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The experiences of Critical Care nurses when providing and facilitating end of
life patient and family care: a cross speciality exploration
Background - Public perception holds that Critical Care
is delivered in a highly technical environment with a
curative focus. However, overall mortality remains at
20.3%, with 70–90% of patients receiving treatment
withdrawal/withholding of life support [Frick et al
2003]. Whilst end of life (EoL) care has significant
health and economic impact, there is poor
understanding of what EoL care challenges are held
across critical care settings.
Findings – Across all critical care areas there
were similarities in what nurses aimed to achieve
for patients and families in EoL care. A
consistent driver in delivering EoL care was to
achieve ‘a good death’ that was conceptualised
as:
•Freedom from pain and distress
•Respect for patient and family
•Privacy and dignity
Within critical care settings, certain technologies
e.g. syringe drivers, were seen to facilitate ‘a
good death’. Other technologies e.g, ventilators,
monitors perceived to be linked to active
treatment/ cure and were withdrawn in a phased
way during EoL care. Personal philosophies and
experiences held by critical care nurses were a
potent influence that shaped the nursing role and
priorities in EoL care.
There were core role characteristics that all
nurses demonstrated when providing and
facilitating EoL care. See model.
Conclusions – This study highlights the complex
role that the critical care nurse plays in EoL care.
The emerging model offers a framework that
more clearly articulates what nurses do in EoL
care, and provide a structure that could underpin
preparation and support nurses as fulfil this and
pivotal role.
Aims - This study explores experiences of critical care nurses
from four clinical specialities [neurological, renal, cardiac
and general Intensive Care] when involved in providing and
facilitating end of life (EoL) patient and family care.
Methods – This qualitative study commenced in November
2008. Interviews are based on responses to end-of-life
vignettes that facilitate exploration of planning and delivery
of EoL care. A stratified [by speciality], purposive sample of
16 nurses regularly involved in EoL care, are participants in
the study. A modified grounded theory method is guiding
data analysis. Study completion date is August 2009.
“If the patient
expresses a wish to go
into a hospice then we
call in all of the outside
social services and
the palliative care
team” [9.9:5.128:128]
“I think it is always
an on going
scenario or process
because you are
constantly
assessing the
patient and the
family and
communicating
with the team so
and that is from the
very beginning
really” [3.3:1.7:7]
“I would say if you [the family] are happy to
have a word with our medical team then I can
set a special time for us all to have a word. You
[the nurse] prepare them [the family]”
[7.7:4.30.30]
Co-ordinate:
Multiple teams
Assess:
Dying process
Facilitate:
Communication
Operationalise:
Withdrawal processes
“the consultant told the family what we intended to do but said he
would leave it to them to indicate when they were ready for us to
start turning the adrenaline down the medications down and
things like that so it was down to me to do it but kind of on the say
so from the family” [8.1:5.45:45]
M. Coombs, R. Palmer – Southampton General Hospital and University of Southampton
H. Willis, D.Ugboma – Queen Alexandra Hospital, Portsmouth
T Long-Sutehall, J. Addington-Hall - University of Southampton