Jos M Latour1, Paul Fulbrook, John W Albarran. 1. Clinical Researcher, Paediatric Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. j.latour@erasmusmc.nl
Abstract
BACKGROUND: Available literature suggests that critical care nurses have varied experiences in relation to end-of-life (EOL) care. Few studies have examined the involvement of European intensive care nurses' involvement in EOL care decisions and the extent to which their nursing practice is based on shared beliefs, experiences and attitudes. AIM: To investigate experiences and attitudes of European intensive care nurses regarding EOL care. METHODS: Using a survey method, delegates (n = 419) attending an international critical care nursing conference were invited to complete a self-administered questionnaire about their involvement with EOL care practices. The questionnaire composed of 45 items and was available in three European languages. RESULTS: A total of 164 questionnaires were completed, yielding a response rate of 39%. The majority of respondents (91.8%) indicated direct involvement in EOL patient care, while 73.4% reported active involvement in decision-making process. 78.6% of respondents expressed commitment to family involvement in EOL decisions, however only 59.3% of the participants said that this was routinely undertaken (p < 0.0005, Z = -4.778). In decisions to withdraw or withhold therapy, 65% would decrease the flow of inspired oxygen, 98.8% provide continuous pain relief and 91.3% endorse open visiting. The majority (78%) disagreed that dying patients should be transferred to a single room. A division of views was observed in relation to 44% agreeing that patients should be kept deeply sedated and equal numbers contesting the continuation of nutritional support (41.6% versus 42.3%). CONCLUSIONS: The involvement of European intensive care nurses in EOL care discussions and decisions is reasonably consistent with many engaged in initiating dialogue with coworkers. In general, views and experiences of EOL care were similar, with the exception of the provision of nutrition and use of sedation. RELEVANCE TO PRACTICE: Use of formal guidelines and education may increase nurses' involvement and confidence with EOL decisions.
BACKGROUND: Available literature suggests that critical care nurses have varied experiences in relation to end-of-life (EOL) care. Few studies have examined the involvement of European intensive care nurses' involvement in EOL care decisions and the extent to which their nursing practice is based on shared beliefs, experiences and attitudes. AIM: To investigate experiences and attitudes of European intensive care nurses regarding EOL care. METHODS: Using a survey method, delegates (n = 419) attending an international critical care nursing conference were invited to complete a self-administered questionnaire about their involvement with EOL care practices. The questionnaire composed of 45 items and was available in three European languages. RESULTS: A total of 164 questionnaires were completed, yielding a response rate of 39%. The majority of respondents (91.8%) indicated direct involvement in EOL patient care, while 73.4% reported active involvement in decision-making process. 78.6% of respondents expressed commitment to family involvement in EOL decisions, however only 59.3% of the participants said that this was routinely undertaken (p < 0.0005, Z = -4.778). In decisions to withdraw or withhold therapy, 65% would decrease the flow of inspired oxygen, 98.8% provide continuous pain relief and 91.3% endorse open visiting. The majority (78%) disagreed that dying patients should be transferred to a single room. A division of views was observed in relation to 44% agreeing that patients should be kept deeply sedated and equal numbers contesting the continuation of nutritional support (41.6% versus 42.3%). CONCLUSIONS: The involvement of European intensive care nurses in EOL care discussions and decisions is reasonably consistent with many engaged in initiating dialogue with coworkers. In general, views and experiences of EOL care were similar, with the exception of the provision of nutrition and use of sedation. RELEVANCE TO PRACTICE: Use of formal guidelines and education may increase nurses' involvement and confidence with EOL decisions.
Authors: J Randall Curtis; Elizabeth L Nielsen; Patsy D Treece; Lois Downey; Danae Dotolo; Sarah E Shannon; Anthony L Back; Gordon D Rubenfeld; Ruth A Engelberg Journal: Am J Respir Crit Care Med Date: 2010-09-10 Impact factor: 21.405