scholarly journals Practice of Expert Critical Care Nurses in Situations of Prognostic Conflict at the End of Life

2006 ◽  
Vol 15 (5) ◽  
pp. 480-491 ◽  
Author(s):  
Catherine McBride Robichaux ◽  
Angela P. Clark
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Narrative Analysis ◽  
Critical Care Nurses ◽  
Realistic Picture ◽  
Inappropriate Treatment ◽  
Expert Nurses ◽  
End Of Life Decision

• Background Prolonging the living-dying process with inappropriate treatment is a profoundly disturbing ethical issue for nurses in many practice areas, including the intensive care unit. Despite the frequent occurrence of such distressing events, research suggests that critical care nurses assume a limited role in end-of-life decision making and care planning. • Objectives To explore the practice of expert critical care nurses in end-of-life conflicts and to describe actions taken when the nurses thought continued aggressive medical interventions were not warranted. • Methods A qualitative design was used with narrative analysis of interview data that had a temporal ordering of events. Interviews were conducted with 21 critical care nurses from 7 facilities in the southwestern United States who were nominated as experts by their colleagues. • Results Three recurrent narrative plots were derived: protecting or speaking for the patient, presenting a realistic picture, and experiencing frustration and resignation. Narratives of protecting or speaking for the patient concerned preventing further technological intrusion and thus permitting a dignified death. Presenting a realistic picture involved helping patients’ family members reframe the members’ sense of the potential for recovery. Inability to affect a patient’s situation was expressed in narratives of frustration and resignation. • Conclusions The transition from curative to end-of-life care in the intensive care unit is often fraught with ambiguity and anguish. The expert nurses demonstrated the ability and willingness to actively protect and advocate for their vulnerable patients even in situations in which the nurses’ actions did not influence the outcomes.

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 EXPERIENCES OF CRITICAL CARE NURSES WITH REGARD TO END-OF-LIFE ISSUES IN THE INTENSIVE CARE UNIT

2015 ◽  
Vol 16 (2) ◽  
pp. 71-84
Author(s):  
Portia Jordan ◽  
I Clifford ◽  
M Williams
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Target Population ◽  
Structured Interview ◽  
Critical Care Nurses ◽  
Life Issues ◽  
End Of Life Issues ◽  
Multi Disciplinary Team

Nurses in the intensive care unit might be faced with emotional conflict, stress and anxiety when dealing with end-of-life issues and thus need to be supported. In understanding the experiences of nurses, enhanced support can be given in order to assist nurses to deal better with end-of life issues in the intensive care unit. The purpose of the study was to explore and describe the experiences of nurses’ with regard to end-of-life issues in the intensive care unit. A qualitative, explorative, descriptive and contextual research design using a semi-structured interview approach was used. The target population for the study comprise twenty registered nurses in the intensive care unit. Of the twenty nurses, only nine were willing to participate in the study. Purposive sampling method was used to interview nine nurses in a private intensive care unit. Data collected was thematically analysed, using Tesch’s method. Four major themes were identified, namely: (1) conflicting emotions; (2) family relations; (3) multi-disciplinary team relations; and (4) supportive strategies when dealing with end-of-life issues. The study concluded that nurses experienced different emotions, conflict and stress when dealing with end-of-life issues in the intensive care unit. A need for supportive relations with family members, the multi-disciplinary team and support from management were reported. Immediate debriefing, enhancing communication amongst multi-disciplinary team members, having a permanent counsellor or pastoral counselling, an ethics committee and training programmes in place to address end-of-life issues are a few of the support strategies that can assist critical care nurses in dealing with end-of-life issues in the intensive care unit. 

scholarly journals Providing End-of-Life Care to Patients: Critical Care Nurses’ Perceived Obstacles and Supportive Behaviors

2005 ◽  
Vol 14 (5) ◽  
pp. 395-403 ◽  
Author(s):  
Renea L. Beckstrand ◽  
Karin T. Kirchhoff
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Critical Care Nurses ◽  
Control Group ◽  
Life Care ◽  
Supportive Behaviors

• Background Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited. • Objective To measure critical care nurses’ perceptions of the intensity and frequency of occurrence of (1) obstacles to providing end-of-life care and (2) supportive behaviors that help in providing end-of-life care in the intensive care unit. • Methods An experimental, posttest-only, control-group design was used. A national, geographically dispersed, random sample of members of the American Association of Critical-Care Nurses was surveyed. • Results The response rate was 61.3%, 864 usable responses from 1409 eligible respondents. The highest scoring obstacles were frequent telephone calls from patients’ family members for information, patients’ families who did not understand the term lifesaving measures, and physicians disagreeing about the direction of a dying patient’s care. The highest scoring supportive behaviors were allowing patients’ family members adequate time alone with patients after death, providing peaceful and dignified bedside scenes after death, and teaching patients’ families how to act around a dying patient. • Conclusions The biggest obstacles to appropriate end-of-life care in the intensive care unit are behaviors of patients’ families that remove nurses from caring for patients, behaviors that prolong patients’ suffering or cause patients pain, and physicians’ disagreement about the plan of care.

Thinking about strengths in end-of-life nursing practice: the case of intensive care unit nurses

2019 ◽  
Vol 25 (8) ◽  
pp. 378-385
Author(s):  
Brandi Vanderspank-Wright ◽  
David Kenneth Wright ◽  
Kim McMillan
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Practice ◽  
Critical Care Nurses ◽  
Life Care ◽  
Ethical Practice ◽  
Care Nursing

Background: The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context. Aim: To stimulate a reflective examination of intensive care nursing practice with respect to end-of-life care. Methods: The work of contemporary nursing scholar Laurie Gottlieb is used to perform a strengths-based relational ethical examination of previously published literature that describes critical care nurses' experiences of providing end-of-life care in the ICU. Findings: This literature suggests that the relational ethical value of authentic engagement, which is fundamental to the disciplinary ethos of expert palliative care nursing, is reflected in the everyday practice of intensive care nurses whose patients die while under their care. Conclusion: A strengths-based approach can make visible the relational ethical practice of critical care nurses who care for dying patients and their families in the ICU.

scholarly journals End-of-life decision making for cancer patients in an intensive care unit

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
M Tavares ◽  
I Neves ◽  
F Coelho ◽  
O Afonso ◽  
A Martins ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Decision ◽  
Life Decision

Sense of responsibility in ICU end-of-life decision-making: Relatives’ experiences

2017 ◽  
Vol 26 (1) ◽  
pp. 270-279 ◽  
Author(s):  
Ranveig Lind
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Secondary Analysis ◽  
Active Role ◽  
Decision Making Process ◽  
Science Data ◽  
End Of Life Decision ◽  
Life Decision

Background: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation. Research objectives: To examine and describe relatives’ experiences of responsibility in the intensive care unit decision-making process. Research design: A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. Participants and research context: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants’ homes, 3–12 months after the patient’s death. Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. Findings: The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians’ intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. Discussion: For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual’s relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. Conclusion: Nurses and physicians should acknowledge and address relatives’ sense of responsibility, include them in regular dialogue and help them separate their responsibility from that of the clinicians.

Pain in Intensive Care Unit: Italian critical care nurses' best practice

2021 ◽  
Vol 87 (7) ◽  
Author(s):  
Alessandro GALAZZI ◽  
Gian D. GIUSTI ◽  
Nicola PAGNUCCI ◽  
Stefano BAMBI ◽  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Best Practice ◽  
Critical Care Nurses

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

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