The purpose of this study was to determine the EoL nursing care rendered to clients who died whilst on admission in the adult medical-surgical units in selected hospitals in the Cape Coast metropolis. It sought to determine the baseline that will serve as reference for the development of a model of EoL nursing care that reflects the holistic model in Ghana.
Methods:
Study design: Retrospective medical record review (MRR) which employed an audit of nursing records; the 24-hour report book and the nurses notes, was conducted to determine the incidence of death in the adult medical-surgical units during the period of the study and to evaluate the nursing care rendered to the clients through the lens of the Holistic Nursing model and the End-of-Life model.
Sampling procedure: Purposive sampling was used to select three public facilities within the Cape-Coast metropolis; Cape Coast Teaching Hospital, The University Hospital, and the Cape Coast Metro Hospital. The facilities are secondary or tertiary facilities that have adult medical and surgical wards that admitted patients within the study period. Consecutive sampling was used to select the records of all patients who died within the selected facilities between 1st January-31st December 2017. There was no contact with the patients in this study.
Eligibility criteria: Records were eligible for inclusion if the clients had been on admission for a minimum of 48 hours.
Exclusion criteria: Coroners’ cases.
Instruments: A data abstraction form was used to abstract the data from the nursing records. Appendix A recorded the socio-demographic and medical characteristics (from the admission and discharge book), the characteristics of the health facilities sampled for the study as well as the nursing documentation indicating end of life care from the 24-hour report book, nurses’ notes, and patients’ bedside records.
Validity and Reliability: Experts in adult nursing and nursing education reviewed the content of the data abstraction form to determine the content and construct validity of the instrument.
Data management and analysis: Quantitative data (patient sociodemographic and medical characteristics) was captured into a password-protected database using SPSS version 20. Data abstraction forms was checked for completeness and quality and cleaned where necessary. Variables were analysed using frequencies and means to determine the incidence of death in the adult medical-surgical units.
Textual analysis of nursing record data were completed by 2 independent reviewers to describe the EoL nursing care rendered to clients who died on the adult medical-surgical units. Content and thematic analysis were conducted to determine the care rendered during the last days of the clients who died.
Ethical Considerations: Ethical approval was obtained from the University of Cape Coast Ethics Review Committee. The ethical considerations outlined in the Helsinki declaration of scientific research (World Medical Association, 2013) involving human subjects was adhered to during this study.
Results:
Most of the EoL nursing care could be categorised as physical and biomedical. Spiritual care and psycho-social care were mainly not documented. Family grieving activities and nursing support were not documented.
Conclusion:
Nursing care of the dying in the study settings does not fully reflect the holistic model of EoL care. There is the need to develop curriculum and nursing protocols for holistic nursing care in Ghana.