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Butler AE, Riegel M, Speedie L, Ranse K, Buckley T. The impact of COVID-19 on the provision of bereavement support in Australian intensive care units: A national survey. Aust Crit Care 2024; 37:577-584. [PMID: 38065795 DOI: 10.1016/j.aucc.2023.10.008] [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: 07/09/2023] [Accepted: 10/20/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Bereavement support is a vital part of caring for families when a patient dies in the intensive care unit (ICU). Previous research has demonstrated that while many ICUs provide some informal aspects of bereavement care, formalised follow-up programmes are uncommon. The impacts of COVID-19 on ICU-based bereavement support are currently unknown. OBJECTIVES The objectives of this study were to explore the current provision of bereavement support in Australian ICUs and identify the impacts of the COVID-19 pandemic on these services. METHODS A cross-sectional exploratory web-based survey was used. The survey was distributed to one senior nurse in each public and private adult, paediatric, and neonatal ICU in Australia between April and July 2022. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Ethical approval was received from La Trobe University. RESULTS One hundred and four ICUs from 82 hospitals responded to the survey, with 36 units reporting a formal bereavement follow-up service. When compared to prepandemic levels, almost all of the common bereavement care practices explored in the survey were significantly reduced during the COVID-19 pandemic. Open-ended responses also demonstrated significant impacts of COVID-19 on bereavement care provision, particularly related to Restricted family togetherness, Logistical Challenges, and Impacts on Staff. Staff members reported adjusting care provision in response to these challenges by exploring Alternative family communications, Facilitation of family togetherness, and Increasing familysupports. CONCLUSIONS Many of the common elements of ICU-based bereavement care were significantly reduced during the COVID-19 pandemic. In addition, the number of formal bereavement follow-up services in Australian ICUs remains largely unchanged since 2015. Ongoing research is needed to explore the long-term effects of these changes on staff and family wellbeing and on ongoing provision of ICU-based bereavement support.
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Affiliation(s)
| | - Melissa Riegel
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Lisa Speedie
- School of Nursing and Midwifery, La Trobe University, Australia
| | - Kristen Ranse
- School of Nursing & Midwifery, Gold Coast Campus, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Lee J, Kim SG, Lee SI, Youn H. Psychosocial Factors Associated With Thoughts Regarding Life-Sustaining Treatment for Oneself and Family Members. Psychiatry Investig 2024; 21:646-654. [PMID: 38960442 PMCID: PMC11222083 DOI: 10.30773/pi.2024.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the thoughts of the general population regarding life-sustaining treatment for both oneself and family members and to assess the factors associated with those thoughts. METHODS A total of 1,500 individuals participated in this study by completing a questionnaire consisting of self-reporting items with some instructions, basic demographic information, thoughts on life-sustaining treatment, and psychosocial scales. The disease status was calculated using the Charlson Comorbidity Index. The psychosocial scales included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index, and Multidimensional Scale of Perceived Social Support. RESULTS The majority of participants did not want to receive life-sustaining treatment for both themselves and their families. However, more people wanted life-sustaining treatment for their family members (35.9%) than for themselves (21.6%). Among the basic demographic characteristics, there were significant differences in age, sex, marital status, living arrangements, occupational status, religion, and disease status. Regarding the psychosocial scales, there were significant differences in the PHQ-9 and GAD-7 scores between the group that preferred life-sustaining treatment for family members and the group that did not. CONCLUSION The findings suggest that life-sustaining treatment decisions for oneself and for one's family members can be different. We recommend a more clear expression of one's preferences regarding the last moments of one's life, including advance directives.
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Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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3
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Stokar YN. Sense of failure in end of life care: Perspectives from physicians and nurses. Soc Sci Med 2024; 348:116805. [PMID: 38569282 DOI: 10.1016/j.socscimed.2024.116805] [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: 06/06/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
Limited knowledge exists regarding sensed failure resulting provision of end-of-life (EOL) care. Among medical health professionals (MHP), a sense of failure is associated with impaired patientcare and reduced worker wellbeing, including higher rates of burnout and secondary traumatic stress. As part of a larger mixed-methods study on the effects of EOL-care provision on MHP in general hospitals, semi-structured in-depth interviews were conducted with 22 physicians and nurses at three tertiary Israeli hospitals, representing a wide range of medical specialties, training, experience, and cultural backgrounds. Qualitative thematic analysis of the interviews led to the identification of the theme 'sense of failure' with the sub-themes 'sources' and 'lived meanings' of the sensed failure. Apart from the source 'losing a patient' all other identified sources were recognized as work-related risk factors, including 'unsupportive environments' and 'shortcomings of the medical practice.' Two of the lived meaning 'sense of personal responsibility' and 'moral injury' were also recognized as work-related risk factors. Surprisingly, albeit the adverse context of EOL-care, the two remaining lived meanings 'learning from failure' and 'sense of purpose' were recognized as protective resilience factors. Changes in workplace norms by focusing on leadership and mentoring programs and implementation of evidence based interventions aimed at reducing the sense of failure and enhancing feelings of purpose are recommended. Finally, the findings described in the study would benefit from continued studies on larger scales.
