Paper
Friday, July 15, 2005
An Investigation of the Factors Influencing Critical Care Nurses' Inclusion of Families in End-of-Life Care
Cynthia Peden-McAlpine, PhD, APRN, BC, School of Nursing, University of Minnesota, Minneapolis, MN, USA and Joan Liaschenko, RN, PhD, FAAN, Center for Bioethics and School of Nursing, University of Minnesota, Minneapolis, MN, USA.
| Learning Objective #1: Describe the barriers that critical care nurses encounter while providing end-of-life care to patients and families |
| Learning Objective #2: Discuss key factors contributing to quality end-of-life care in critical care |
‘Death and dying' and ‘end of life' issues have received significant attention over the past thirty years. As a result, there have been changes in practice including, for example, the development and expansion of hospice and palliative care, advance directives, and more education in schools of the health professions. In spite of these changes, recent large-scale studies indicate that end of life care is inadequate and, in particular, for those who die in hospitals, including critical care units. Families report poor communication with physicians, inadequate emotional support, and poor symptom control, including pain management. Because nurses are typically involved with families for the longest periods of time, they are key to initiating and sustaining sensitive and compassionate communication with families during this very difficult period. In accordance with the quality care identified by families, nurses designated five clinical outcomes for the best possible end of life care: 1) absence of pain; 2) comfort; 3) dignity and respect; 4) being at peace; and 5) presence of significant others or other caring persons. Despite nursing's commitment highlighted in the AACN standards of care, we know little about why families continue to struggle with poor experiences of end-of-life care in ICUs. Significantly, there is also little knowledge about how ICU nurses actually work with families to achieve these goals. Few studies have critically explored nurses' understandings of those factors that facilitate or hamper sensitive and compassionate interactions with families regarding end of life care. This study proposes to identify these factors through six focus groups with 48 experienced critical care nurses in two major metropolitan teaching hospitals in the Midwest. Data is currently being collected and qualitative content analysis will be completed in Spring 2005.