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Salins N, Dhyani VS, Mathew M, Prasad A, Rao AP, Damani A, Rao K, Nair S, Shanbhag V, Rao S, Iyer S, Gursahani R, Mani RK, Bhatnagar S, Simha S. Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review. Intensive Care Med 2024:10.1007/s00134-024-07565-7. [PMID: 39141091 DOI: 10.1007/s00134-024-07565-7] [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: 04/02/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission. METHODS Seven databases were systematically searched for systematic reviews, and the umbrella review was conducted according to the guidelines laid out by the Joanna Briggs Institute (JBI). RESULTS Out of 3122 initial records identified, 40 systematic reviews were included in the synthesis. Six key themes were generated that reflect the palliative and end-of-life care practices in the ICUs and their outcomes. Effective communication and accurate prognostications enabled families to make informed decisions, cope with uncertainty, ease distress, and shorten ICU stays. Inter-team discussions and agreement on a plan are essential before discussing care goals. Recording care preferences prevents unnecessary end-of-life treatments. Exceptional end-of-life care should include symptom management, family support, hydration and nutrition optimisation, avoidance of unhelpful treatments, and bereavement support. Evaluating end-of-life care quality is critical and can be accomplished by seeking family feedback or conducting a survey. CONCLUSION This umbrella review encapsulates current palliative care practices in ICUs, influencing patient and family outcomes and providing insights into developing an appropriate care framework for critically ill patients needing end-of-life care and their families.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Mebin Mathew
- Karunashraya Bangalore Hospice Trust, Bangalore, India
| | | | - Arathi Prahallada Rao
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krithika Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shreya Nair
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth University Medical College, Pune, India
| | | | | | - Sushma Bhatnagar
- Oncoanaesthesia and Palliative Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Haidinger E, Krutter S. [Nurses' common experiences of old age and intensive care: A qualitative study]. Pflege 2024; 37:139-147. [PMID: 36866776 DOI: 10.1024/1012-5302/a000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Nurses' common experiences of old age and intensive care: A qualitative study Abstract. Background: Increasingly more people in the 80+ age group are receiving treatment in the ICU-setting. The related critical care nurses' experience has been the subject of very few studies. Aim: To better understand the everyday nursing practice in the care of old patients in the ICU setting, the knowledge of critical care nurses that guides their actions will be examined and presented in terms of their orientations and typologies. Method: Within the interpretative paradigm, three guideline-based group discussions were conducted with a total of 14 critical care nurses from an Austrian clinic. Data was analyzed using the documentary method according to Bohnsack. Results: Five orientations characterize the knowledge and the actions of critical care nurses relating to old patients: the respect for the patients' will, the search for ethical justification, the beauty of the job, the own reflection of professional actions as well as the perception of a partly misguided health care system. The superior action-guiding typology is advocacy in the representation of the very old patients' interests. Conclusions: The multi-faceted experiences of critical care nurses are characterized by personal, interpersonal, and structural challenges, but also by positive experiences. The findings offer approaches to improve the care situation for nurses as well as for old people in intensive care units.
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Affiliation(s)
- Eduard Haidinger
- Masterstudium Pflegewissenschaft, Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Simon Krutter
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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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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Coventry A, Gerdtz M, McInnes E, Dickson J, Hudson P. Supporting families of patients who die in adult intensive care: A scoping review of interventions. Intensive Crit Care Nurs 2023; 78:103454. [PMID: 37253283 DOI: 10.1016/j.iccn.2023.103454] [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: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Families who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement. AIM To identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used. DESIGN Scoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines. DATA SOURCES A systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently. RESULTS Seven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported. CONCLUSION This review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure.
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Affiliation(s)
- Alysia Coventry
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia; The Centre for Palliative Care, St Vincent's Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia; Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. https://twitter.com/@AlysiaCoventry
| | - Marie Gerdtz
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia. https://twitter.com/@MarieGerdtz
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
| | - Jessica Dickson
- Library and Academic Research Services, Australian Catholic University, Melbourne, Australia. https://twitter.com/@jess_dickson15
| | - Peter Hudson
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia; The Centre for Palliative Care, St Vincent's Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia; Vrije University, Brussels, Belgium
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Simpson C, Lee-Ameduri K, Hartwick M, Shaul RZ, Kanji A, Healey A, Murphy NB, Pope TM. Navigating disagreement and conflict in the context of a brain-based definition of death. Can J Anaesth 2023; 70:724-735. [PMID: 37131031 PMCID: PMC10202992 DOI: 10.1007/s12630-023-02417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/03/2022] [Accepted: 09/20/2022] [Indexed: 05/04/2023] Open
Abstract
In this paper, we discuss situations in which disagreement or conflict arises in the critical care setting in relation to the determination of death by neurologic criteria, including the removal of ventilation and other somatic support. Given the significance of declaring a person dead for all involved, an overarching goal is to resolve disagreement or conflict in ways that are respectful and, if possible, relationship preserving. We describe four different categories of reasons for these disagreements or conflicts: 1) grief, unexpected events, and needing time to process these events; 2) misunderstanding; 3) loss of trust; and 4) religious, spiritual, or philosophical differences. Relevant aspects of the critical care setting are also identified and discussed. We propose several strategies for navigating these situations, appreciating that these may be tailored for a given care context and that multiple strategies may be helpfully used. We recommend that health institutions develop policies that outline the process and steps involved in addressing situations where there is ongoing or escalating conflict. These policies should include input from a broad range of stakeholders, including patients and families, as part of their development and review.
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Affiliation(s)
- Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada.
- Canadian Blood Services, Ottawa, ON, Canada.
| | - Katarina Lee-Ameduri
- St. Boniface Hospital, Reseau Compassion Network, Winnipeg, MB, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Hartwick
- Department of Medicine, Divisions of Critical Care and Palliative Medicine, University of Ottawa, Ottawa, ON, Canada
- Trillium Gift of Life, Ottawa, ON, Canada
| | - Randi Zlotnik Shaul
- Bioethics Department, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Aly Kanji
- McGill University, Montreal, QC, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Hamilton, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nicholas B Murphy
- Departments of Medicine and Philosophy, Western University, London, ON, Canada
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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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