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Affiliation(s)
- Yaffa Naomi Stokar
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel; Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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Pamuk Cebeci S, Bilgiç Ş. Perception of Good Death and Level of Perceived Stress in Relatives of Palliative Care Patients. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241237838. [PMID: 38656222 DOI: 10.1177/00302228241237838] [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: 04/26/2024]
Abstract
This study aimed to examine the perception of a good death and the level of perceived stress in relatives of palliative care patients. Relatives of 110 patients hospitalized in a palliative care center constituted the research sample. A personal information form, the "Good Death Scale," and the "Perceived Stress Scale" were used for data collection. The patients' relatives defined good death as being with family members and living this process without suffering. The mean total Good Death Scale score of the relatives of palliative care patients was 54.86 ± 7.78, and their mean total Perceived Stress Scale score was 31.11 ± 10.10. These findings showed that patients' relatives had high perceptions of good death and that their stress levels were above average. To expand the scope of nursing care, it is important to know how patients' relatives are affected by this process. It is recommended that more studies be conducted on this subject.
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Affiliation(s)
- Sevil Pamuk Cebeci
- Fundamentals of Nursing Department, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Şebnem Bilgiç
- Fundamentals of Nursing Department, Faculty of Health Science, Trakya University, Edirne, Turkey
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5
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Çakmak B, Inkaya B. The Effect of a Repeated Standardized Patient-Based End-of-Life Care Training Program on Nursing Students' Knowledge, Attitudes, and Emotions Toward End-of-Life Patients. Am J Hosp Palliat Care 2024:10499091241236921. [PMID: 38437522 DOI: 10.1177/10499091241236921] [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: 03/06/2024] Open
Abstract
BACKGROUND Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it. AIM This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients. METHOD This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test. RESULTS The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills. CONCLUSION Universities should integrate repeated standardized patient-based into nursing curricula.
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Affiliation(s)
- Betül Çakmak
- Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bahar Inkaya
- Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Uzunkaya Oztoprak P, Terzioglu F. Attitudes of Oncology Nurses Towards Care of Dying Patients and the Principles of Dying with Dignity and Their Views on Good Death. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:961-976. [PMID: 34870522 DOI: 10.1177/00302228211057743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study investigated oncology nurses' attitudes toward caring for dying patients, their principles of dying with dignity, and their views on good death. This descriptive study included 257 oncology nurses working at two university hospitals, an educational research hospital and a state hospital in Turkey. Data were collected using the descriptive characteristics information form, the Frommelt Attitudes toward Care of the Dying scale, the Assessment Scale of Attitudes toward the Principles of Dying with Dignity, and the Good Death Scale. The nurses obtained mean scores of 99.53 ± 7.76 on the Frommelt Attitudes toward Care of the Dying scale, 26.84 ± 12.45 on the Assessment Scale of Attitudes toward the Principles of Dying with Dignity, and 57.23 ± 7.48 on the Good Death Scale. The nurses' personal and professional characteristics influenced their attitudes toward caring for dying patients, the principles of dying with dignity, and their views on good death.
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Affiliation(s)
- Pinar Uzunkaya Oztoprak
- Faculty of Nursing, Department of Obstetrics and Gynecologic Nursing, Hacettepe University, Ankara, Turkey
| | - Fusun Terzioglu
- Nursing, Department, Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
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Lovell T, Mitchell M, Powell M, Tonge A, Strube P, O'Neill K, Dunstan E, Bonnin-Trickett A, Miller E, Suliman A, Ownsworth T, Ranse K. Dying in intensive care: An analysis of the perspectives of families and clinicians on end-of-life care. Aust Crit Care 2022:S1036-7314(22)00094-7. [PMID: 36089461 DOI: 10.1016/j.aucc.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians. OBJECTIVE The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records. METHODS A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data. RESULTS Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient's death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted. CONCLUSIONS This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians' EOLC practices and education to improve clinician confidence with communication.
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Affiliation(s)
- Tania Lovell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia.
