Objective: To review and analyze end-of-life content in recent critical-care nursing textbooks.
Design: This was a descriptive study. Critical-care nursing textbooks published in the year 1995 or later were used for this study. The textbooks were identified from Weston Clinical Science Library, University of Wisconsin, Madison and the library at Brigham Young University, College of Nursing, Provo, Utah.
Sample and years: In this study 14 critical-care nursing textbooks were reviewed, analyzed and rated by two critical-care nurses who were graduate students at University of Wisconsin, Madison.
Method: Categorized competencies were derived from the American Association of Colleges of Nursing?s (AACN) end-of-life competencies for undergraduate nursing students that were used as a framework for analysis of end-of-life content in the textbooks. The categorized competencies were a) health assessment, b) pharmacology, c) psychological care, d) nursing care, e) ethical/legal issues, f) cultural issues, g) professional issues/health care settings. During review of end-of-life content, four additional end-of-life content areas that were not mentioned in the AACN competencies were identified. These were also used for the purpose of analysis. Additional end-of-life content areas that were identified were a) family presence during resuscitation, b) organ donation, c) brain death, and d) withdrawal or withholding of treatment. End-of-life content in 14 textbooks pertaining to categorized competencies and additional end-of-life content areas were rated as being helpful (2), present (1), or absent (0) by the raters.
Findings: The study revealed that none of the textbooks covered all the end-of-life categorized competencies and additional content areas that were used for the analysis. Three textbooks did not contain any end of life content. Helpful content on areas such as a) brain death, b) organ donation, c) respect for others' attitudes and values and d) information on state and federal laws regarding informed consent, advance directives, portable (community based) do-not-resuscitate orders, etc. was present in nearly half of the textbooks. Whereas helpful information on areas such as a) role of nurse in supporting the family, b) cultural issues, c) provision of comfort care to the dying patient, d) assisting the patient, family and colleagues to cope with suffering, grief, and loss, e) eliciting patients? and families? wishes for end-of-life care, f) communication with patient and family, and g) withdrawal or withholding of treatment was covered in one to three textbooks. Many textbooks did not have any information on many areas of categorized competencies and additional content areas.
Conclusion: This study indicates that more comprehensive content on end-of-life care in critical-care nursing textbooks is desired.
Implications: This study poses an important question of whether editors and authors of critical-care nursing textbooks find a dearth of information on end-of-life nursing care in critical-care settings. If the authors do find a deficiency of information, it makes us aware of the need for research on end-of-life care in critical-care settings. The study also points to the need for applying available end-of-life literature to the critical-care setting and publishing it in textbooks. This study may also point to the need for developing end-of-life competencies for critical-care nurses. These competencies can then serve as a framework for authors writing chapters on end-of-life care in critical-care nursing textbooks. The competencies can also be modified as more research is published in this area. This study makes us aware of the need for a separate chapter on end-of-life care in the ICU in critical-care nursing textbooks.
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