Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand

This study explored the role of the research nurse in New Zealand (NZ) Level III intensive care units (ICU). Little was known about this role in NZ prior to this study. A qualitative, descriptive approach, using semi-structured interviews was used. The study was conducted in six Level III ICUs throughout NZ, who employed a research nurse. Interviews were conducted with research nurses (n = 11), the doctors they work with (principal investigators) (n = 6) and nurse managers (n = 6) for the ICUs, and the findings were triangulated. The views across all ICUs and stakeholders were generally similar, with differences only being in some operational areas. This study found that the primary role of the research nurse was trial management, where they coordinated all elements of trial conduct. Almost half of the research nurses were also involved in trial design through their positions on management committees. Research nurses also played a vital role in patient and trial advocacy, and they bridged the knowledge gap by bringing research to staff nurses, patients and their families. The issue of consent for clinical trials in the ICU setting was significant, as this was a process which research nurses were very involved in. Consenting patients was a shared responsibility of research nurses and doctors. There was a perception that research nurses were senior nurses, but not necessarily because of their role in research. The majority of research nurses reported to a nursing line manager, and also had an informal accountability to the principal investigator (PI). Research nurses and PIs worked closely in the pursuit of rigorous research for ICU patients, and research nurses were highly regarded by PIs. This study provides clarity about the research nurse‟s role and showcases their key contribution in ensuring that NZ ICUs undertake high quality research, thus contributing to potential improvements for future patients‟ outcomes.

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A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment*

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000123547.28099.44 ◽

2004 ◽

Vol 5 (3) ◽

pp. 216-223 ◽

Cited By ~ 48

Author(s):

Christine A. Zawistowski ◽

Michael A. DeVita

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Descriptive Study ◽

Life Sustaining Treatment

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Making ICU Research Happen: a Qualitative Descriptive Study About the Role of the Research Nurse in New Zealand Level III Intensive Care Units

10.26686/wgtn.17003314 ◽

2021 ◽

Author(s):

◽

Diane Margaret Mackle

Keyword(s):

Intensive Care ◽

New Zealand ◽

Intensive Care Units ◽

Shared Responsibility ◽

Research Nurse ◽

Primary Role ◽

High Quality Research ◽

Qualitative Descriptive ◽

Research Nurses

This study explored the role of the research nurse in New Zealand (NZ) Level III intensive care units (ICU). Little was known about this role in NZ prior to this study. A qualitative, descriptive approach, using semi-structured interviews was used. The study was conducted in six Level III ICUs throughout NZ, who employed a research nurse. Interviews were conducted with research nurses (n = 11), the doctors they work with (principal investigators) (n = 6) and nurse managers (n = 6) for the ICUs, and the findings were triangulated. The views across all ICUs and stakeholders were generally similar, with differences only being in some operational areas. This study found that the primary role of the research nurse was trial management, where they coordinated all elements of trial conduct. Almost half of the research nurses were also involved in trial design through their positions on management committees. Research nurses also played a vital role in patient and trial advocacy, and they bridged the knowledge gap by bringing research to staff nurses, patients and their families. The issue of consent for clinical trials in the ICU setting was significant, as this was a process which research nurses were very involved in. Consenting patients was a shared responsibility of research nurses and doctors. There was a perception that research nurses were senior nurses, but not necessarily because of their role in research. The majority of research nurses reported to a nursing line manager, and also had an informal accountability to the principal investigator (PI). Research nurses and PIs worked closely in the pursuit of rigorous research for ICU patients, and research nurses were highly regarded by PIs. This study provides clarity about the research nurse‟s role and showcases their key contribution in ensuring that NZ ICUs undertake high quality research, thus contributing to potential improvements for future patients‟ outcomes.

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Over the Great Wall: A Qualitative Descriptive Study of the Experiences and Preferences of Chinese Immigrant Families when Receiving Hospice Services in New Zealand

10.26686/wgtn.16969066 ◽

2021 ◽

Author(s):

◽

Joanna Clare Hathaway

Keyword(s):

New Zealand ◽

End Of Life Care ◽

Immigrant Families ◽

Chinese Immigrants ◽

Descriptive Study ◽

Sensitive Information ◽

Chinese Immigrant ◽

Life Care ◽

Chinese Immigrant Families ◽

Qualitative Descriptive

This thesis discusses the background, processes, findings and recommendations of a qualitative descriptive study to explore and describe the experiences and preferences of Chinese immigrant families when receiving hospice services in New Zealand (NZ). The study arose from clinical practice questions about how hospice services were providing end-of-life care to the growing number of Chinese immigrants in NZ. With the assistance of a Cultural Advisor and a team of professional interpreters, eight bereaved Chinese immigrants living in the greater Auckland area who had cared for a terminally ill close family member with hospice service involvement were interviewed using a semi-structured approach. Participants were asked to describe their family support in NZ as well as their experiences of referral to a hospice, the types of care and treatment provided, communication processes between staff and the patient/family, care in the patient's last days of life, comparisons with care provided in their country of origin and suggestions for NZ hospice service improvements. Four key themes emerged: 1) Unfamiliar territory - participants were unfamiliar with the role or services of hospice and staff's lack of awareness of Chinese customs had led to distressing situations; 2) Service experiences and expectations - while some services were deemed useful others were not; participants had expected more medical treatments to manage the patient's symptoms; deaths in in-patient settings were less concerning to families and were preferred to deaths at home; 3) Support to cope - participants wanted more psychological support from hospice and regarded the maintenance of hope as a key component of a good death; 4) Uncovering sensitive information - families wanted to be consulted before sensitive information was discussed with patients and they preferred information to be uncovered slowly and gently to avoid causing the patient psychological harm. Recommendations for hospice service development included: improved access to information for families; greater provision of support services, especially for patients and families at home; education for hospice staff about Chinese culture and customs; options for in-patient admission in the last days of life; and the involvement of families in disclosure decisions. It is hoped that by responding to the experiences and preferences shared by participants, hospice services will be better equipped to address the end-of-life care needs of Chinese immigrant families.