| | - Marion Mitchell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Madeleine Powell
- School of Population Health, University of New South Wales, NSW, Australia; National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Angela Tonge
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Petra Strube
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Kylie O'Neill
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Elspeth Dunstan
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Amity Bonnin-Trickett
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Elizabeth Miller
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Adam Suliman
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Kristen Ranse
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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8
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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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9
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Stanzl N, Scammell J. Nurses' perceptions of supporting a 'good death' in intensive care units. Int J Palliat Nurs 2022; 28:357-364. [PMID: 36006787 DOI: 10.12968/ijpn.2022.28.8.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Death in the intensive care unit (ICU) is an unavoidable aspect of nursing practice. Nurses are the primary front-line healthcare professionals (HCPs) which care for dying patients in this setting. Facilitating 'good deaths' in the ICU has become increasingly debated due to the challenges involved, especially during the COVID-19 pandemic. Aim: To explore how nurses perceive a 'good death' for patients in the ICU. METHOD Literature published in English between 2005 and 2020 was rigorously searched and recorded using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources were: CINAHL Complete, MEDLINE complete, APA PsycInfo, ScienceDirect, SocINDEX, SwePub, SciELO, Complementary Index, Academic Search Ultimate, Supplemental Index, Education Source and Directory of Open Access Journals. Search terms included: nurses' perceptions, ICUs, 'good deaths', quality of death and dignified deaths. FINDINGS Seven articles met the search criteria, five used qualitative methods, one used a quantitative method and one used a mixed method design. Each of these were critically analysed. A process of thematic analysis identified three prevalent themes: ensuring physical comfort, providing an appropriate physical environment and the importance of relatives. CONCLUSION The review revealed that creating a less technical environment within the ICU can influence a 'good death', but further research is needed to establish how this can be enacted. More effective management of physical symptoms such as pain and dyspnoea are also recommended. Including care of relatives in care plans was also found to contribute toward a 'good death' and that this could be facilitated through improved staff education. Providing a private area for grieving relatives within the ICU has also had an impact in enabling a 'good death'.
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Affiliation(s)
- Nicola Stanzl
- Adult Nursing Student, Department of Nursing and Clinical Sciences, Bournemouth University, UK
| | - Janet Scammell
- Associate Professor; Co-Director, Nursing Long-term Health Challenges Research Centre, Department of Nursing and Clinical Sciences, Bournemouth University, UK
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10
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The perspective of professional caregivers working in generalist palliative care on 'good dying': An integrative review. Soc Sci Med 2021; 293:114647. [PMID: 34902648 DOI: 10.1016/j.socscimed.2021.114647] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022]
Abstract
In today's industrial societies, many people die receiving professional care. Although specialist palliative and hospice care have often been identified as ideal care approaches to promote good dying, more people die receiving generalist palliative care. This integrative review examines how professional caregivers providing generalist palliative care in hospitals, nursing or private homes define good dying. Furthermore, through comparative analysis of existing empirical studies, it explores conceptual aspects in researching good dying that better reflect the social complexity of this phenomenon. Three databases (Scopus, MEDLINE, and CINAHL) were searched for peer-reviewed studies published between January 2000 and April 2020. Studies were selected if they presented original empirical findings from qualitative or quantitative studies on the perspective of professional caregivers in generalist palliative care (nurses, physicians, surgeons, clergy, and other staff) on good dying or related concepts (e.g., good death, dignity in dying, or quality of life at the end of life). 42 studies were included in the review. They identified good dying as expected, accepted and prepared dying, as free from pain and suffering, as socially embedded, as being at peace with one's life and situation, as supported with individualised and holistic care, as based upon professional cooperation and communication, and as in a peaceful and private environment. The paper concludes that the perspective of professional caregivers in generalist palliative care shares many elements of good dying with societal and specialist palliative care discourses around good dying. Through comparing the different studies, the review found that studies that explicated who benefitted from ideals and practices of good dying, questioned the dichotomous categorisation of good/bad dying, or discussed the compatibility of elements of good dying, provided more nuanced perspectives on this topic. Thus, the review calls for a more systematic analysis of these aspects in research of good dying.
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11
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Rushton C, Edvardsson D. A genealogy of what nurses know about 'the good death': A socio-materialist perspective. Nurs Philos 2021; 22:e12365. [PMID: 34428347 DOI: 10.1111/nup.12365] [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: 03/05/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.
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Affiliation(s)
- Carole Rushton
- School of Nursing and Midwifery, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
| | - David Edvardsson
- School of Nursing and Midwifery, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
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12
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Al-Shamaly HS. A focused ethnography of the culture of inclusive caring practice in the intensive care unit. Nurs Open 2021; 8:2973-2985. [PMID: 34318598 PMCID: PMC8510735 DOI: 10.1002/nop2.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To explore and understand the culture of nurses' multidimensional “caring‐for” practice in intensive care unit (ICU). Design A focused ethnography. Methods Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used. Findings Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring‐for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.
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13
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Guidozzi F, Guidozzi D. God, spirituality and religion in women dying from gynecological cancer. Climacteric 2021; 25:215-219. [PMID: 34278909 DOI: 10.1080/13697137.2021.1948995] [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: 10/20/2022]
Abstract
Thoughts of death and dying will prevail constantly in the minds of women with gynecologic cancer. Invariably, there is the hope that, when the end comes, there will be 'a good death'. End-of-life decisions, with particular emphasis on what the patient and her family constitute 'a good death' to be, will be influenced by emotional, psychological, mental, physical, spiritual and religious backgrounds. It is important to allow patients to resolve their despair by communicating their innermost thoughts. Spirituality and religious belief are important components that may play major roles in enabling patients to obtain peace and require the participation of all members of the health-care team managing the cases. Clinicians should appreciate the patient's concerns, beliefs, fears, spiritual and religious needs and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals, chaplains, counselors and clergy.
