Persepsi Perawat Neurosurgical Critical Care Unitterhadap Perawatan Pasien Menjelang Ajal

1970 ◽  
Vol 2 (1) ◽  
Author(s):  
Meilita Enggune ◽  
Kusman Ibrahim ◽  
Hana Rizmadewi Agustina
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Life Care ◽  
Dying Patients ◽  
The Family ◽  
Dying Patient

Tingginya angka kematian yang terjadi di unit perawatan intensif, menuntut peningkatan pelayanan perawatan paliatif termasuk perawatan pasien menjelang ajal, yang melibatkan perawat perawatan kritis. Tujuan penelitian ini untuk memperoleh gambaran persepsi perawat terhadap perawatan pasien menjelang ajal di ruang Neurosurgical Critical Care Unit(NCCU). Delapan perawat pelaksana di ruang NCCU RSHS Bandung dilibatkan dalam penelitian deskriptif kualitatif ini dengan rentang usia antara 27– 43 tahun, dan bekerja selama 3–20 tahun. Teknik sampling yang digunakan adalah purposive samplingdan jumlah informan dibatasi setelah data jenuh. Pengumpulan data dengan melakukan wawancara semi terstruktur, dan analisis yang digunakan adalah content analysis. Hasil penelitian didapatkan 4 tema dan 15 subtema yaitu: (1) Pemahaman perawat tentang perawatan pasien menjelang ajal yaitu: membantu pasien meninggal dengan tenang, menghadirkan keluarga untuk memberikan dukungan, dan lebih berfokus pada bimbingan spiritual; (2) Cara menghadapi kematian yang sering terjadi yaitu: adaptasi perawat terhadap kondisi pasien menjelang ajal, kesulitan menentukan fase menjelang ajal pasien kritis, dilema dalam pengambilan keputusan, dan empati; (3) Peran perawat dalam mempersiapkan pasien menjelang ajal yaitu: pembimbing spiritual pasien, komunikator, fasilitator, dan pemberi dukungan emosional keluarga; (4) Hal-hal yang perlu diperbaiki dalam perawatan menjelang ajal yaitu: diperlukan pelatihan perawatan paliatif pada pasien kritis, diperlukan ruangan khusus pasien menjelang ajal, diperlukan pembimbing rohani khusus, dan diperlukan standar operasional prosedur (SOP) perawatan pasien menjelang ajal. Perawat perlu memberikan perawatan yang membantu pasien meninggal dengan tenang, memberikan dukungan untuk keluarga, dan lebih difokuskan untuk memenuhi kebutuhan spiritual pasien.Kata kunci: Intensive Care Unit, perawatan akhir hidup, persepsi perawat AbstractThe high number of death that occurred in the Intensive Care Unit, strive to improve palliative care services including the provision of care of dying patients by critical care nurses. The purpose of this study was to obtain a perception of nurses toward the care of dying patients in the Neurosurgical Critical Care Unit ( NCCU ). Eight nurses who work at NCCU were involved in this study, age between 27- 43 and have been working from 3 to 20 years. The sampling technique used the purposive sampling method and a limited number of informants after data saturated. Data collection was done by conducting semi- structured interviews, content analysis was used to analyse the data. There are four themes with 15 sub-themes include: 1) Nurse understanding about caring for dying patients: help the patients to die peacefully, presenting the family to provide supports, and more focused on spiritual guidance. 2) Way of handling the frequent of death occurance: adaptation of nurses to dying condition, difficulty determining the critical phase of the dying patient, dilemmas in decision-making, and empathy. 3) The role of nurses in preparing for the dying patient: the patient spiritual guides, communicators, facilitators, and providers of family emotional support. 4) The Things that need to be improved in end of life care: the palliative care training is required in critically ill patients as well as separate unit for dying patients, exclusive spiritual guide, and standard operating procedures (SOP) of care for the dying patients. It can be concluded that nurses need to provide treatment that helping patients to die peacefully, and providing support for the family, which is focused on meeting the spiritual needs of patients.Key words:Intensive Care Unit, end of life care, nurses perception

CUIDADO PALIATIVO NA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 1 (2) ◽  
pp. 68-94
Author(s):  
Raquel JESUS Melânia de Jesus Tassini ◽  
Joseph Fabiano Guimarães Santos ◽  
Maria Emídia de Melo Coelho
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Comfort Care ◽  
Terapia Intensiva

No cotidiano da prática da medicina de urgência e emergência, mais especificamente na terapia intensiva, surgem diversas situações onde o paciente encontra-se na condição de um processo de morte inexorável, e muitas vezes já com o suporte avançado de vida instalado. Diante desta realidade, cada vez mais presente, necessitamos de intervenções que amenizem os sofrimentos consequentes à mesma, em que a capacidade humana de compaixão e misericórdia possam prevalecer. Neste estudo fez-se revisão sistemática, na busca de estudos observacionais e intervencionistas, além de estudos de revisão sistemática e meta-análise, obtidos através de pesquisa eletrônica realizada no banco de dados do Pubmed e Medline. O período pesquisado foi entre 2006 a 2018. Os termos pesquisados foram: “intensive care unit”, “critical care unit”, “palliative care”, “improving palliative care”, “palliative care service”, “palliative care consult”, “end-of-life care”, “comfort care” e “supportive care”. Fez-se descrição didática dos diversos aspectos encontrados na revisão, onde avaliou-se a importância e necessidade da integração dos cuidados paliativos com a terapia intensiva, por se tratar de uma opção com elevada eficiência e eficácia para dar suporte na assistência aos pacientes, principalmente àqueles com doença terminal e seus familiares. Conclui-se ser imprescindível a educação sobre a filosofia, princípios e prática dos cuidados paliativos na equipe multiprofissional, assim como nos especialistas envolvidos no cuidado do paciente.

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.

scholarly journals 108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Marina Journault ◽  
Simone Stenekes ◽  
Robin McClure ◽  
Chelsea Ruth
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Infant Death ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Age At Death

Abstract Background Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur. Objectives The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care. Design/Methods A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis. Results Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”. Conclusion There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.

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 Practice Recommendations for End-of-Life Care in the Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. 14-22 ◽  
Author(s):  
Hanne Irene Jensen ◽  
Kristin Halvorsen ◽  
Heidi Jerpseth ◽  
Isabell Fridh ◽  
Ranveig Lind
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Life Care ◽  
Family Needs ◽  
High Quality ◽  
Number Of Patients ◽  
The Family

Topic A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices. Clinical Relevance Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members. Purpose of Paper To provide recommendations for high-quality end-of-life care for patients and family members. Content Covered This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.

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