Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Abstract

Aim To explore the association of organizational structures when integrating palliative care in intensive care units. Background Palliative care within intensive care settings has been widely recognized as an area requiring improvement when caring for patients and their families. Despite this, intensive care units continue to struggle to integrate palliative care. Methods A qualitative descriptive methodology was used. Data were collected through research interviews with 15 managers and 36 health care professionals working in intensive care. The data were analysed adopting constant comparative analysis. Results This study provides insight into a diverse range of perspectives on organizational structure in the context of facilitation and the challenges posed. Three themes were identified: Do not resuscitate policy as a gateway to palliative care, facilitating family members to enable participation and support and barriers for palliative care in intensive care unit as a result of intensive care organization. Conclusions In fostering a sustainable organizational culture and practice development in intensive care, the findings indicate the need for specific palliative care policies and implementation strategies tailored according to context. Implications for nursing management Management has a responsibility to facilitate dialogue within any multidisciplinary team regarding palliative care and, in particular, to focus on ‘do not resuscitate’ policies as a gateway into this conversation.

What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review

“… 8 [ 42 ] Yes Yes Yes Yes Yes not clear . No Yes Yes Yes 8 [ 43 ] Yes Yes Yes Yes Yes Not clear No Yes Yes Yes 8 [ 44 ] Yes Yes Yes Yes Yes Yes Not clear Yes Yes Yes 8 [ 45 ] Yes Yes Yes Yes Yes Not clear Not clear Yes Yes Yes 8 …”

“…Cross-sectional studies sought to measure ICU staff perceptions of barriers and supportive behaviors to the provision of end-of-life care in the intensive care unit [ 46 – 48 ]. The qualitative studies focus on exploring critical care nurses’ experiences and perceptions of providing end-of-life care for critically ill patients in an intensive care unit [ 43 , 45 ]; evaluating nurses’ care practices at the end of life and their understanding of the provision of spiritual care at the end of life [ 41 , 42 ]; identifying the needs, beliefs, and practices of Muslim family members during end-of-life care for a family member in the intensive care unit [ 40 ]; and the impact of organisational structures when integrating palliative care in intensive care units [ 44 ].…”

“…With the exception of one study that focused on family members [ 40 ], all the studies were of healthcare professionals. Participants in six studies of the studies were ICU nurses [ 41 – 43 , 45 , 46 , 48 ]; one study involved ICU managers alongside health professionals [ 44 ] and another study involved ICU physicians and nurses [ 47 ].…”

Nurses' Subjectivity in Patient-Centered Communication for End-of-Life Patients

“…This may involve streamlining documentation tasks, redistributing workload, or implementing strategies to reduce nonessential administrative tasks. Health care organizations can establish policies and create environments that prioritize patient-centered communication 28 . Flexible scheduling, interdisciplinary collaboration, and supportive supervision can contribute to an environment that values and facilitates effective communication.…”

Impacto dos cuidados paliativos nos pacientes internados em Unidade de Terapia Intensiva

“…9 No entanto, segundo Hamdan Alshehri et al (2021), a assimilação desta atividade na unidade de terapia intensiva requer uma orquestração cuidadosa, apoiada por estruturas organizacionais que incluem explicitamente a política de cuidados paliativos nos hospitais, isso inclui o próprio ambiente de trabalho, bem como os recursos profissionais tanto dos especialistas de saúde quanto dos gestores. 10 Outro estudo analisou os possíveis efeitos da implementação multidisciplinar de cuidados paliativos através das experiências dos médicos e das experiências e satisfação Brazilian Journal of Development, Curitiba, v.8, n.8, p. 57191-57198, aug., 2022 dos familiares dos pacientes. Por meio da aplicação de questionários, chegou-se a conclusão de que quando são iniciadas a aplicação da medicina paliativa, os médicos se tornam mais proativos e os familiares sentem que os enfermos adquiriam mais qualidade de vida.…”