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Affiliation(s)
- F Guidozzi
- Department of Obstetrics and Gynaecology, Parklane Clinic, Johannesburg, South Africa
| | - D Guidozzi
- Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
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14
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Gagnon M, Kunyk D. Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end-of-life patients. Nurs Inq 2021; 29:e12437. [PMID: 34157180 DOI: 10.1111/nin.12437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Moral distress is an experience of profound moral compromise with deeply impactful and potentially long-term consequences to the individual. Critical care areas are fraught with ethical issues, and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality.
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Affiliation(s)
- Michelle Gagnon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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15
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Implementing a Comfort Care Cart: A Quality Improvement Nurse-Driven Initiative in the Intensive Care Unit. Dimens Crit Care Nurs 2021; 39:134-139. [PMID: 32251160 DOI: 10.1097/dcc.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The field of critical care nursing is multidimensional and filled with opportunities to bring change to current practice. In the United States, nearly 13% of patients (range, 8%-24%) admitted to an intensive care unit (ICU) die during or after the admission (https://www.dartmouthatlas.org/interactive-apps/end-of-life-care/). Critical care nurses provide care at every stage of acute and chronic illness. Often this includes care of the patient and family at end of life, guided by palliative care principles supported by the national guidelines including the American Association of Critical Care (Dimens Crit Care Nurs 2017;36(2):110-115). While enrolled in the final registered nurse-to-bachelor of science in nursing (RN-to-BSN) course, students are challenged to complete a quality improvement (QI) project. The project leader noted a clinical problem in the ICU. The landmark Dying in America report, as well as published theories on comfort, and the Institute for Healthcare Improvement (IHI) Open School Plan-Do-Study-Act (PDSA) model were used as the theoretical foundation for a clinical practice change. This assignment was the impetus to provide items at the bedside using a comfort cart. Description of this nurse-driven pilot project initiative includes a replicable guide of implementing a comfort care cart, transforming the patient's room into a home-like atmosphere for the families at the bedside.
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Abstract
Health care providers are coping with unprecedented deaths, decisions for which patient receives a lifesaving ventilator, and the personal fear of contracting a virus that presently has no known treatment protocol. This article discusses the concepts of moral injury; compassion fatigue; experiencing secondary stress associated with a continuous demanding daily work environment; and the idea of giving your patient a “good death” during a time when even if family and friends are present during the dying process, there is no touching, kissing, or ability to offer physical comfort. Suggestions for self-care for yourself and colleagues are discussed.
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Abstract
PURPOSE/OBJECTIVES The end-of-life needs and desires of patients, whether it is related to a terminal illness or age-related end-of-life physiological function, can vary from patient to patient. Each dying patient's case should be approached in an individual and patient-centered fashion while supporting the dying patient's desired preferences related to end-of-life treatment. This serves to recognize the dying patient's individual rights related to self-determination of preserving his or her dignity during the end-of-life process. As the U.S. population continues to age at the fastest pace in history, it is vital for end-of-life patients and their family members, health care providers, and lawmakers to consider how health policy can drive legislation that supports the dying patient's right to express his or her dignity and own end-of-life desires related to aid-in-dying by allowing health care providers to legally provide physician-assisted health (PAD) and death with dignity (DD) the end-of-life care dying patients prefer. PRIMARY PRACTICE SETTING(S) Palliative, hospice, and long-term care. FINDINGS/CONCLUSIONS When state laws do not support a terminally ill person's ability to make his or her own end-of-life decisions based on his or her own preferences and desires related to PAD and dignity in dying, there can be moral conflictions with the existing ethical principles that can contribute to additional distress and anxiety in the terminally ill patient. Not allowing the terminally ill patient the legal right to choose his or her preferences and desires at the end of life goes against the freedom of the patient to choose. The aging population is growing quickly, and people are living longer, which means the frail elderly in their final stages of death due to multisystem organ failure might also desire to have the option of PAD that supports dignity in dying. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Case managers are an instrumental and integral part of the end-of-life care team. They are held to the same standard of practice as clinical care providers when it comes to promoting the biomedical ethical points autonomy, beneficence, nonmaleficence, justice, and fidelity. Following these ethical principles is critical for case managers to consider when supporting the desires and preferences of terminally ill patients. Case managers should be involved in all the patient-centered decision making for a terminally ill patient's desire for DD and PAD. It is critical for case managers to follow their organization's defined code of professional conduct as well their specific professional organization and professional certifying body's defined code of ethics and conduct despite their personal convictions.
