Determining the Perceived Barriers and Supportive Behaviors of Intensive Care Nurses towards End-of-Life Care

Year 2023, , 237 - 245, 28.12.2023

Güler Ağgün Yavuz , Şenay Sarmasoğlu Kılıkçıer

https://doi.org/10.31125/hunhemsire.1172182

Abstract

Aim: The aim of this study was to determine the most important barriers and supportive behaviors perceived by intensive care nurses while providing end-of-life care.
Material and Methods: The sample of this cross-sectional descriptive study consisted of 278 intensive care unit nurses who have been working at the Ankara City Hospital.
Results: The three most highly perceived barriers to providing end-of-life care by intensive care unit nurses are: “Families not accepting poor patient prognosis”, “Family not with the patient when he/she is dying”, “Family not understanding the term life-saving measures and its implications” and the three most highly perceived supportive behaviors to providing end of life care by intensive care unit nurses are: “Physicians meet in person with the family after the patient’s death”, “Staff compiles all paperwork to be signed by the family before they leave the unit”, “Nurses take care of patients while affected nurse gets away for a moment after the death of a patient”.
Conclusion: The highly perceived barriers to providing end-of-life care by intensive care unit nurses are related to the patient's families, and the highly perceived supportive behaviors are related to healthcare professionals. It is recommended that families should be provided with opportunities (psychological support, etc.) to facilitate their acceptance of the poor prognosis of their patients and that research be conducted to understand the conditions that enable the information provided by physicians and to ensure their continuity.

Keywords

COVID-19, end-of-life care, intensive care unit, nurse, palliative care

Yoğun Bakım Hemşirelerinin Yaşam Sonu Bakıma Yönelik Algıladıkları Engellerin ve Destekleyici Davranışların Belirlenmesi

Abstract

Amaç: Bu araştırmanın amacı yoğun bakım hemşirelerinin yaşam sonu bakım sunarken algıladıkları en önemli engellerin ve destekleyici davranışların belirlenmesidir.
Gereç ve Yöntem: Araştırma kesitsel tanımlayıcı türde olup, evrenini Ankara Şehir Hastanesi’nde yoğun bakım ünitesinde çalışan 278 hemşire oluşturmuştur.
Bulgular: Yoğun bakım ünitesi hemşirelerinin yaşam sonu bakım sunmaya yönelik algıladıkları en önemli ilk üç engel: “Hastanın kötü prognozunun aile bireylerince kabullenilmemesi”, “Hastanın ölüm anında aile üyelerinin onunla olmaması” ve “Aile bireylerince yaşam kurtarıcı tedbirler ile etkilerinin anlamının bilinmemesi” iken; algıladıkları en önemli ilk üç destekleyici davranış: “Hastanın ölümünden sonra aile üyeleriyle hekimlerin görüşmesi”, “Aile üyeleri tarafından imzalatılacak olan tüm evrakların sağlık çalışanı tarafınca üniteden ayrılmadan hazırlanması” ve “Hastanın ölümünden etkilenen hemşirenin bir süreliğine ayrılması durumunda diğer hastalar için hemşirelerin sorumluluklarını yerine getirmesi” olarak belirlenmiştir.
Sonuç: Yoğun bakım ünitesi hemşireleri tarafından yaşam sonu bakım sunmaya yönelik algılanan en önemli engeller hastaların aileleri ile ilgili olup, algılanan en önemli destekleyici davranışlar ise sağlık çalışanları ile ilgilidir. Ailelere hastalarının kötü prognozunu kabul etmelerini kolaylaştırıcı (psikolojik destek vb.) olanakların sunulması ve hekimlerin yaptıkları bilgilendirmeyi sağlayan koşulların anlaşılmasına ve devamlılığının sağlanmasına yönelik araştırmaların yapılması önerilmektedir.

