Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study

2021 ◽  
Vol 30 (18) ◽  
pp. 1084-1089
Author(s):  
Teju Limbu ◽  
Paul M Taylor
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Dying Patients ◽  
Surgical Nurses ◽  
Training And Support ◽  
Surgical Setting ◽  
Eol Care ◽  
Physical Care

Background: The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. Aims and methods: This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. Results: Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. Conclusion: Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.

scholarly journals The challenges of using physical restraint in intensive care units in Iran: A qualitative study

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

Characteristics and Outcomes of Patients Referred to an Emergency Department-Based End-of-Life Care Service in Hong Kong: A Retrospective Cohort Study

2020 ◽  
Vol 38 (1) ◽  
pp. 25-31
Author(s):  
Yat Chun Chan ◽  
Marc L. C. Yang ◽  
Hiu Fai Ho
Keyword(s):  
Emergency Department ◽  
Hong Kong ◽  
End Of Life ◽  
Care Service ◽  
Active Role ◽  
Emergency Physicians ◽  
Time To Death ◽  
Dying Patients ◽  
Eol Care ◽  
Mean Time

Background: This study describes the characteristics and outcomes of patients referred to an emergency department (ED)-based end-of-life (EOL) service in a tertiary acute hospital in Hong Kong. We examine how emergency physicians (EPs) perform in recognizing and managing dying patients. Methods: From September 2010 to April 2018, patients referred to this EOL service in this hospital were included. A group of 5 EPs assessed whether the referred patient would die within a few days. Dying patients (EOL group) were admitted to ED-based EOL service whereas those not likely dying within few days (non-EOL group) would continue management in respective specialty wards. Baseline characteristics of these 2 groups were compared. The time-to-death and use of opioids and anticholinergics were compared. Results: In total, 783 of 830 patients assessed were recognized as being in dying phase, with 688 admitted under ED-based EOL care. Their demographics and characteristics were described. Mean time from assessment to death (time-to-death) was significantly less in EOL group (38.93 hours) than in non-EOL group (250.36 hours; P = .004). Mean time-to-death was not significantly different between those under EP-based EOL service or not. The ED-based EOL care had significantly more patients receiving symptomatic treatment. Interpretation: The characteristics of patients under an ED-based EOL service are described. Emergency physicians are capable of recognizing dying patients. Emergency department-based EOL service does not alter the dying process and offers adequate palliation of symptoms. Emergency physician should assume a more active role in providing adequate EOL care to suitable patients.

Conceptualization of a good end-of-life experience with dementia in Japan: a qualitative study

2019 ◽  
Vol 32 (2) ◽  
pp. 255-265
Author(s):  
Mayumi Nishimura ◽  
Ayako Kohno ◽  
Jenny T. van der Steen ◽  
Toru Naganuma ◽  
Takeo Nakayama
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Family Caregivers ◽  
Life Experience ◽  
Central Position ◽  
Structured Interviews ◽  
Cultural Backgrounds ◽  
Term Care ◽  
Family Structures ◽  
People With Dementia

ABSTRACTObjectives:To conceptualize a “good end of life” for people with dementia from the perspectives of bereaved family caregivers in Japan.Design and participants:A qualitative study using in-depth, semi-structured interviews focused on the family caregivers’ perceptions of their loved one’s experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted.Results:From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a “Peaceful Death” while “Maintaining Personhood” at a “Preferred Place” allowing for feelings of “Life Satisfaction.” A “Preferred Place” emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, “Maintaining Personhood.” However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a “Preferred Place.”Conclusions:Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort.TRIAL REGISTRATION NUMBEREthics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2)

scholarly journals End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives

2010 ◽  
Vol 17 (4) ◽  
pp. 317-326 ◽  
Author(s):  
Joyce Cavaye ◽  
Jacqueline H. Watts
Keyword(s):  
End Of Life ◽  
Quality Care ◽  
Death And Dying ◽  
Nurse Education ◽  
Nursing Curriculum ◽  
Nurse Training ◽  
Dying Patients ◽  
National Priority ◽  
The Uk ◽  
Eol Care

Providing good quality care for dying patients has been highlighted as a national priority in the UK. The Department of Health’s end-of-life (EOL) care strategy outlines how patients should be cared for to ensure that they experience a ‘good death’. Nurses have an important role to play in the delivery of EOL care and need to be knowledgeable about the palliation of symptoms and the social context of death and dying. Traditionally, the pre-registration nursing curriculum has had a limited emphasis on EOL care. While there have been significant developments in nurse education in the last decade, the amount of EOL content in nurse education remains inadequate. Drawing on literature mainly from the UK and USA, this review explores from the perspectives of students, newly qualified nurses, patients and carers the outcomes of EOL education. It reviews the evidence to determine whether newly qualified nurses are adequately prepared to deliver quality care to patients at the end of their lives. The evidence suggests that despite a greater emphasis on EOL care in nurse training, adequately preparing nurses remains a challenge to educators.

