Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study

Abstract

Background and aim Patient deaths are common in the intensive care unit, and a nurse’s perception of barriers to and supportive behaviors in end-of-life care varies widely depending upon their cultural background. The aim of this study was to describe the perceptions of intensive care nurses regarding barriers to and supportive behaviors in providing end-of-life care in a Chinese cultural context. Methods A cross-sectional survey was conducted among intensive care nurses in 20 intensive care units in 11 general hospitals in central and eastern China. Instruments used in this study were general survey and Beckstrand’s questionnaire. Data were collected via online survey platform. Descriptive analysis was used to describe general characteristics of participants and mean and standard deviations of the barriers and supportive behaviors. The mean and standard deviation were used to describe the intensity and frequency of each barrier or supportive behavior following Beckstrand’s method to calculate the score of barriers and supportive behaviors. Content analysis was used to analyze the responses to open-ended questions. Results The response rate was 53% (n = 368/700). Five of the top six barriers related to families and the other was the nurse’s lack of time. Supportive behaviors included three related to families and three related to healthcare providers. Nurses in the intensive care unit felt that families should be present at the bedside of a dying patient, there is a need to provide a quiet, independent environment and psychological support should be provided to the patient and family. Nurses believe that if possible, families can be given flexibility to visit dying patients, such as increasing the number of visits, rather than limiting visiting hours altogether. Families need to be given enough time to perform the final rites on the dying patient. Moreover, it is remarkable that nurses’ supportive behaviors almost all concern care after death. Conclusions According to ICU-nurses family-related factors, such as accompany of the dying patients and acceptence of patient’s imminent death, were found the major factors affecting the quality of end-of-life care. These findings identify the most prominent current barriers and supportive behaviors, which may provide a basis for addressing these issues in the future to improve the quality of end-of-life care.

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

“…This is to focus hospitals’ care management system based on the maximisation of treatment efficiency and physicians’ stance on critically ill patients not undergoing WLT and patients who have the hope of recovering. Our findings are consistent with other studies investigating difficulties in providing end-of-life care among ICU nurses in other countries [ 27 , 28 ]. Nasu et al’s systematic review of end-of-life care practice also highlighted the need for proper legal documentation regarding nurses’ roles and authority in dignified end-of-life care [ 29 ].…”

Quality assessments of the quality of dying and death by medical record review for patients dying in intensive care units in China

“…Although no dedicated Quality of Death Index for ICU patients exists, this ranking broadly hints at a potentially inadequate quality of death among ICU patients in mainland China. Cultural norms such as lial piety and the principle of "saving lives and aiding the wounded" in mainland China contribute to the adoption of aggressive life support interventions-such as arterial puncture, tracheal intubation, and tracheostomy-near the end of life [11,12].…”