Yoğun Bakım Hemşireleri ve Hekimlerinin Ölüm Öncesi ve Sonrası Değişiklikler Konusundaki Yeterliliklerinin Değerlendirilmesi: Kapsamlı Bir İnceleme

Yıl 2025, Cilt: 14 Sayı: 2, 418 - 425, 30.08.2025

Esra Özkan , Halil İlhan Aydoğdu

Öz

Amaç: Bu çalışma, ölüm öncesi ve sonrası meydana gelen doğal ve doğal olmayan değişikliklere ilişkin yoğun bakım hemşireleri ve hekimlerinin bilgi düzeylerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Araştırma, Mart-Mayıs 2024 tarihleri arasında Türkiye’nin kuzeyindeki üç hastanenin yoğun bakım ünitelerinde gerçekleştirilmiştir. Çalışmaya, bu ünitelerde görev yapan sağlık çalışanları katılmıştır. Veriler, araştırmacılar tarafından literatür taramasına dayanarak geliştirilen 32 soruluk bir anket aracılığıyla toplanmıştır. Bulgular: Araştırmaya katılanların %78.4’ünün kadın, %93.3’ünün hemşire olduğu belirlenmiştir. Katılımcılar, ayda ortalama 4.9 ± 0.2 ölüm vakasıyla karşılaştıklarını bildirmiştir. Anket sonuçlarına göre en yüksek doğru yanıt oranı (%81.35) beyin ölümü ile ilgili sorularda, en düşük doğru yanıt oranı ise (%45.95) post-mortem değişikliklere ilişkin sorularda belirlenmiştir. Sonuç: Ölüm öncesi ve sonrası meydana gelen değişikliklerin doğru şekilde yorumlanması hem bilgi hem de deneyim gerektirmektedir. Bu değişikliklerin anlaşılması, tıbbi, hukuki ve etik karar alma süreçleri açısından kritik öneme sahiptir. Bakım kalitesinin artırılabilmesi için sağlık profesyonellerine yönelik temel eğitim programlarının güncellenmesi gerekmektedir. Bu eğitimlerin disiplinlerarası bir yaklaşımla, güncel bilimsel kanıtlara dayalı olarak sürekli mesleki gelişim programlarına entegre edilmesi önem arz etmektedir.

Anahtar Kelimeler

Ölüm , Yoğun bakım , Ölüm sonrası değişiklikler

Assessing Intensive Care Nurses' and Physicians’ Proficiency in Ante-Post Mortem Changes: A Comprehensive Evaluation

Öz

Objective: This study aims to evaluate the knowledge levels of intensive care nurses and physicians regarding the natural and unnatural changes that occur before and after death. Materials and Methods:. This descriptive study was conducted from March-May 2024, in the intensive care units of three hospitals in northern Türkiye. The participants included healthcare professionals from these units. Data were collected through a 32-question questionnaire developed by the researchers, based on a literature review. Results: The study found that 78.4% of the participants were female, and 93.3% were nurses. On average, the participants reported encountering 4.9 ± 0.2 deaths per month. In the questionnaire, the highest correct answer rate (81.35%) was observed for questions related to brain death, while the lowest correct answer rate (45.95%) was for questions about post-mortem changes. Conclusion: Correctly interpreting the changes that occur before and after death requires both knowledge and experience. Understanding these changes is critical to medical, legal and ethical decision-making processes. In order to improve the quality of care, basic education programs for health professionals need to be updated. It is important that these trainings are integrated into continuous professional development programs with an interdisciplinary approach and based on current scientific evidence.

Anahtar Kelimeler

Death , Intensive care , Post öortem changes

Etik Beyan

Ethics committee approval was obtained from the Ethics Committee of XXX University Hospital (Date:21/02/2024, Issue No:02).