scholarly journals GPs’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702809
Author(s):  
Ben Bowers ◽  
Kristian Pollock ◽  
Sam Barclay ◽  
Stephen Barclay
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
End Of Life ◽  
Thematic Analysis ◽  
Symptom Management ◽  
Symptom Relief ◽  
Structured Interviews ◽  
Family Experiences ◽  
Decision Making Processes ◽  
Purposive Sample

BackgroundGPs have a central role in decisions about prescribing anticipatory medications (AMs) to help control symptoms at the end of life. Little is known about GPs’ decision-making processes in prescribing AMs and the subsequent use of prescribed drugs.AimTo explore GPs’ decision-making processes in the prescribing and use of AMs for patients at the end of life.MethodA qualitative interpretive descriptive enquiry with a purposive sample of 13 GPs working across one English county. Data was collected in 2017 via semi-structured interviews and analysed inductively using Braun and Clarke’s thematic analysis.ResultsThree themes were constructed from the data: 1) ‘Something we can do’: AMs were a tangible intervention GPs felt they could offer to provide symptom relief for patients approaching death. 2) ‘Getting the timing right’: the prescribing of AMs was recognised as a harbinger of death for patients and families. GPs preferred to prescribe drugs weeks before death was expected, while recognising this meant that many prescribed AMs were never used. 3) ‘Delegating care while retaining accountability’: GPs relied on nurse to assess when to administer drugs and keep them updated about their use.ConclusionGPs view AMs as key to symptom management for dying people. AMs are routinely prescribed even though they are often not used. In order to feel comfortable delegating care, GPs need regular access to nurses and trust in their skills to administer drugs appropriately. Patient and family experiences of AMs, and their preference for involvement in decision-making about their use warrant urgent investigation.

Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying

2019 ◽  
Vol 33 (6) ◽  
pp. 562-569 ◽  
Author(s):  
Sarah-May Blaschke ◽  
Penelope Schofield ◽  
Keryn Taylor ◽  
Anna Ugalde
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Policy Development ◽  
Sampling Strategy ◽  
Assisted Dying ◽  
Life Care ◽  
Structured Interviews ◽  
Moral Philosophies

Background: Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals’ role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered. Aim: To explore end-of-life care professionals’ attitudes towards voluntary assisted dying 6 months prior to vote on legalization. Design: Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques. Participants: A total of 16 health professionals with experience in caring for people with life-limiting illness. Results: Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available. Conclusion: Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.

scholarly journals What is Quality End‐of‐Life Care for Patients With Heart Failure? A Qualitative Study With Physicians

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Rebecca N. Hutchinson ◽  
Caitlin Gutheil ◽  
Benjamin S. Wessler ◽  
Hayley Prevatt ◽  
Douglas B. Sawyer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Qualitative Study ◽  
End Of Life ◽  
Symptom Control ◽  
Quality Metrics ◽  
High Quality ◽  
Dual Nature ◽  
Patients With Heart Failure ◽  
Aggressive Care ◽  
Eol Care

Background Advanced heart failure (AHF) carries a morbidity and mortality that are similar or worse than many advanced cancers. Despite this, there are no accepted quality metrics for end‐of‐life (EOL) care for patients with AHF. Methods and Results As a first step toward identifying quality measures, we performed a qualitative study with 23 physicians who care for patients with AHF. Individual, in‐depth, semistructured interviews explored physicians' perceptions of characteristics of high‐quality EOL care and the barriers encountered. Interviews were analyzed using software‐assisted line‐by‐line coding in order to identify emergent themes. Although some elements and barriers of high‐quality EOL care for AHF were similar to those described for other diseases, we identified several unique features. We found a competing desire to avoid overly aggressive care at EOL alongside a need to ensure that life‐prolonging interventions were exhausted. We also identified several barriers related to identifying EOL including greater prognostic uncertainty, inadequate recognition of AHF as a terminal disease and dependence of symptom control on disease‐modifying therapies. Conclusions Our findings support quality metrics that prioritize receipt of goal‐concordant care over utilization measures as well as a need for more inclusive payment models that appropriately reflect the dual nature of many AHF therapies.

