‘Viewing in slow motion’: patients', families', nurses' and doctors' perspectives on end‐of‐life care in critical care

Abstract

There is an opportunity for nurses to use the care of patients dying in critical care to develop specialist knowledge and lead in care, but it requires mastery and reconciliation of both technology and end-of-life care. Healthcare professionals can help facilitate acceptance for families and patients, particularly regarding involvement in decisions and ensuring patient advocacy.

Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective

“…There is a growing body of both quantitative and qualitative research on the topic of a good death [3,4,5], including work on a Good Death Inventory [6] and a Quality of Dying and Death scale [7]. Research on quality of death has focused on the perspective of clinical caregivers [8,9], the dying person [10,11] or a combination of healthcare participants [12,13,14,15]. Although there is not full consensus in the literature about what factors or qualities contribute to a good death, there are clear overlapping aspects to a good death, including “pain and symptom management, clear decision making, preparation for death, completion, contributing to others and affirmation of the whole person” [12] (p. 825).…”

Managing clinical uncertainty: An ethnographic study of the impact of critical care outreach on end‐of‐life transitions in ward‐based critically ill patients with a life‐limiting illness

“…Uncertainty regarding underlying disease was compounded by the intercurrent critical illness. The finding is, to some degree, unique to this population, all of whom had cancer and this element of uncertainty has been termed "dual prognostication" (Pattison et al, 2013). There is an impetus to focus on better decision-making in chronic illness and to include patient and families' perspectives much more (Legare et al, 2012;Morton, Tong, Howard, Snelling, & Webster, 2010;Thorne, Paterson, & Russell, 2003).…”

“…These critical transition decisions have significant consequences for smooth transitions in foci of care. Uncertainty in decisions appears to hinder smooth, timely and sensitive transitions for patients and families (Fisher & Ridley, 2012;Pattison, Carr, Turnock, & Dolan, 2013). Decisions to limit critical care treatment, or not admit to critical care, can mean that a person's disease trajectory is shortened, and death may be perceived to occur more quickly (Dahmen, Vollmann, Nadolny, & Schildmann, 2017;Fisher & Ridley, 2012;Hua, Halpern, Gabler, & Wunsch, 2016).…”

“…Decisions to limit critical care treatment, or not admit to critical care, can mean that a person's disease trajectory is shortened, and death may be perceived to occur more quickly (Dahmen, Vollmann, Nadolny, & Schildmann, 2017;Fisher & Ridley, 2012;Hua, Halpern, Gabler, & Wunsch, 2016). Conversely, while admitting to critical care might, but not always, lead to prolonging life, it can also mean subjecting a person to difficult and painful treatments for uncertain benefit (Aslakson, 2015;Pattison et al, 2013). Critical care outreach plays a key role in deciding to escalate, or de-escalate care, because it is most often at the point of serious and acute illness that a review of goals of treatment is made (Jones et al, 2012;Pattison, O'Gara, & Wigmore, 2015).…”

Patient Dignity at The End-Of-Life: Is it Possible in Critical Care?

“…Dying with dignity in the ICU implies understanding the patient as a unique person in their vulnerability; for this reason, professionals must take care with matters related to diagnosis and treatment, but also those related to prevention and palliative care [19]. Professionals can help patients and family members to accept their situation and facilitate their participation in decisions whilst also ensuring the patient is protected [20]. Nurses must acknowledge the importance of shared humanity in the preservation of dignity, which, together with family support, presents a challenge when attending to a dying person in critical care [21].…”