Destekleyen Kurum

There is no funding

Kaynakça

• Allen, M. L. (2018). Examining nursing students’ stress in an end-of-life care simulation. Clinical Simulation in Nursing, 14(1), 21–28. https://doi.org/10.1016/J.ECNS.2017.10.006
• Boissier, F., Seegers, V., Seguin, A., Legriel, S., Cariou, A., Jaber, S., … Kentish-Barnes, N. (2020). Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments. Critical Care, 24(1). https://doi.org/10.1186/S13054-020-03191-Z
• Can, R., Tambağ, H., Öztürk, M., Kaykunoğlu, M., Erenoğlu, R., Gümüşoğlu, & Fatma. (2020). The attitudes of intensive care nurses towards euthanasia, death and terminal patients. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi, 10(2), 190–200. https://doi.org/10.31020/MUTFTD.693100
• Çelik, S. (2004). Yoğun bakım ünitesinde hastanın post-mortem bakımı. Yoğun Bakım Hemşireliği Dergisi, 8(1), 45–47. Retrieved from https://dergipark.org.tr/tr/pub/ybhd/issue/26499/278829
• Caton, A. P., & Klemm, P. (2006). Introduction of novice oncology nurses to end-of-life care. Clinical Journal of Oncology Nursing, 10(5), 604–608. https://doi.org/10.1188/06.CJON.604-608
• Ceyhan, Ö., Özen, B., Zincir, H., Şimşek, N., & Başaran, M. (2018). How intensive care nurses perceive good death. Death Studies, 42(10), 667–672. https://doi.org/10.1080/07481187.2018.1430084
• De Takao Kaneko-Wada, F. J., Domínguez-Cherit, G., Marcela Colmenares-Vásquez, A., Santana-Martínez, P., Gutiérrez-Mejía, J., Arroliga, A. C., & de Takao Kaneko-Wada Instituto Nacional de Ciencias Médicas Nutrición Salvador Zubirán, F. J. (2015). The process of death in the intensive care unit (ICU). From a medical, thanatological and legislative point of view. Gac Med Mex, 151(586), 591. Retrieved from www.anmm.org.mx
• De Vries, M. L., Dorn, T., Eppink, M., & Reijnders, U. J. L. (2019). Forensic nursing education and practice in the netherlands: where are we at? Journal of Forensic Nursing, 15(2), 78–83. https://doi.org/10.1097/JFN.0000000000000235
• Drake, S. A., Tabor, P., Hamilton, H., & Cannon, A. (2020). Nurses and medicolegal death investigation. Journal of Forensic Nursing, 16(4), 207–214. https://doi.org/10.1097/JFN.0000000000000310
• Ersoy, G. (2024). Ölüm ve postmortem değişimlerden ölüm zamanı tayini. In in Adli Tıp ve Adli Bilimler, H. Dokgöz, Editor. 2019, Akademisyen: Ankara. (Vol. 8, pp. 91–135). İstanbul Üniversitesi–Cerrahpaşa Üniversite Yayınevi. https://doi.org/10.5152/0602
• Ferrand, E., Jabre, P., Vincent-Genod, C., Aubry, R., Badet, M., Badia, P., … Marty, J. (2008). Circumstances of death in hospitalized patients and nurses’ perceptions: French multicenter Mort-a-l’Hôpital survey. Archives of Internal Medicine, 168(8), 867–875. https://doi.org/10.1001/ARCHINTE.168.8.867
• Ferrand, E., Lemaire, F., Regnier, B., Kuteifan, K., Badet, M., Asfar, P., … Duvaldestin, P. (2003). Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. American Journal of Respiratory and Critical Care Medicine, 167(10), 1310–1315. https://doi.org/10.1164/RCCM.200207-752OC
• Gerritsen, R. T., Hofhuis, J. G. M., Koopmans, M., Van Der Woude, M., Bormans, L., Hovingh, A., & Spronk, P. E. (2013). Perception by family members and ICU staff of the quality of dying and death in the ICU: a prospective multicenter study in The Netherlands. Chest, 143(2), 357–363. https://doi.org/10.1378/CHEST.12-0569
• Gordon, J. K., & McKinlay, J. (2012). Physiological changes after brain stem death and management of the heart-beating donor. Continuing Education in Anaesthesia, Critical Care and Pain, 12(5), 225–229. https://doi.org/10.1093/BJACEACCP/MKS026
