Technical comment on: Biskup E, et al. Oncological patients in the intensive care unit: prognosis, decision-making, therapies and end-of-life care

End-of-life decision-making is an important area of research, and few sociological studies have considered family grief in light of end-of-life decision-making in the hospital. Drawing on in-depth interviews with family members in the intensive care unit (ICU) during an end-of-life hospitalization and into their bereavement period up to six months after the death of the patient, this article examines bereaved family members’ experiences of grief by examining three aspects from the end-of-life hospitalization and decision-making in the ICU that informed their subsequent bereavement experiences. First, this article explores how the process of advance care planning (ACP) shaped family experiences of grief, by demonstrating that even prior informal conversations around end-of-life care outside of having an advance directive in the hospital was beneficial for family members both during the hospitalization and afterwards in bereavement. Second, clinicians’ compassionate caring for both patients and families through the “little things” or small gestures were important to families during the end-of-life hospitalization and afterwards in bereavement. Third, the transition time in the hospital before the patient’s death facilitated family experiences of grief by providing a sense of support and meaning in bereavement. The findings have implications for clinicians who provide end-of-life care by highlighting salient aspects from the hospitalization that may shape family grief following the patient’s death. Most importantly, the notion that ACP as a social process may be a “gift” to families during end-of-life decision-making and carry through into bereavement can serve as a motivator to engage patients in ACP.

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Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review

Journal of Korean Critical Care Nursing ◽

10.34250/jkccn.2020.13.1.27 ◽

2020 ◽

Vol 13 (1) ◽

pp. 27-43

Author(s):

JiYeon Choi ◽

Youn-Jung Son ◽

Kyounghoon Lee

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Integrative Review ◽

Life Care ◽

Intensive Care Unit Nurses ◽

Care Decision

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Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2017774 ◽

2017 ◽

Vol 26 (4) ◽

pp. 336-341 ◽

Cited By ~ 15

Author(s):

Laura Anne Brooks ◽

Elizabeth Manias ◽

Patricia Nicholson

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care

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Ethical Dilemmas of End of Life Care in Intensive Care Unit : A Literature Review

JURNAL PENDIDIKAN KEPERAWATAN INDONESIA ◽

10.17509/jpki.v4i2.13637 ◽

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.

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