Friday, September 27, 2002: 9:45 AM-11:15 AM | |||
Improving Information for EOL Care | |||
| The purpose of this symposium is to introduce research concerning three issues related to end-of-life care. The major points that will be addressed in this symposium are (a) the need for a comprehensive approach to promote patient-centered advanced care planning, (b) a need for improved information on end-of-life care for nurses especially through journals and textbooks, (c) the need for greater consensus and communication among health care providers withdrawing life support, and (d) one issue in recruiting recently bereaved for research. A pilot study was conducted to test the efficacy and feasibility of a Patient-Centered Advance Care Planning (PC-ACP) intervention on shared decision-making for patients with chronic illness with a high risk of end-of-life care needs. Eligible patients and their designated surrogates were allocated to either control or experimental group. There were three special populations of patients: end-stage congestive heart failure, end-stage renal disease, and preoperative open-heart surgery. A representational approach to patient education developed from social science theories formed the conceptual model for the intervention. The representational approach works on the theory that, through a detailed discussion of illness representations patients can examine their own belief systems and the limitations or outcomes of continuing with misconceptions. About 85% of the experimental group's surrogates changed their decisions regarding patient's future medical care at least in one situation of Statement of Treatment Preferences following the PC-ACP intervention. Congruence in specific treatment preferences between patient and surrogate was statistically significantly different between the experimental and control groups (p=.008). Experimental group patients' satisfaction with the quality of patient-clinician communication was significantly higher than that of control group (t = 2.1, p = .043). Likewise, patient's decisional conflict regarding preferences regarding future medical care was significantly lower than that of control group (t = -3.21, p = .004). Two reports are about end-of-life information available in the American Journal of Nursing over time and in recent critical-care nursing textbooks regarding end-of-life care. In the study on end-of-life information in the American Journal of Nursing from 1900 to 1999, only nine articles were published before 1930. Over fifty percent of the articles reviewed were published between 1990 and 1999. The types of writings included educational articles about terminal illnesses and care, poems, and first-person narratives. The first-person narratives made an appearance in the 60s and have persisted as the most predominant form of publication about the end of life. The American Journal of Nursing did not have any research studies published for 100 years. In another study, 14 critical-care nursing textbooks published in the year 1995 or later were reviewed for end-of-life content. Modified American Association of Colleges of Nursing's (AACN) end-of-life competencies, called categorized competencies served as a framework for analysis. During review of end-of-life content, four additional end-of-life content areas that were not mentioned in the AACN competencies were identified and used for analysis. 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. One study examined the withdrawal process and compared perceptions among health care providers (physicians, nurses, and respiratory therapists) regarding the preferred order of withdrawal of life supports, frequency of withdrawal discussions, and perceptions about how withdrawal of mechanical ventilation actually occurs. Comparisons were made among the health care providers at two points of time, three years apart using surveys. Physicians and nurses preferred hemodialysis and blood products as treatments to be withdrawn first while respiratory therapists preferred antibiotics and total parenteral nutrition to be withdrawn first. Significant disagreement about physician's responsibilities during withdrawal of mechanical ventilation existed among the three groups. One study identified issues related to recruiting bereaved family members for research. There was difficulty in recruiting bereaved family members because of their relocation, reluctance to "relive" the death, and their failure to keep appointment or return calls. External events such as 9/11 exacerbate these difficulties. Consideration to improve response rate might include different methods of contact, different time periods, and sensitivity to concurrent local or national events. | |||
| Organizer: | Karin T. Kirchhoff, PhD, RN, FAAN, Professor | ||
| A historical analysis of 100 years of American Journal of Nursing writings about dying care: Can nurses from the “good old days” inform us? Margaret L. Campbell, MSN, RN, FAAN, Advance Care Nurse, Linda K Strodtman, PhD, RN, Assistant professor | |||
| A Patient-Centered Approach to Advance Care Planning: Results of a Pilot Study Linda Briggs, RN, MS, MA, Assistant Director for Advance Care Planning, Karin T. Kirchhoff, RN, PhD, FAAN, Rodefer Chair & Professor, Mi-Kyung Song, RN, MS, Doctoral candidate | |||
| Comparison of Perceptions of Withdrawal of Life-Support among ICU Health Care Providers Mi-Kyung Song, RN, MS, Doctoral candidate, Kenneth E. Wood, DO, Associate Professor (CHS), Karin T. Kirchhoff, PhD, RN, FAAN, Rodefer Chair & Professor, Susan Kay Lichte-Krueger, RN, BS, Graduate student | |||
| Issues in Recruiting Bereaved Family Members Karen A. Kehl, RN, MS, CHPN, Predoctoral Fellow Patient Centered Informational Interventions, Karin T. Kirchhoff, PhD, RN, FAAN, Rodefer Chair & Professor | |||
| Review of End-Of-Life Content in Critical-Care Nursing Textbooks Prashanth Reddy Anumandla, RN, BScN, Graduate student, Karin T. Kirchhoff, RN, PhD, FAAN, Rodefer Chair & Professor, Renea L. Beckstrand, RN, PhD, Associate Professor | |||
The Advancing Nursing Practice Excellence: State of the Science