Experiences of Nurses and Physicians When Making End-of-Life Decisions in Intensive Care Units

Abstract

Purpose/Objectives: The purpose of the study was to describe the relationship between anger, spirituality, and subjective and objective indices of heart disease risk among a convenience sample of nontraditional college students at a small private university in South Texas. Nontraditional college students are defined as slightly older commuter students who balance family, work, and school schedules.Research Hypothesis/Question(s):(1) What are the risk factors, level of anger, and spirituality of nontraditional college students participating in a wellness course at a small private south Texas university? (2) What are the self-assessed risk factors among nontraditional college students participating in a wellness course at a small private south Texas university?Design: The study used a descriptive correlational design. Methods: The sample consisted of 19 mostly single female students with a mean age of 30 years (range, 21Y64 years). Instruments included Self-assessment of Health Risk Profile, State Trait Anger Expression Inventory (6 scales and 5 subscales), Anger Expression Index, and Spiritual Well-being Index.Findings: Over half were minority. Sixty-nine percent were overweight; 60% were prehypertensive; 26% had a total cholesterol greater than 200. Over two-thirds stated they weighed more than they should. Over half reported a family history of high blood pressure; 37% reported a family history of diabetes; 42% smoked. Fifteen percent of the sample had anger scores suggesting a need for referral. Over half had scores in the moderate range for spiritual well-being. Scores on the existential well-being subscale were negatively correlated with overall anger expression.Conclusions: These findings suggest the need for targeted lifestyle and anger management interventions among this population.Implications for Practice: Future studies with larger samples are needed to determine whether spirituality mediates anger, and how anger is related to cardiac risk among this group.

Caring for the dying patient in the ICU – The past, the present and the future

“…Thus, this issue was a growing problem at this time, acknowledged by ICU nurses but perhaps not yet on the agenda among most ICU physicians in Europe. However, today all ICU health care professionals report that the transition from curative medical care to EOL care is the most problematic stage in providing EOL care (Coombs et al, 2012;McAndrew and Leske, 2014).…”

Moral distress in critical care nursing: The state of the science

“…21,29,47,52,60 Nurses were more likely to report physician communication as a cause of a medication error when they reported higher levels of moral distress. 42 The challenges of working within an interdisciplinary team and consequential poor communication and collaboration were described in many studies 11,22,30,31,49,53,56,57 Nurses reported that medical values take priority over nursing values within the organizations they practice. 43,53 Unprofessional behavior of physician colleagues is also described by nurses as a barrier to addressing ethical conflict in patient care.…”

“…38,42,47,52,59 Patients and families may experience poor communication, prolonged deaths, and inadequate nursing support. 22,30,31,48,49,53,56,57,59 There is a weak positive relationship between moral distress and burnout. 32 Elements of nurse burnout including depersonalization and emotional exhaustion are both negatively correlated with job satisfaction.…”

Nurses and physicians bring different perspectives to end-of-life decisions in intensive care units

“…It is well documented that communication challenges during decisions about life-sustaining treatments are a source of moral distress 2 4. Inadequate nurse–physician collaboration and healthcare professional conflict can lead to inadequate nurse involvement in decision-making processes,3and undermine patient and family end-of-life care 5. Given the critical importance of nurse–physician collaborative practice, the purpose of the study by Laurent and colleagues1 was to describe the experiences of nurses and doctors when making end-of-life decisions in the ICU.…”

“…Positive end-of-life experiences may provide valuable insights about aspects that facilitate smooth end-of-life transitions and enhance interprofessional communication 3. Studying the dynamic intersection among healthcare professionals, patients and family members within the ICU and various organisational settings is required to advance the science.…”