scholarly journals An Exploratory Investigation into the Roles of Critical Care Response Teams in End-of-Life Care

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Adrienne Kwong ◽  
Stephanie Chenail ◽  
Aimee Sarti ◽  
Laura H. Thompson ◽  
Marlena Dang Nguyen ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Constructivist Grounded Theory ◽  
Theory Approach ◽  
Life Care ◽  
Respiratory Therapists ◽  
Advance Care ◽  
Care Response

Background. Critical Care Response Teams (CCRTs) represent an important interface between end-of-life care (EOLC) and critical care medicine (CCM). The aim of this study was to explore the roles and interactions of CCRTs in the provision of EOLC from the perspective of CCRT members. Methods. Twelve registered nurses (RNs) and four respiratory therapists (RTs) took part in focus groups, and one-on-one interviews were conducted with six critical care physicians. Thematic coding using a modified constructivist grounded theory approach was used to identify emerging themes through an iterative process involving a four-member coding team. Results. Three main perspectives were identified that spoke to CCRT interactions and perceptions of EOLC encounters. CCRT members felt that they provide a unique skill set of multidisciplinary expertise in treating critically ill patients and evaluating the utility of intensive care treatments. However, despite feeling that they possessed the skills and resources to deliver quality EOLC, CCRT members were ambivalent with respect to whether EOLC was a part of their mandate. Challenges were also identified that impacted the ability of CCRTs to deliver quality EOLC. Conclusions. This research aids in understanding for the first time CCRT roles in EOLC from the perspectives of individual CCRT members themselves. While CCRTs provide unique multidisciplinary expertise to evaluate the utility of intensive care treatments, opportunities exist to support CCRTs in EOLC, such as dedicated EOLC training, protocols for advance care planning, documentation, and transitions to palliative care.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

2022 ◽  
pp. 088506662110690
Author(s):  
Daniel King ◽  
Erica Schockett ◽  
Ghazi Rizvi ◽  
Daniel Fischer ◽  
Richard Amdur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Over Time

Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine

2008 ◽  
Vol 36 (3) ◽  
pp. 953-963 ◽  
Author(s):  
Robert D. Truog ◽  
Margaret L. Campbell ◽  
J Randall Curtis ◽  
Curtis E. Haas ◽  
John M. Luce ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Consensus Statement ◽  
Critical Care Medicine ◽  
Life Care

scholarly journals Providing a “Good Death”: Critical Care Nurses’ Suggestions for Improving End-of-Life Care

2006 ◽  
Vol 15 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Renea L. Beckstrand ◽  
Lynn Clark Callister ◽  
Karin T. Kirchhoff
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Good Death ◽  
Primary Concern ◽  
Major Theme ◽  
Life Care ◽  
The Public

• Background Providing appropriate end-of-life care has become a primary concern of nurses and the public. The highly technological critical care environment may not facilitate such care. • Objective To collect suggestions from critical care nurses for improving end-of-life care in intensive care units. • Methods A geographically dispersed, random sample of 1409 members of the American Association of Critical-Care Nurses was sent a 72-item survey on perceptions of end-of life care. The survey included a request for suggestions on ways to improve end-of life care. • Results Of the 861 critical care nurses who responded to the survey, 485 offered 530 suggestions for improving end-of-life care. Providing a “good death” was the major theme; specific suggestions included ways to help ensure death with dignity and peace. Barriers to providing good deaths included nursing time constraints, staffing patterns, communication challenges, and treatment decisions that were based on physicians’ rather than patients’ needs. Suggestions for providing a good death included facilitating dying with dignity; not allowing patients to be alone while dying; managing patients’ pain and discomfort; knowing, and then following, patients’ wishes for end-of-life care; promoting earlier cessation of treatment or not initiating aggressive treatment at all; and communicating effectively as a health-care team. Educational initiatives for professionals and the public were also suggested. • Conclusions Implementation of specific suggestions provided by experienced critical care nurses might increase the quality of end-of-life care, facilitating a good death for intensive care patients.

scholarly journals Ethical Dilemmas of End of Life Care in Intensive Care Unit : A Literature Review

2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Albertus Budi Arianto ◽  
Yanny Trisyani ◽  
Etika Emiliyawati
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Ethical Principle ◽  
Life Care ◽  
Eol Care

