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Background
Twenty percent of Americans take their last breath in the ICU. About 14% of people 85 and older die in the ICU. In no other country do so many people die in intensive care. Prior to the twentieth century, people used to die at home. The patient and family members prepared for death, said good-bye, completed end of life (EOL) closure tasks and created memories. The significance of objects in relation to death and grief has poignant accounts in the literature, particularly among the pediatric literature. The concept of Attachment Theory, Continuing Bonds and Object Linking has been used for bereavement support, to aid the mourning process. Families of deceased infants, children and teenagers are offered mementos, such as locks of hair, foot prints, etc. Yet, according to the IOM (2001), there is a paucity of data available to validate the benefits of these interventions among adults. This research evaluated the impact of using the ECG rhythm strip as a Memento, to provide the grieving or bereaved family members a transitional object, to displace the experience of grief.
Purpose: This study examined the effectiveness of the ECG Memento©, as a transitional object for families who have experienced the loss of a loved one in the ICU/ICCU, as they transitioned from anticipatory to bereaved status. We also examined the role of the staff nurse and their experience/satisfaction facilitating the use of the ECG Memento© ,as a mediating object to facilitate and meet the emotional and psychological needs of the families.
Methods: A prospective, posttest, survey design was used to observe and describe the effect of the ECG Memento©, on the anticipated bereavement process among families who have lost a loved one in the intensive care units (ICUs) or intermediate cardiac care unit (ICCU).
Sample: A convenience sample of 50 patients/families (dyad); actively dying, with a “Do Not Resuscitate (DNR)” Comfort Care, Hospice order; or who are recently deceased, will be study eligible. Families provided consent and agreed to participate in post-discharge bereavement survey. We also recruited 50 nurses who have provided care to enrolled patients/families during the EOL process and death, to take the Quality of Dying and Death Questionnaire for Nurses (QODD).
Instruments: Families completed the Satisfaction and Bereavement Experiences Questionnaire (SBEQ), to examine their perceptions of the EOL experience and utility of the ECG Memento© , 5-6 weeks after the patient death. Whereas, the nurses completed the QODD, to examine their experience of EOL care and the death experience within 2-3 weeks post-care of a study patients. Ratings were based on how nurses thought these experiences affect the quality of the patient’s dying and death. We also examined the severity of illness, and predicted mortality of patients at admission, using the Charlson Comorbidity Index (CCI) score.
Results: Preliminary: 12/50 patients-66% male; mean age 73; mean-ICU stay 7.3 days; 58% > 3 days. Family member-91.7% female; age <50 years (33%); 50-70> (66%); SBEQ: Completed-(41%) spouse; (58%) children; Scores (1=very satisfied, 4=very dissatisfied); Hospital Experiences 1.6 (101) SD; Personal Responses 1.8 (0.9SD); Ritual Experiences 1.4 (0.8SD), Post Hospital Experiences 2.1 (1.2SD). Families found ECG Memento© (16.7%) extremely helpful; (50%) viewed ECG daily; (50%) found very helpful/viewed 2-3 days/week: (25%) rarely viewed it. 22 nurses completed QODD; 11.8 years ICU experience; >57.5% Baccalaureate; Nurses rated patient dying experience- 14% pain controlled; 19% breathing comfortably; 50% dignity/self-respect; 68% time with loved ones; 87.5% spiritual support. RN QODD (0-10 scale); mean 8.6 (1.8SD).
Conclusion: Impact of this novel, pilot study, shows the ‘ECG Memento©’ provides a tangible link to aid families with grieving, yet, larger studies are needed. 100% nurses described ECG Memento© as well received, but, only 40% felt patient symptoms controlled.