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Over the Great Wall: A Qualitative Descriptive Study of the Experiences and Preferences of Chinese Immigrant Families when Receiving Hospice Services in New Zealand

10.26686/wgtn.16969066.v1 ◽

2021 ◽

Author(s):

◽

Joanna Clare Hathaway

Keyword(s):

New Zealand ◽

End Of Life Care ◽

Immigrant Families ◽

Chinese Immigrants ◽

Descriptive Study ◽

Sensitive Information ◽

Chinese Immigrant ◽

Life Care ◽

Chinese Immigrant Families ◽

Qualitative Descriptive

This thesis discusses the background, processes, findings and recommendations of a qualitative descriptive study to explore and describe the experiences and preferences of Chinese immigrant families when receiving hospice services in New Zealand (NZ). The study arose from clinical practice questions about how hospice services were providing end-of-life care to the growing number of Chinese immigrants in NZ. With the assistance of a Cultural Advisor and a team of professional interpreters, eight bereaved Chinese immigrants living in the greater Auckland area who had cared for a terminally ill close family member with hospice service involvement were interviewed using a semi-structured approach. Participants were asked to describe their family support in NZ as well as their experiences of referral to a hospice, the types of care and treatment provided, communication processes between staff and the patient/family, care in the patient's last days of life, comparisons with care provided in their country of origin and suggestions for NZ hospice service improvements. Four key themes emerged: 1) Unfamiliar territory - participants were unfamiliar with the role or services of hospice and staff's lack of awareness of Chinese customs had led to distressing situations; 2) Service experiences and expectations - while some services were deemed useful others were not; participants had expected more medical treatments to manage the patient's symptoms; deaths in in-patient settings were less concerning to families and were preferred to deaths at home; 3) Support to cope - participants wanted more psychological support from hospice and regarded the maintenance of hope as a key component of a good death; 4) Uncovering sensitive information - families wanted to be consulted before sensitive information was discussed with patients and they preferred information to be uncovered slowly and gently to avoid causing the patient psychological harm. Recommendations for hospice service development included: improved access to information for families; greater provision of support services, especially for patients and families at home; education for hospice staff about Chinese culture and customs; options for in-patient admission in the last days of life; and the involvement of families in disclosure decisions. It is hoped that by responding to the experiences and preferences shared by participants, hospice services will be better equipped to address the end-of-life care needs of Chinese immigrant families.

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Transitions in the communication experiences of tracheostomised patients in intensive care: a qualitative descriptive study

Journal of Clinical Nursing ◽

10.1111/jocn.12826 ◽

2015 ◽

Vol 24 (15-16) ◽

pp. 2295-2304 ◽

Cited By ~ 17

Author(s):

Stine Irene Flinterud ◽

Birgitta Andershed

Keyword(s):

Intensive Care ◽

Descriptive Study ◽

Qualitative Descriptive

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Qualitative descriptive study to explore nurses’ perceptions and experience on pain, agitation and delirium management in a community intensive care unit

BMJ Open ◽

10.1136/bmjopen-2018-024328 ◽

2019 ◽

Vol 9 (4) ◽

pp. e024328 ◽

Cited By ~ 5

Author(s):

Jennifer L Y Tsang ◽

Katie Ross ◽

Franziska Miller ◽

Ramez Maximous ◽

Priscilla Yung ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Focus Group ◽

Critically Ill ◽

Critically Ill Patients ◽

Descriptive Study ◽

Medium Size ◽

Healthcare Teams ◽

Qualitative Descriptive ◽

Professional Perspectives

ObjectivesThe purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients.DesignA qualitative descriptive study.SettingThis study took place in a community hospital ICU located in a medium size Canadian city.ParticipantsPurposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated.MethodsA total of five focus group sessions were held to collect data. There were one to three separate groups in each focus group session, with no more than seven participants in each group. There were 10 separate groups in total. A semistructured question guide was used. Thematic analysis method was adopted to analyse the data, and to search for emergent themes and patterns.ResultsThree main themes emerged: (1) the professional perspectives on patient wakefulness state, (2) the professional perspectives on PAD management of critically ill patients and (3) the factors impacting PAD management. Nurses have different opinions on the optimal level of patient sedation and felt that many factors, including environmental, healthcare teams, patients and family members, can influence PAD management. This potentially leads to inconsistent PAD management in critically ill patients. The nurses also believed that PAD management requires a multidisciplinary approach including healthcare teams and patients’ families.ConclusionsMany external and internal factors contribute to the complexity of PAD management including the attitudes of nursing staff towards PAD. The themes emerged from this study suggested the need of a multifaceted and multidisciplinary quality improvement programme to optimise the management of PAD in the ICU.

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