• Joffe, A. R., Anton, N. R., Duff, J. P., & deCaen, A. (2012). A survey of American neurologists about brain death: Understanding the conceptual basis and diagnostic tests for brain death. Annals of Intensive Care, 2(1), 1–8. https://doi.org/10.1186/2110-5820-2-4/TABLES/2
• Kentish-Barnes, N., Seegers, V., Legriel, S., Cariou, A., Jaber, S., Lefrant, J. Y., … Azoulay, E. (2016). CAESAR: a new tool to assess relatives’ experience of dying and death in the ICU. Intensive Care Medicine, 42(6), 995–1002. https://doi.org/10.1007/S00134-016-4260-4
• Koç, S. (2016). The bulletin of legal medicine. Turkiye Klinikleri Forensic Medicine-Special Topics, 2(1), 1–7. Retrieved from https://orcid.org/0000-0002-8183-874X
• Köktürk Dalcali, B., & Taş, A. S. (2021). What intern nursing students in turkey think about death and end-of-life care? a qualitative exploration. Journal of Religion and Health, 60(6), 4417–4434. https://doi.org/10.1007/S10943-021-01330-6
• Köktürk Dalcalı, B., Can, Ş., & Durgun, H. (2022). Emotional responses of neonatal intensive care nurses to neonatal death. Omega, 85(2), 497–513. https://doi.org/10.1177/0030222820971880
• Kudubes, A. A., Akıl, Z. K., Bektas, M., & Bektas, İ. (2021). Nurses’ attitudes towards death and their effects on spirituality and spiritual care. Journal of Religion and Health, 60(1), 153–161. https://doi.org/10.1007/S10943-019-00927-2
• Osborn, T. R., Curtis, J. R., Nielsen, E. L., Back, A. L., Shannon, S. E., & Engelberg, R. A. (2012). Identifying elements of ICU care that families report as important but unsatisfactory: decision-making, control, and ICU atmosphere. Chest, 142(5), 1185–1192. https://doi.org/10.1378/CHEST.11-3277
• Russell, J. A., Epstein, L. G., Greer, D. M., Kirschen, M., Rubin, M. A., & Lewis, A. (2019). Brain death, the determination of brain death, and member guidance for brain death accommodation requests. Neurology, 92(5), 228–232. https://doi.org/10.1212/WNL.0000000000006750
• Schwill, S., Reith, D., Walter, T., Engeser, P., Wensing, M., Flum, E., … Krug, K. (2020). How to ensure basic competencies in end of life care- A mixed methods study with post-graduate trainees in primary care in Germany. BMC Palliative Care, 19(1), 1–12. https://doi.org/10.1186/S12904-020-00540-1
• Sherman, D. W., Matzo, M. L. P., Pitorak, E., Ferrell, B. R., & Malloy, P. (2005). Preparation and care at the time of death: content of the ELNEC curriculum and teaching strategies. Journal for Nurses in Staff Development : JNSD : Official Journal of the National Nursing Staff Development Organization, 21(3), 93–100; quiz 101. https://doi.org/10.1097/00124645-200505000-00003
• Smith, M. B., Macieira, T. G. R., Bumbach, M. D., Garbutt, S. J., Citty, S. W., Stephen, A., … Keenan, G. (2018). The use of simulation to teach nursing students and clinicians palliative care and end-of-life communication: a systematic review. The American Journal of Hospice & Palliative Care, 35(8), 1140–1154. https://doi.org/10.1177/1049909118761386
• Uzun, L. N., & Cerit, B. (2024). Effect of postmortem care education using a creative drama method on nursing students’ knowledge, skills, and satisfaction: A randomized controlled trial. Nurse Education Today, 133, 2–8. https://doi.org/10.1016/J.NEDT.2023.106066
• Zheng, R., Lee, S. F., & Bloomer, M. J. (2018). How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal of Clinical Nursing, 27(1–2), e39–e49. https://doi.org/10.1111/JOCN.13975