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  3. Intensive care: experiences of family & friends
  4. The ‘good’ death that could have been much better
  5. Providing a “Good Death”: Critical Care Nurses’ Suggestions for Improving End-of-Life Care

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The results also provide information for a continuing discussion of improving end-of-life care in critical care units. The high number of responses to the research question Which aspect of end-of-life care in ICUs would critical care nurses most like to see changed? Nurses want to ensure that dying patients experience a good death.

Unfortunately, these experienced nurses did not think that good deaths were routinely possible while patients were in an ICU. Nurses placed importance on dying with dignity and on not dying while alone. In interviews with family members of those who had recently died, Berns and Colvin 20 found that being present or absent at the time of the death of the loved one was a significant memory for survivors.

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Nearly all of the family members they studied who were present at the death wanted to be with the dying patient. Of those who were not present at the death, most indicated that they had planned to be at the bedside. Some reported feelings of guilt related to their unplanned absence. For example, in a study by Singer et al, 18 patients with end-stage cancer identified the components of a good death as having adequate pain and symptom management, avoiding a prolonged death, having control, limiting burden, and strengthening relationships with loved ones. Of the 44 attributes, 26 were rated as being important by all 4 groups of participants.

In general, participants reported wanting to be kept clean, to decide who will make critical decisions, to be cared for by a nurse with whom they felt comfortable, to know what to expect about their physical condition, to have someone who would listen, and to maintain their own personal dignity at the end of life.

Further, participants endorsed management of pain and symptoms at the end of life and stressed the importance of having time to prepare for their death. These finding are supported in the literature. In a comparative study 22 of physicians and nurses, nurses were less satisfied with the decision-making process than were physicians.

Nurses are seldom involved in end-of-life decision making, a situation that often is extremely frustrating for nurses and may create moral distress. Walter et al also found evidence indicating that treatments should not be implemented whenever information indicates that a patient would not want them. This restraint in implementing treatments is especially crucial when the treatments are also most likely to be futile.


Intensive care: experiences of family & friends

Further research is indicated to clarify the meaning of these concepts, such as the tension between technological and humanized care to critical care nurses, which is referred to as being trapped between technology and reality. Barriers continue to exist in providing quality end-of-life care in critical care units, and some clinicians seem impervious to change despite the evidence that exists about the provision of a good death. A multidisciplinary team of clinicians and researchers should investigate ways of incorporating these results into interventions that decrease or eliminate obstacles to providing end-of-life care and enhance or support helpful care practices at the end of life.

With the establishment of the Nursing Leadership Academy for End-of-Life Care, 22 nursing organizations, including the American Association of Critical-Care Nurses, are collaborating to improve both palliative and end-of-life care. Quill 30 emphasized the importance of honesty, expertise, advocacy, compassion, and commitment in providing end-of-life care. These same suggestions were confirmed by participants in our study. Work is being done on the development and validation of a tool known as the Preferences for Care Near the End-of-Life Scale, which would be completed by adults as part of advance healthcare planning.

Such tools may be helpful in ameliorating the difficulties that occur when a patient is no longer able to participate in making decisions about end-of-life care. The importance of conducting qualitative research and the usefulness of such inquiry are becoming increasingly evident, especially in end-of-life care. Educational programs need to be developed to educate healthcare providers about quality end-of-life care. Recommended competencies for baccalaureate nursing graduates, the End-of-Life Competency Statements for a Peaceful Death, 35 have been generated by the American Association of Colleges of Nursing and should be used to guide curricular changes.

These efforts can be enhanced by use of a new multimedia kit for nurse educators that has been developed and provided to all basic nursing programs in the United States. Outcomes evaluation of innovative programs should be shared and disseminated to foster evidence-based end-of-life care. Through dissemination of the findings of our study, additional research studies, and educational offerings, the care of dying patients in ICUs can be improved to ensure a good death.

Dialogue should continue on ways to overcome barriers to the implementation of such findings in clinical practice. Nurses have a major involvement and high-level responsibilities but limited participation in end-of-life decision making. It is important to enhance the visibility and power of nursing by changing the critical care milieu in ways that would be more supportive in providing a good death. User Name Password Sign In. Previous Section Next Section. Barriers to Facilitating a Good Death Respondents identified several barriers or obstacles to providing a good death in ICUs, including staffing patterns and a shortage of nurses that contribute to a lack of time to care for dying patients appropriately.

Staffing Patterns and Shortage of Nurses. Communication Challenges. View this table: In this window In a new window. Facilitators to providing a good death. Managing Pain and Discomfort. Communicating Effectively as a Healthcare Team. Educational Initiatives Study participants also mentioned that all members of the healthcare team should receive education on end-of-life care. Previous Section. Am J Crit Care. Deaths: preliminary data for Natl Vital Stat Rep.

The ‘good’ death that could have been much better

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Holistic Nurs Pract. Stanley KJ. End-of-life care: Where are we headed? What do we know? Who will decide? Innov Breast Cancer Care. Theory construction based on standards of care: a proposed theory of the peaceful end of life. July—August ; 46 : — Dignified dying as a nursing outcome. Outcomes Manage Nurs Pract. Berns R , Colvin ER. The final story: events at the bedside of dying patients as told by survivors. ANNA J. Factors considered important at the end of life by patients, family, physicians, and other care providers.

Providing a “Good Death”: Critical Care Nurses’ Suggestions for Improving End-of-Life Care

Nurse-physician collaboration and satisfaction with the decision-making process in three critical care units. Baggs J.

State of the science on limitation of treatment decisions in intensive care units [abstract]. Abstract Confidence in life-support decisions in the intensive care unit: a survey of healthcare workers. Canadian Critical Care Trials Group. Ten years later, my dear year-old father took his last breath with his family at his side. While his two-year battle with laryngeal cancer was filled with its share of dehumanizing and ultimately futile treatments, such as surgery and radiation, his peaceful death, on a hospice unit in Minneapolis, was a world apart from the horrors of my mother's last hours.

I witnessed, firsthand, the special "midwifery" of professionals who know how to guide the passage from this life. Are the people who die in intensive care units a completely different set of patients? I believe they are not.