AC 2015. [DOI: 10.26634/jnur.5.1.3492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Palliative care is emerging as an alternative care paradigm for critically ill older patients in the critical care setting. Critical care nurses are well positioned to take on a leadership role in reconceptualizing care in the critical care unit, and creating the space and opportunity for palliative care. This article provides information on the practice of palliative care with critically ill older adults along with evidence-based content and resources, allowing critical care nurses to advocate for palliative care in their own work environments accompanied by the necessary resources that will support efficient implementation.
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Hoping for the best, preparing for the worst: strategies to promote honesty and prevent medical futility at end-of-life. Dimens Crit Care Nurs 2015; 33:22-7. [PMID: 24310712 DOI: 10.1097/dcc.0000000000000013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Critical care nurses frequently care for patients nearing end of life. Associated advance care planning is often not introduced as early as it needs to be, and nurses can help to stimulate a culture change by initiating honest discussions about end-of-life treatment options. The Physician Orders for Life-Sustaining Treatment form can provide a framework for honesty and information sharing at end of life. This article discusses the use of the Physician Orders for Life-Sustaining Treatment form as an end-of-life care planning tool as well as evidence-based communication strategies that promote honest, effective end-of-life conversations.
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Abstract
Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.
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Ranse K, Yates P, Coyer F. Factors influencing the provision of end-of-life care in critical care settings: development and testing of a survey instrument. J Adv Nurs 2014; 71:697-709. [PMID: 25429994 DOI: 10.1111/jan.12576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Abstract
AIM To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. BACKGROUND Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. DESIGN A cross-sectional survey of critical care nurses. METHOD An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. RESULTS Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. CONCLUSION This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.
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Affiliation(s)
- Kristen Ranse
- Disciplines of Nursing & Midwifery, Faculty of Health, University of Canberra, Australian Capital Territory, Australia
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Holms N, Milligan S, Kydd A. A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit. Int J Palliat Nurs 2014; 20:549-56. [PMID: 25426882 DOI: 10.12968/ijpn.2014.20.11.549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Natalie Holms
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Stuart Milligan
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Angela Kydd
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
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Gama G, Barbosa F, Vieira M. Personal determinants of nurses' burnout in end of life care. Eur J Oncol Nurs 2014; 18:527-33. [DOI: 10.1016/j.ejon.2014.04.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 04/06/2014] [Accepted: 04/19/2014] [Indexed: 11/15/2022]
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