Providing End-of-Life Care to Patients: Critical Care Nurses’ Perceived Obstacles and Supportive Behaviors

Abstract

• Background Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited. • Objective To measure critical care nurses’ perceptions of the intensity and frequency of occurrence of (1) obstacles to providing end-of-life care and (2) supportive behaviors that help in providing end-of-life care in the intensive care unit. • Methods An experimental, posttest-only, control-group design was used. A national, geographically dispersed, random sample of members of the American Association of Critical-Care Nurses was surveyed. • Results The response rate was 61.3%, 864 usable responses from 1409 eligible respondents. The highest scoring obstacles were frequent telephone calls from patients’ family members for information, patients’ families who did not understand the term lifesaving measures, and physicians disagreeing about the direction of a dying patient’s care. The highest scoring supportive behaviors were allowing patients’ family members adequate time alone with patients after death, providing peaceful and dignified bedside scenes after death, and teaching patients’ families how to act around a dying patient. • Conclusions The biggest obstacles to appropriate end-of-life care in the intensive care unit are behaviors of patients’ families that remove nurses from caring for patients, behaviors that prolong patients’ suffering or cause patients pain, and physicians’ disagreement about the plan of care.

Cultural aspects of death notification following cardiopulmonary resuscitation

“…In addition, communication of one team member with the patient's family from the beginning, constantly keeping them informed about the patients treatment and resuscitation process is the best method; this will prevent sudden shocks and will gradually prepare the family (Field, Kudenchuk, O'Connor, & VandenHoek, 2012). Similar to the current study, explaining the patient's condition slowly and gently, while providing a calm and respectful environment, were also seen to be helpful behaviours which were addressed by the nurses in the study by Beckstrand and Kirchhoff (Beckstrand & Kirchhoff, 2005).…”

Alleviating existential distress of cancer patients: can relational ethics guide clinicians?

“…Thus, studies indicate that caring for patients with a life-limiting disease is moderated by several environmental factors that relationally influence the attitude to patients' mental, emotional and spiritual/existential concerns. A few studies conclude that attitudes to death itself do not have a significant relationship to clinicians' caring for and about terminally ill patients, but that the relational impediments of family, lack of agreement among physicians and restrictions of the unit or organizational culture may be more problematic issues (Beckstrand & Kirchhoff 2005;Dunn et al 2005).…”

This article has been retracted and is available online only: Exploration of Iranian intensive care nurses' experience of end‐of‐life care: a qualitative study

“…Death is an unavoidable phenomenon for all creatures (Haisfield-Wolfe, 1996). Nowadays, with regard to the increase in lifespan and advancement of technology, many people are in need of end-of-life care and offering care to the end-of-life patients is one of the most important concerns in health systems (Beckstrand and Kirchhoff 2005). The occurrence of death is common in intensive care units and it is, by no means, a simple and natural issue (Chapple, 1999).…”

“…The occurrence of death is common in intensive care units and it is, by no means, a simple and natural issue (Chapple, 1999). As a matter of fact, the death process at intensive care units can be complex, noisy and complicated (Beckstrand and Kirchhoff 2005) and most of the patients are hospitalized in these units before their death and are in need of care. Lorenz et al (2005) consider end-of-life as a fleeting part of human life through which the patients and their families struggle for survival.…”

“…Besides, in Calvin et al's (2009) study, which examined the experience of nurses at cardiovascular intensive care units regarding end-of-life care, excessive exhaustion in treating the patients and moving on a straight line was reported. Generally, it must be mentioned that nurses' experiences in end-of-life care can be effective in their manner of caretaking (Beckstrand and Kirchhoff 2005). Despite the available researches on the sufferings and defects involved in offering care to end-of-life patients, studies on the nurses' experience with regard to these patients, especially at general intensive care units are limited (Dunn et al, 2005).…”