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Gupta A, Bahl B, Rabadi S, Mebane A, Levey R, Vasudevan V. Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions. Am J Hosp Palliat Care 2020; 38:191-198. [PMID: 33021094 DOI: 10.1177/1049909120963698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
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Affiliation(s)
- Amol Gupta
- 24508The Brooklyn Hospital Center, NY, USA
| | | | - Saher Rabadi
- 12340University of Texas Health Sciences Center, Houston, TX, USA
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Sanli D, Iltus F. Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:936-957. [PMID: 32955992 DOI: 10.1177/0030222820961232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.
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Affiliation(s)
- Deniz Sanli
- Department of Surgical Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Fatma Iltus
- Department of Nursing, Aksehir Kadir Yallagoz School of Health, Selcuk University, Konya, Turkey
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Yoshioka S, Katayama H. Actual Situations and Factors Related to Nursing Activities in Supporting the Transition to Homecare Settings for End-Stage Cancer Patients in General Wards in Japan. Am J Hosp Palliat Care 2020; 38:750-757. [PMID: 32940540 DOI: 10.1177/1049909120959787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate actual situations of nursing activities in supporting the transition to homecare settings for end-stage cancer patients and to determine factors related to executing such nursing activities from the perspectives of communication skills and interprofessional collaboration. A cross-sectional study was conducted with 513 nurses who worked at designated cancer care hospitals in Japan. A total of 318 valid responses were obtained (valid response rate: 62.0%). Scores for nursing activities were higher for the following items: sharing information regarding the transition to homecare settings, intentionally engaging with patients after their medical conditions were explained, providing care for families, and understanding a patient's will about the transition to homecare settings. On the other hand, scores were lower for items that were related to guiding juniors and self-improvement. A multiple regression analysis was performed with nursing activities as the dependent variable. 8 factors related to nursing activities were determined: experience in supporting the transition to homecare settings as a primary nurse, contribution to a team (Team Approach Assessment Scale [TAAS]), years of nursing experience, function of a team (TAAS), regulation of interpersonal relationship (ENDCOREs communication skills scale), experience of participation in homecare nursing education or seminars, verbal communication skills for good communication (End-of-life Care Nurses' Communication Skills scale), and educational background. Future challenges include developing an educational program based on the results of the present study and promoting educational intervention studies.
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Affiliation(s)
- Saori Yoshioka
- Graduate School of Nursing for Health Care Science, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Harumi Katayama
- Department of Fundamental Nursing, 12898Hamamatsu University School of Medicine, Shizuoka, Japan
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Gurdogan EP, Aksoy B, Kinici E. The Concept of a Good Death From the Perspectives of Family Caregivers of Advanced Cancer Patients. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:303-316. [PMID: 32703073 DOI: 10.1177/0030222820945082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to examine the importance of the concept of a good death and the contributing factors from the perspectives of family caregivers of advanced cancer patients. This descriptive and cross-sectional study, conducted with 182 family caregivers, were collected using a questionnaire form and the "Good Death Scale". The number and percentage distribution, multiple linear regression were used evaluation of data. The total score of the Good Death Scale was 62.65 ± 4.60. The factors contributing to the importance of the concept of a good death were determined as the presence of chronic disease; the type of treatment given to the patient; the presence of another family member who was previously diagnosed with cancer; the presence of a family member who has died of cancer and previously caregiving to a terminally ill family member. This study revealed that the concept of a good death is seen as very important.
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Affiliation(s)
- Eylem Pasli Gurdogan
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Berna Aksoy
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ezgi Kinici
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Broden EG, Deatrick J, Ulrich C, Curley MAQ. Defining a "Good Death" in the Pediatric Intensive Care Unit. Am J Crit Care 2020; 29:111-121. [PMID: 32114610 PMCID: PMC11288184 DOI: 10.4037/ajcc2020466] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Societal attitudes about end-of-life events are at odds with how, where, and when children die. In addition, parents' ideas about what constitutes a "good death" in a pediatric intensive care unit vary widely. OBJECTIVE To synthesize parents' perspectives on end-of-life care in the pediatric intensive care unit in order to define the characteristics of a good death in this setting from the perspectives of parents. METHODS A concept analysis was conducted of parents' views of a good death in the pediatric intensive care unit. Empirical studies of parents who had experienced their child's death in the inpatient setting were identified through database searches. RESULTS The concept analysis allowed the definition of antecedents, attributes, and consequences of a good death. Empirical referents and exemplar cases of care of a dying child in the pediatric intensive care unit serve to further operationalize the concept. CONCLUSIONS Conceptual knowledge of what constitutes a good death from a parent's perspective may allow pediatric nurses to care for dying children in a way that promotes parents' coping with bereavement and continued bonds and memories of the deceased child. The proposed conceptual model synthesizes characteristics of a good death into actionable attributes to guide bedside nursing care of the dying child.