Keywords

Covid-19, hemşire, palyatif bakım, yaşam sonu bakım, yoğun bakım ünitesi

References

• 1. Palliative care World Health Organization 2022. [Internet]. [Erişim Tarihi 07.12.2022]. Erişim Adresi: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
• 2. Cohen SR, Sawatzky R, Russell LB, Shahidi J, Heyland DK, Gadermann AM. Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire–Revised. Palliative Medicine. 2017;31(2):120-9.
• 3. Li WW, Chhabra J, Singh S. Palliative care education and its effectiveness: A systematic review. Public Health. 2021;94:96-108.
• 4. Hui D, Bruera E. Models of Palliative Care Delivery for Patients with Cancer. J Clin Oncol. 2020;38(9):852-65.
• 5. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: An epidemiologic study. Crit Care Med. 2004;32(3):638-43.
• 6. Capuzzo M, Volta CA, Tassinati T, Moreno RP, Valentin A, Guidet B, et al. Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: A multicentre European cohort study. Criti Care. 2014;18(5):551-60.
• 7. Who Top-10 Causes Of Death 2021 [Internet]. [Erişim Tarihi 12.05.2021]. Erişim Adresi: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
• 8. World Health Organization. Coronavirus Disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update [İnternet]. 2021 [Erişim Tarihi 30.11.2021]. Erişim Adresi: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---30-november-2021
• 9. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55.
• 10. Li L, Gong S, Yan J. Covid-19 in China: Ten critical issues for intensive care medicine. Crit Care. 2020;24(1):124.
• 11. COVID-19 mortality and ICU admission: The Italian experience Critical Care 2020 [İnternet]. 2020 [Erişim Tarihi: 29.10.2020]. Erişim Adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228672/.
• 12. Sharma S, Badami V, Rojas E, Mittal A, Stansbury R, Rana B, et al. ICU Mortality in Patients With Coronavirus Disease 2019 Infection: Highlighting Healthcare Disparities in Rural Appalachia. Crit Care Explor. 2021;3(10):e547.
• 13. Delgado S. End-of-Life Care During the COVID-19 Pandemic 2020. [Internet]. 2020 [Erişim Tarihi: 20.07.2021]. Erişim Adresi: https://www.aacn.org/blog/end-of-life-care-during-the-covid-19-pandemic
• 14. Gross AG. End-of-life care obstacles and facilitators in the critical care units of a community hospital. Journal of Hospice & Palliative Nursing. 2006;8:92-102.
• 15. Efstathiou N, Clifford C. The critical care nurse's role in end-of-life care: issues and challenges. Nurs Crit Care. 2011;16(3):116-23.
• 16. Beckstrand RL, Callister LC, Kirchhoff KT. Providing a "good death": Critical care nurses' suggestions for improving end-of-life care. Am J Crit Care. 2006;15(1):38-46.
• 17. Aslakson R, Wyskiel R, Thornton I, Copley C, Shaffer D, Zyra M, et al. Nurse-Perceived Barriers to Effective Communication Regarding Prognosis and Optimal End-of-Life Care for Surgical ICU Patients: A Qualitative Exploration. J Palliat Med. 2012;15(8):910-5.
• 18. Crump SK, Schaffer MA, Schulte E. Critical care nurses' perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimens Crit Care Nurs. 2010;29(6):297-306.
• 19. Friedenberg AS, Levy MM, Ross S, Evans LE. Barriers to end-of-life care in the intensive care unit: perceptions vary by level of training, discipline, and institution. J Palliat Med. 2012;15(4):404-11.
• 20. Valiee S, Negarandeh R, Dehghan Nayeri N. Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study. Nurs Crit Care. 2012;17(6):309-15.
• 21. Attia AK, Abd-Elaziz WW, Kandeel NA. Critical care nurses' perception of barriers and supportive behaviors in end-of-life care. Am J Hosp Palliat Care. 2013;30(3):297-304.
• 22. King PA, Thomas SP. Phenomenological study of ICU nurses' experiences caring for dying patients. West J Nurs Res. 2013;35(10):1292-308.
• 23. Chan CWH, Chow MCM, Chan S, Sanson-Fisher R, Waller A, Lai TTK, et al. Nurses' perceptions of and barriers to the optimal end-of-life care in hospitals: A cross-sectional study. J Clin Nurs. 2020;29(7-8):1209-19.
• 24. Beckstrand RL, Kirchhoff KT. Providing end-of-life care to patients: Critical care nurses' perceived obstacles and supportive behaviors. Am JCriti Care. 2005;14(5):395-403.
• 25. Akyol A, Sılay F, Ayvaz İ. Yoğun Bakım Hemşirelerinin Yaşam Sonu Bakımda Algılanan Engeller Ve Destekleyici Davranışlar Ölçeğinin geçerliği ve güvenilirliği. 1. Uluslararası Sağlık Bilimleri Kongresi Aydın: Adnan Menderes Üniversitesi. 2017. s. 276
• 26. Borhani F, Hosseini SH, Abbaszadeh A. Commitment to care: a qualitative study of intensive care nurses' perspectives of end-of-life care in an Islamic context. Int Nurs Rev. 2014;61(1):140-7.
• 27. Boulton AJ, Jordan H, Adams CE, Polgarova P, Trick Network W, Morris AC, et al. Intensive care unit visiting and family communication during the COVID-19 pandemic: A UK survey. J Intensive Care Soc. 2022;23(3):293-6.
• 28. Ning J, Cope V. Open visiting in adult intensive care units–A structured literature review. Intensive Crit. Care Nurs. 2020;56:102763.
• 29. Margaret LI, Curtis R. Palliative care: Issues in the intensive care unit in adults. [Erişim Tarihi: 05.01.2022]. Erişim Adresi: https://www.medilib.ir/uptodate/show/83235
• 30. Mack JW, Currie ER, Martello V, Gittzus J, Isack, Fisher L, Bakitas M. Barriers to optimal end-of-life care for adolescents and young adults with cancer: bereaved caregiver perspectives. J Natl Compr Canc Netw. 2021;19(5):528-33
• 31. Liu YC, Chiang, HH. From vulnerability to passion in the end-of-life care: The lived experience of nurses. Eur J Oncol Nurs. 2017;31:30-6.
• 32. Beckstrand RL, Moore J, Callister L, Bond AE. Oncology Nurses' Perceptions of Obstacles and Supportive Behaviors at the End of Life. Oncology Nursing Forum. 2009;36(4):446-53.