scholarly journals Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

2020 ◽  
Vol 10 (3) ◽  
pp. 260-274
Author(s):  
Reni Sulung Utami ◽  
Ahmat Pujianto ◽  
Dody Setyawan ◽  
Elsa Naviati ◽  
Nana Rochana
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Qualitative Study ◽  
End Of Life ◽  
Family Support ◽  
End Of Life Care ◽  
Sampling Technique ◽  
Critical Care Nurses ◽  
Life Care ◽  
The Family

Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out.Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC.Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes.Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions. Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.

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.

Critical Care Nurses’ Suggestions to Improve End-of-Life Care Obstacles

2017 ◽  
Vol 36 (4) ◽  
pp. 264-270 ◽  
Author(s):  
Renea L. Beckstrand ◽  
Kacie Hart Hadley ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care

530: Education on End-of-Life Care for Pediatric Critical Care Nurses: A Needs Assessment

2020 ◽  
Vol 49 (1) ◽  
pp. 257-257
Author(s):  
Kelley Groves ◽  
Larissa Anglim ◽  
Tensing Maa ◽  
Megan Daniel ◽  
Markita Suttle
Keyword(s):  
Critical Care ◽  
Needs Assessment ◽  
End Of Life ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Pediatric Critical Care

Family communication and decision making at the end of life: A literature review

2014 ◽  
Vol 13 (3) ◽  
pp. 815-825 ◽  
Author(s):  
Cara L. Wallace
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Family Communication ◽  
End Of Life Care ◽  
Family Members ◽  
Empirical Literature ◽  
Future Research ◽  
Life Care ◽  
The Family

AbstractObjective:Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research.Method:Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest.Results:The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life.Significance of results:Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

scholarly journals A framework for resolving disagreement during end of life care in the critical care unit

2010 ◽  
Vol 33 (4) ◽  
pp. 240 ◽  
Author(s):  
Karen Choong ◽  
Cynthia Cupido ◽  
Erin Nelson ◽  
Donald M Arnold ◽  
Karen Burns ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Conflict Resolution ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
End Of Life Decision ◽  
Life Decision

Background: End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically “futile” care. Such disagreements can cause tension and moral distress among families and clinicians. Purpose: To outline the roles and responsibilities of physicians, substitute decision makers, and the judicial system when decisions must be made on behalf of incapable persons, and to provide a framework for conflict resolution during end-of-life decision-making for physicians practicing in Canada. Source: We used a case-based example to illustrate our objectives. We employed a comprehensive approach to understanding end-of-life decision making that included: 1) a search for relevant literature; 2) a review of provincial college policies; 3) a review of provincial legislation on consent; 4) a consultation with two bioethicists and 5) a consultation with two legal experts in health law. Principal Findings: In Canada, laws about substitute decision-making for health care are primarily provincial or territorial. Thus, laws and policies from professional regulatory bodies on end-of-life care vary across the country. We tabulated the provincial college policies on end-of-life care and the provincial legislation on consent and advance directives, and constructed a 10-step approach to conflict resolution. Conclusion: Knowledge of underlying ethical principles, understanding of professional duties, and adoption of a process for mediation and conflict resolution are essential to ensuring that physicians and institutions act responsibly in maintaining a patients’ best interests in the context of family-centred care.

Family support, consent, and end of life care

2017 ◽  
Author(s):  
Grenville Fox ◽  
Nicholas Hoque ◽  
Timothy Watts
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Family Support ◽  
End Of Life Care ◽  
Post Mortem ◽  
Life Care ◽  
End Of Life Decisions ◽  
Practical Advice ◽  
Post Mortem Examination ◽  
Consent To Treatment

The chapter has a theme of supporting families, including strategies to develop successful relationships with families and involve families in decision-making in neonatal care. There are sections on effective communication with families, and consent to treatment. A detailed description of end of life decisions is included, with practical advice on redirection of care from intensive to palliative. Consent for post mortem examination is also covered.

‘Death rounds to support critical care nurses: a qualitative study’

2020 ◽  
pp. bmjspcare-2020-002533
Author(s):  
Keh Kiong Ong ◽  
Chew Lai Sum ◽  
Xuelian Jamie Zhou ◽  
Yeow Leng Chow
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychological Impact ◽  
Structured Interview ◽  
Tertiary Hospital ◽  
Critical Care Nurses ◽  
Life Care ◽  
One To One ◽  
Nurses Perceptions

ObjectiveProviding end-of-life care has a significant psychological impact on critical care nurses. Little is known about whether critical care nurses find death rounds useful as a support system. This study aimed to describe critical care nurses’ perceptions of attending death rounds.MethodsThis study was conducted using a qualitative descriptive design, using one-to-one audio-recorded interviews. The study was conducted at a 20-bed medical intensive care unit in a 1200-bed public tertiary hospital in Singapore. One-to-one interviews were conducted with 14 nurses using a semi-structured interview guide. Data was analysed using thematic analysis.ResultsCritical care nurses valued attending death rounds. They found death rounds to be an outlet to express themselves and remember patients, to draw and give peer support, to build nursing and interprofessional cohesiveness and to learn to improve palliative care. The death rounds were optimal when they felt safe to share, when there was a good facilitator, when the hierarchy was flat and when the audience was interdisciplinary. The barriers to a successful death round were the rounds being too formal, timing and not knowing the patients.ConclusionDeath rounds are a viable way to support critical care nurses in providing end-of-life care.

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