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Affiliation(s)
- Elizabeth G Broden
- Elizabeth G. Broden is a doctoral student, University of Pennsylvania School of Nursing, and a registered nurse, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janet Deatrick
- Janet Deatrick is a professor emerita, Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Connie Ulrich
- Connie Ulrich is a professor, Department of Biobehavioral Health, School of Nursing, and a professor of bioethics, School of Medicine, University of Pennsylvania
| | - Martha A Q Curley
- Martha A.Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing, Children's Hospital of Philadelphia, and a professor, Department of Family and Community Health, School of Nursing and Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania
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Ganz FD. Improving Family Intensive Care Unit Experiences at the End of Life: Barriers and Facilitators. Crit Care Nurse 2020; 39:52-58. [PMID: 31154331 DOI: 10.4037/ccn2019721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Experiencing the end of life of a family member in the intensive care unit is clearly difficult. An important role of critical care nurses is to help family members through this challenging period. This article highlights a few clinically significant barriers and facilitators related to improving family experiences at the patient's end of life that have received less attention in the literature thus far. Facilitators include specific aspects of communication, the nurse's role as the coordinator of care, bereavement care, promoting a "good death," and caring for health care providers. Barriers include medical uncertainty and differences in values and culture.
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Affiliation(s)
- Freda DeKeyser Ganz
- Freda DeKeyser Ganz is Department Chair, Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
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Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review. Aust Crit Care 2019; 32:516-523. [DOI: 10.1016/j.aucc.2018.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/08/2018] [Accepted: 07/24/2018] [Indexed: 11/22/2022] Open
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Srinonprasert V, Limpawattana P, Manjavong M, Kuichanuan T, Juntararuangtong T, Yongrattanakit K. Perspectives regarding what constitutes a “good death” among Thai nurses: A cross‐sectional study. Nurs Health Sci 2019; 21:416-421. [DOI: 10.1111/nhs.12634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Varalak Srinonprasert
- Department of Internal MedicineFaculty of Medicine, Siriraj hospital, Mahidol University Bangkok Thailand
| | - Panita Limpawattana
- Department of Internal MedicineFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Manchumad Manjavong
- Department of Internal MedicineFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | - Thunchanok Kuichanuan
- Department of Internal MedicineFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
| | | | - Kongpob Yongrattanakit
- Department of Internal MedicineFaculty of Medicine, Khon Kaen University Khon Kaen Thailand
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Stokes H, Vanderspank-Wright B, Fothergill Bourbonnais F, Wright DK. Meaningful experiences and end-of-life care in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2019; 53:1-7. [DOI: 10.1016/j.iccn.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/14/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
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Brooks LA, Manias E, Bloomer MJ. Culturally sensitive communication in healthcare: A concept analysis. Collegian 2019. [DOI: 10.1016/j.colegn.2018.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Muskat B, Greenblatt A, Anthony S, Beaune L, Hubley P, Newman C, Brownstone D, Rapoport A. The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital. DEATH STUDIES 2019; 44:105-116. [PMID: 30832553 DOI: 10.1080/07481187.2018.1526829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.
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Affiliation(s)
- Barbara Muskat
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Greenblatt
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Anthony
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Beaune
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pam Hubley
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Newman
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Brownstone
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Rapoport
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
The components of good and bad deaths have not been well elucidated in the literature. Furthermore, the value of using narratives in palliative care research has not been extensively explored. We invited people involved in palliative care (patients, caregivers, physicians, and nurses) to tell us their stories of good and bad deaths, and 15 responded. We asked them to tell us about the good and bad deaths that they had witnessed and to describe what a good death and a bad death would be like for them, personally. Several common themes emerged from their good death narratives: a death free from pain, the sense of a life well lived, and a sense of community. Common bad death themes included a painful death and a loss of control and independence. We found that the use of story in palliative care provided an opportunity to create meaning and to heal for both the teller and the listener.
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Affiliation(s)
- Jennifer D. De Jong
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda E. Clarke
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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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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Queiroz TA, Ribeiro ACM, Guedes MVC, Coutinho DTR, Galiza FTD, Freitas MCD. CUIDADOS PALIATIVOS AO IDOSO NA TERAPIA INTENSIVA: OLHAR DA EQUIPE DE ENFERMAGEM. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018001420016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: conhecer o significado de cuidados paliativos ao idoso para a equipe de enfermagem e identificar como ocorrem as interações da família com o idoso na unidade de terapia intensiva. Método: pesquisa descritiva, realizada unidade de terapia intensiva de hospital público em Fortaleza-Ceará-Brasil. Amostra composta por 58 profissionais da equipe de enfermagem. Fez-se a coleta de dados no segundo semestre de 2015 por meio de entrevista semiestruturada e gravada. Resultados: os resultados apontaram três categorias temáticas: cuidados paliativos, com destaque para alívioda dor e do sofrimento; interação familiar e pessoa idosa, sobressaindo comunicação como mais importante; e ambiente imprópriopara cuidados paliativos, com ênfase em orientação para o cuidado. Conclusão: conforme o estudo mostrou, a equipe tem conhecimento sobre cuidados paliativos e reconhece a família como elo entre profissional e idoso. Considera-se, ainda, que a terapia intensiva não é um ambiente apropriado para cuidados paliativos.
