End-of-Life Decisions in Intensive Care Units in Croatia—Pre COVID-19 Perspectives and Experiences From Nurses and Physicians

Abstract

Healthcare professionals working in intensive care units (ICUs) are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians (45 in total) of diverse professional and clinical backgrounds at three research sites (Zagreb, Rijeka, Split). In total, six institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties.

End-of-life decisions: A focus group study with German health professionals from human and veterinary medicine

“…That (veterinary) nurses in our study much more frequently merged the perspectives of all involved parties when deliberating about aspects of a good death than veterinarians and doctors, is, at first glance, incongruous with recent findings that nurses are primarily concerned with the patient's perspective, while physicians place much more emphasis on, for example, the family's needs ( 39 , 40 ). On closer inspection, however, our results can be seen as complementary.…”

“…Both nurses and physicians seemingly viewed themselves as advocates of their patients, but interpreted their role differently: Nurses regarded themselves as spokesperson for their patients ( 39 ) (p. 2025) and ( 40 ) (p. 638) , occasionally fighting for the acknowledgment of their needs. They strongly identified with their suffering ( 40 ) (p. 637) and even “ feel that they alone understand patients' feelings because family members are overwhelmed by emotions and are thus unable to evaluate the situation” ( 21 , 39 ) (p. 2025) . They also identified with the family's emotions and experiences and “ consider themselves to be close relatives” (ibid.)…”

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review

“… Spiritual hospice caregiver. 4 C Ćurković M, Brajković L et al., 2021 [ 35 ], Croatia Qualitative focus group interviews 45 professionally homogeneous ICU nurses and doctors ICUs in Croatia The aim of this study was to investigate the perceptions, experiences and challenges faced by healthcare professionals when making EOL decisions in ICUs in Croatia. The experiences and perceptions of nurses focus closely on beneficence, non-maleficence and autonomy of the patient, the immediate context of the treatment and their participation in the care and decision-making process, as well as the consequences that the care and the participation they have for them in a personal and professional sense.…”

End-of-Life Decision-Making in Pediatric and Neonatal Intensive Care Units in Croatia—A Focus Group Study among Nurses and Physicians

“…The importance of the child's best interest in a situation of vulnerability and medical prognostic uncertainty was stressed. The understating of the various values and goals of healthcare professionals and families, when it comes to treatment and end-of-life decisionmaking, was expressed as in previous studies [32][33][34][35][36]. Different approaches to coming to an understanding and mutual agreement were also deemed important, keeping in mind the special cultural circumstances in Croatia.…”

“…This difference in the perceptions and experience of physicians and nurses was not present in PICUs and NICUs. It seems that physician and nurses in PICUs and NICUs are all in the "same boat" when it comes to the issues and burdens that they experience [36].…”