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.

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.

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 Cuidado humanizado en pacientes con limitación del esfuerzo terapéutico en cuidados intensivos, desafíos para enfermería

2018 ◽  
Vol 22 (1) ◽  
pp. 56-75 ◽  
Author(s):  
Macarena Yáñez Dabdoub ◽  
Ivonne Esmeralda Vargas Celus
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Palabras Clave ◽  
Human Care ◽  
Care Nursing

En las unidades de cuidados intensivos (UCI) el equipo de salud utiliza todas las medidas posibles para preservar la vida de sus pacientes. No obstante, cuando las terapias son fútiles, se decide limitar el esfuerzo terapéutico (LET). Este artículo tiene como objetivo describir los factores que pueden llevar a enfermería a deshumanizar sus cuidados en pacientes en LET en UCI. Revisión de la literatura en bases de datos, con las palabras clave: critical care, intensive care unit, limitation of therapeutic effort, end of life care, humanized/human care, nursing. Los hallazgos fueron agrupados en seis categorías que pueden influir en la deshumanización del cuidado en UCI. Se concluye que en el cuidado humanizado se destacan los roles de enfermería como defensora de los intereses del paciente y como agente comunicador.

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