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Abstract
OBJECTIVES Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. METHODS A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. RESULTS Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.
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Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence. Int J Nurs Stud 2018; 77:15-26. [DOI: 10.1016/j.ijnurstu.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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Morrissey Stahl KA, Bower KL, Seponski DM, Lewis DC, Farnham AL, Cava-Tadik Y. A Practitioner's Guide to End-of-Life Intimacy: Suggestions for Conceptualization and Intervention in Palliative Care. OMEGA-JOURNAL OF DEATH AND DYING 2017; 77:15-35. [PMID: 29285977 DOI: 10.1177/0030222817696540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sexuality and intimacy, including contact, tenderness, and love, are important at every life stage. Intimate expression is especially vital at the end of life, when relationships with loved ones are time limited. Unfortunately, care providers often ignore the potential need for sexual expression, especially at the end of life. In this article, we consider current research on sexuality and end-of-life care and situate these two fields in an ecological framework. We explore how end-of-life sexuality and intimacy can be supported by practitioners in multiple nested contexts and provide suggestions for theoretically-driven interventions. We also provide reflexive considerations for practitioners.
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Hahne P, Lundström S, Leveälahti H, Winnhed J, Öhlén J. Changes in professionals' beliefs following a palliative care implementation programme at a surgical department: a qualitative evaluation. BMC Palliat Care 2017; 16:77. [PMID: 29282050 PMCID: PMC5745985 DOI: 10.1186/s12904-017-0262-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One ambition regarding palliative care is that it should be more accessible to patients and families regardless of care setting. Previous studies show many difficulties and shortcomings in the care of patients with palliative care needs in acute care facilities, but also challenges regarding efforts to implement palliative care. The aim of this study is to evaluate how the implementation of palliative care, using a combination of integration and consultation strategies, can change beliefs regarding palliative care among professionals in a surgical department. METHOD In order to explore professionals' experiential outcome of an educational implementation strategy, a before-after qualitative design was used. The study was based on three focus group discussions. Two discussions were conducted before introducing the implementation strategy and one was conducted after. The participants consisted of five nurses and two specialist surgeons from a surgical department in Sweden. The focus group discussions revealed a variety of different attitudes and beliefs, which were analysed using qualitative systematic text condensation. RESULTS Beliefs regarding palliative care were identified in seven areas; the importance of palliative care, working methods in palliative care, team collaboration in palliative care, collegial support, discussions about diagnosis, symptoms at the end of life, and families of patients in palliative care. Changes in beliefs were seen in all areas except one: team collaboration in palliative care. CONCLUSION It is possible to change the beliefs of health care professionals in a surgical department regarding palliative care through the implementation of palliative knowledge. Beliefs were changed from an individual to a collective development where the group initiated a shared palliative working method. The changes observed were palliative care being described as more complex and participants differentiating between surgical care and palliative care.
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Affiliation(s)
- Pia Hahne
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Ersta Sköndal Bräcke University College, Box 111 89, -100 61 Stockholm, SE Sweden
| | - Staffan Lundström
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Department of Oncology-Pathology Karolinska Institutet, Stockholm, Sweden
| | - Helena Leveälahti
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
| | - Janet Winnhed
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- ASIH Praktikertjänst Västerort N.Ä.R.A, Vällingby, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Center for Person-Centered Care, Salgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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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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Frenette M, Saint-Arnaud J, Serri K. Levels of Intervention: How Are They Used in Quebec Hospitals? JOURNAL OF BIOETHICAL INQUIRY 2017; 14:229-239. [PMID: 28324205 DOI: 10.1007/s11673-017-9778-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered. Results were analysed through a principlism ethical framework. High compliance with the level of intervention ordered at the time of death was recorded, as well as high involvement of patient and/or family, demonstrating the efficiency of LOI in promoting respect for autonomy. Other results show delays in end-of-life care discussions in the course of the hospitalization. Only a small proportion of patients who died had a palliative care consultation, which may reflect equity issues in access to care. This study highlights the importance of the LOI in Quebec and the role it is playing in respect for end-of-life preferences as well as in the involvement of patients and families in the decision-making process. Training specific to end-of-life decision-making conversations would help support the LOI form's use, as would developing provincial or national guidelines on the use of LOI to standardize organizational policies and practice around end-of-life care.