 ABSTRACTThe end-of-life (EOL) care is the progressive terminal illness, leading to death; that in the situation the nurse have significant role in decision making. In decision making, temporarily, the nurse will experiences the ethical dilemmas, including in intensive care unit (ICU) with any factors resulting in problem in medical decision making. The literature review intends to analyze the description of ethical dilemmas occurred in intensive care unit, especially to the EOL care. A method used is critical review full text of 2007-2018 periods in English langguage. The multiple databases used is PubMed, Proquest and Google Scholar with keyword “End of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life critical care”, and “Dilemmas Ethic in ICU.” The articles selected gradually by using of Appraisal tool of PRISMA and obtained 21 articles. The literature study obtaining 4 themes related to description of the ethical dilemmas in ICU including (1) the ethical principle involved in EOL care at ICU, (2) resource of ethical conflict in ICU, (3) impact of ethical conflict in ICU, and (4) response of nurse in dealing with ethical dilemmas. The discussion of literature review related to the perception of nurse on EOL care; that nurse have important role in medical decision making involving ethical principle in the implementation. it is required further research on exploration of nurse experience on implementation of ethical principle in case of EOL care.ABSTRAKPerawatan end of life (EOL) merupakan suatu perawatan pada penyakit terminal yang bersifat progresif, yang akan berujung dengan kematian, pada kondisi ini perawat mempunyai peran dalam pengambilan keputusan perawatan. Terkadang dalam pengambilan keputusan ini perawat akan mengalami kondisi dilema etik, tak terkecuali di ruangan intensive care unit dimana diruangan tersebut banyak faktor yang mengakibatkan kesulitan dalam pengambilan keputusan medis. Literature reviews ini bertujuan untuk menganalisia gambaran dilema etik yang terjadi di area intensive khususnya pada kasus end of life care. Metode yang digunakan adalah critical review full text dengan rentang tahun 2007-2018 dalam Bahasa Inggris. Multiple database yang digunakan adalah PubMed, Proquest dan Google Scholar merupakan database yang digunakan, dengan kata kunci “End Of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life in critical care”, and“Dilema Ethic in ICU”. Artikel diseleksi bertahap menggunakan Appraisal tool PRISMA dan didapatkan 21 artikel. Studi literatur diperoleh 4 tema terkait gambaran dilema etik di ruang ICU diantaranya (1) Prinsip etik yang terlibat dalam end of life care di ICU, (2) Sumber konflik etik di ICU, (3) Dampak konflik etik di ICU, dan (4) Respon perawat dalam menghadapi dilema etik. Pembahasan telaah literatur ini terkait persepsi perawat mengenai perawatan end of life, dimana perawat mempunyai peran penting dalam pengambilan keputusan medis yang melibatkan prinsip etik dalam pelaksanaannya. Diperlukan penelitian lebih lanjut mengenai eksplorasi pengalaman perawat terhadap implementasi prinsip etik pada kasus perawatan menjelang ajal.

scholarly journals No place like home: A case study of a patient discharged from an Intensive Care Unit for end of life care at home

2018 ◽  
Vol 19 (3) ◽  
pp. 259-263 ◽  
Author(s):  
David Smith ◽  
Donna Hall ◽  
Geraldine Parke ◽  
Rebecca Lane ◽  
Alison Gray
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Community Services ◽  
Life Care ◽  
Good Communication ◽  
Advance Care ◽  
The Uk

Introduction Both in the UK and internationally, discharge from an intensive care unit to home for end of life care is a rare and challenging occurrence. These challenges include clinicians’ ability to identify appropriate patients in whom it is possible to communicate with about their wishes and preferences, the critical nature of their condition and the interface between hospital and community services. Method We present a case report of a patient who had been admitted to hospital with a myocardial infarction and subsequently suffered a cardiac arrest, from which he was successfully resuscitated. Subsequently, he suffered multi-organ failure, but despite treatments, the ceiling of care was reached. With a poor prognosis, medical and nursing staff engaged in advance care planning to determine his wishes and preferences at the end of life and to facilitate his discharge from the intensive care unit to his home. Conclusion This case study has highlighted that through good communication amongst patients, families and professionals and collaborative working across boundaries and organisations, appropriate patients in the critical care setting can have a real choice regarding where they wish to be cared for and die at the end of their life.

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