The nursing role during end‐of‐life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review

Abstract

Scand J Caring Sci; 2016; 30; 645-661 The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review Aim: The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during Endof-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). Method: Three electronic databases, PubMed, CINAHL and EMBASE, and reference lists of included studies were searched for studies in English, Dutch or German between January 2002 and August 2015. Studies were included if they presented data about EOLC in the adult ICU, and the role of ICU nurses around EOLC. Quantitative and qualitative studies and opinion articles were extracted. Inductive content analysis was carried out to analyse and categorise the data. Results: Twenty studies were included. Four categories emerged: care for the ICU patient, care for the family, environmental aspects of EOLC and organisational aspects of EOLC. Regarding the care triad, a gap exists between theoretical models and the actual care provided by ICU nurses during EOLC. The relational aspect of care, like aimed with care triad, is absent. Conclusion: The literature clearly indicates that the role of ICU nurses concerns care for the patient, family and environment. It described which care should be given, but it remains unclear how care should be given (attitude). Therefore, it is difficult for ICU nurses to provide this care. Further, it seems that care provided to family mainly consists of giving advice on how to care for the patient; care for family members themselves was only mentioned in a few studies. Therefore, it seems that family does not always receive adequate care yet, which may be helpful in preventing problems like depression, anxiety or post-traumatic stress disorder. It can be concluded that it is important for ICU nurses to be aware of the existing relationships; however, comparing the literature, care triad does not appear to be reached.

Difficulties Perceived by ICU Nurses Providing End-of-Life Care: A Qualitative Study

“…8 As far as care provided to patients' families at ICUs is concerned, nurses recognized the need for satisfying the basic needs such as company, intimacy, education, and psychological and social support for families while also claiming that this is not enough. 1,6,8,21 There is extensive literature on issues related to this subject, but even though family's needs are recognized, its importance is not explicitly emphasized, and family-centered care involves primarily informing relatives about the treatment, procedures, and prognosis. 1,6,8,21 Contrary to expectations, studies have shown that some families consider communication from nurses to be vague and evasive, as they pay most of their attention to patients.…”

“…Researchers report that this may be due to the fact that the specificity of the nurses' role in EOLC is not clearly understood, and the related evidence is scarce, 6,7,25 ranging from specific to standardized strategies, and the ability to effectively cope with stress. 6,7,25 Care is understood as a continuous and dynamic process, and death is a part of it. 20,26 It was found that nurses providing care to end-of-life patients and their families are likely to experience emotional and psychological distress, and this finding was consistent with other studies.…”

The experience of the nurse caring for families of patients at the end of life in the intensive care unit

“…In other studies, the same thoughts of nurses have been found. In this sense, despite the fact that the family is included in the literature, it is not explicit, and family care consists mainly of providing information about the treatments, procedures and patient's prognosis, providing emotional and spiritual support (4,15,19). However, the participants in this study did not explicitly mention spiritual support.…”

Princípios dos cuidados paliativos em terapia intensiva na perspectiva dos enfermeiros

“…O item que recebeu menor valor reflete a dificuldade do profissional em quantificar riscos e benefícios das decisões tomadas. Um dos possíveis motivos é provavelmente a falha na sua participação nestas decisões em equipe ou junto à família e a falta de protocolos claros e difundidos por toda equipe através de treinamentos e educação continuada 11,14,[16][17] . Em outra pesquisa realizada no Brasil acerca das percepções de profissionais intensivistas sobre cuidados paliativos, verificouse que eles identificavam este princípio a um cuidado na fase terminal da vida, sem medidas fúteis, com prioridades as medidas de conforto, mas que a falta de uniformização e protocolos era uma barreira à racionalização sobre quais práticas aderir 11 .…”