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Affiliation(s)
- Marjolaine Frenette
- Public Health School (local 3035), University of Montreal, C. P. 6128, succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - Jocelyne Saint-Arnaud
- Department of Social and Preventive Medicine, Public Health School, University of Montreal and Center for Research in Ethics (CRÉ), President Clinical Ethics Committee, Sacré-Coeur Hospital, Montreal, QC, Canada
| | - Karim Serri
- Sacré-Coeur Hospital and University of Montreal, Montreal, QC, Canada
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Brooks LA, Manias E, Nicholson P. Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Aust Crit Care 2017; 30:161-166. [DOI: 10.1016/j.aucc.2016.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022] Open
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Abstract
BACKGROUND The survival rate for infants born with life-threatening problems has improved greatly over the last few decades. Nevertheless, infants still die in neonatal intensive care units (NICUs) every day. Despite existing standards of care, some aspects of end-of-life care (EOLC) are still not delivered consistently. Little is known about how NICU nurses' individual experiences affect EOLC. PURPOSE The purpose of this study was to explore, through lived and told stories, the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Coping strategies and changes in practice were also explored. METHODS Thirty-six members of the National Association of Neonatal Nurses submitted written narratives about an EOLC experience during which the nurse experienced strong emotions. FINDINGS Narrative analysis revealed many affective responses, but 3 were the most frequent: responsibility, moral distress, and identification. Coping methods included healthy and less healthy strategies, such as colleague support, informal and formal debriefing, practicing intentional gratefulness, avoidance, and compartmentalization. Changes in practice identified were universally described as professional growth through the use of reflective practice. IMPLICATIONS FOR PRACTICE & RESEARCH Educators should discuss the range of emotions experienced by caregivers related to EOLC and healthy coping strategies and encourage the use of reflective practice as a facilitator of professional growth. Nurse leaders should promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Future research should focus on formulating interventions to utilize debriefing with NICU nurses and perhaps the development of EOLC mentors.
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Generous MA, Keeley M. Wished for and avoided conversations with terminally ill individuals during final conversations. DEATH STUDIES 2017; 41:162-172. [PMID: 27845611 DOI: 10.1080/07481187.2016.1236850] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current investigation examines retrospectively wished for and avoided conversations during the end of life with a deceased relational partner. Participants reported on conversations they wished they had engaged in and conversations that they intentionally avoided, as well as reasons why they did not engage in the conversations. Analyses revealed the following wished for and avoided conversations: negative relationship characteristics; death and dying; postdeath arrangements; and personal information. Furthermore, participants indicated the following reasons for not discussing the aforementioned topics during final conversations: emotional protection, relational differences, and condition of the dying. Theoretical and practical implications for end-of-life communication are discussed.
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Affiliation(s)
- Mark A Generous
- a Department of Communication , Saint Mary's College of California , Moraga , California , USA
| | - Maureen Keeley
- b Department of Communication Studies , Texas State University , San Marcos , Texas , USA
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Tripathy S, Routray PK, Mishra JC. Intensive Care Nurses' Attitude on Palliative and End of Life Care. Indian J Crit Care Med 2017; 21:655-659. [PMID: 29142376 PMCID: PMC5672670 DOI: 10.4103/ijccm.ijccm_240_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation. Aim This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL. Materials and Methods A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs. Results Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms "EOL care or palliative care in ICU" were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions (P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions (P = 0.001). Conclusion Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.
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Affiliation(s)
- Swagata Tripathy
- Department of Anesthesia and and Intensive Care, AIIMS, Bhubaneswar, Odisha, India
| | - Pragyan K Routray
- Department of Intensive Care Medicine, Care Hospitals, Bhubaneswar, Odisha, India
| | - Jagdish C Mishra
- Department of Anesthesia and and Intensive Care, KIMS, Bhubaneswar, Odisha, India
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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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Description of good patient care at the end of life. Appl Nurs Res 2016; 32:245-246. [DOI: 10.1016/j.apnr.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/05/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022]
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Difficulties Felt by Intensive Care Unit Nurses in Providing End-of-Life Care in Southeast Iran. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. RESEARCH OBJECTIVE The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. RESEARCH DESIGN The study used a qualitative narrative approach. PARTICIPANTS Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher's university Institutional Review Board for ethical review was obtained. FINDINGS Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. DISCUSSION The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses' deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. CONCLUSION A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.
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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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Bloomer MJ, Lee SF, Lewis DP, Biro MA, Moss C. Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study. J Clin Nurs 2016; 25:2200-10. [PMID: 27263512 DOI: 10.1111/jocn.13264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service. BACKGROUND There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice. DESIGN This study used a sequential exploratory design with data collected in 2014. METHODS A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation. RESULTS Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need. CONCLUSION Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making. RELEVANCE TO CLINICAL PRACTICE There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University and Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
| | - Susan F Lee
- Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - David P Lewis
- CLOVeR Clinical Systems Support, Peninsula Health, Frankston, Victoria, Australia
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - Cheryle Moss
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Abu-Ghori IK, Bodrick MM, Hussain R, Rassool GH. Nurses’ involvement in end-of-life care of patients after a do not resuscitate decision on general medical units in Saudi Arabia. Intensive Crit Care Nurs 2016; 33:21-9. [DOI: 10.1016/j.iccn.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/26/2022]
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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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