scholarly journals KNOWLEDGE OF END-OF-LIFE CARE, LIFE-SUSTAINING TREATMENT, AND ADVANCE DIRECTIVES IN NURSING STUDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S727-S727
Author(s):  
Jooyoung Cheon
Keyword(s):  
Nursing Students ◽  
End Of Life ◽  
Advance Directives ◽  
Critical Role ◽  
Cross Sectional ◽  
Clinical Practicum ◽  
Undergraduate Nursing ◽  
Dying Patients ◽  
Life Sustaining Treatment ◽  
Eol Care

Abstract Knowledge of end-of-life (EOL) care and being able to make the appropriate decisions for patients who are dying is important for nursing students, who will soon play a critical role in EOL decision-making among patients and their caregivers. Accordingly, the purpose of this study was to examine the level of knowledge of EOL care, life-sustaining treatment, and advance directives among nursing students in South Korea. This cross-sectional descriptive study was conducted from December 2017 to February 2018. Data were collected from 220 undergraduate nursing students and analyzed using descriptive statistics, t-tests, one-way ANOVA, and a post hoc test with the SPSS 19.0 program. The score for knowledge of EOL care was 7.8 out of 11 points, for knowledge of life-sustaining treatment was 4.6 out of 6 points, and for knowledge of advance directives was 7.0 out of 9 points. There were significant differences in knowledge of EOL care scores by year of study, experiences in clinical practicum education, and experiences of caring for dying patients. Knowledge of life-sustaining treatment significantly differed by year of study, experiences in clinical practicum education, experiences of caring for and observing dying patients during clinical practicum education, and perceived self-rated health. There were significant differences in knowledge of advance directive scores by year of study, satisfaction with nursing major, experiences in clinical practicum education, and experiences of caring for and observing dying patients during clinical practicum education. Further studies should develop educational intervention programs that improve knowledge of EOL care, life-sustaining treatment, and advance directives.

Novice RNs' Lived Experience Providing End-of-Life Care: A Hermeneutic Phenomenology

2019 ◽  
Vol 23 (4) ◽  
pp. 302-311
Author(s):  
Ruby Z. Chu ◽  
Donna Taliaferro
Keyword(s):  
Lived Experience ◽  
End Of Life ◽  
End Of Life Care ◽  
Professional Growth ◽  
Life Care ◽  
Compassionate Care ◽  
Structured Interviews ◽  
Hermeneutic Circle ◽  
Dying Patients ◽  
Colaizzi's Method

This hermeneutic study explored the lived experience of novice RNs who care for dying patients in acute care settings to understand to meaning of their experience. Fourteen novice RNs participated in individual telephone semi-structured interviews. Transcripts were analyzed using Colaizzi's method. Results obtained were based on the hermeneutic circle. The findings identified 3 major themes: (a) obstacles in end-of-life care; (b) personal response; and (c) coping strategies and 12 subthemes. Despite the obstacles in care, compassionate care was provided that resulted in professional growth.

scholarly journals A decalogue for end-of-life care in Internal Medicine

2018 ◽  
Vol 12 (3) ◽  
pp. 230-234
Author(s):  
Luigi Lusiani ◽  
Giorgio Ballardini ◽  
Roberto Nardi ◽  
Luigi Magnani ◽  
Claudio Santini ◽  
...  
Keyword(s):  
Internal Medicine ◽  
End Of Life ◽  
Ad Hoc ◽  
Academic Education ◽  
Medicine Department ◽  
Dying Patients ◽  
Number Of Patients ◽  
Hospital Doctors ◽  
Scientific Meetings ◽  
Eol Care

Since a large number of patients with chronical medical diseases die in hospital, often in an internal medicine ward, internists are urged to improve their expertise in end-of-life (EOL) care, which is a neglected part of their academic education. Recently, FADOI (the Italian Federation of the Associations Hospital Doctors on Internal Medicine) has addressed EOL-medicine in many ways, promoting many scientific meetings on this and allied topics, providing educational material made available in its website on a free basis and establishing an ad hoc Committee charged with the task of organizing dedicated events annually. The Committee has also elaborated a series of recommendations on EOL-care in internal medicine (a decalogue), reflecting largely shared visions. It has been endorsed also by ANIMO (the Association of the Italian Nurses working in an Internal Medicine Department). The decalogue for EOL care in internal medicine is issued here, and calls for its diffusion and implementation. The driving concept is that doctors and nurses must feel responsible for disregarding appropriate EOL-care for the dying patients, because delaying it means to add suffering and discomfort to them in the final phase of their existence.

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