Knowing the occasion of a peaceful death in intensive care units in Thailand

The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit.     

Going home from ICU to die: a celebration of life

There is much literature regarding going home to die in terminally ill cancer patients however, little is written about withdrawing treatment at home in critical care. One intensive care unit's experience in New Zealand demonstrates how this can be done safely. The preparation of families and patients must be done with great care. There are challenges to be overcome including supportive resources in the community, staffing and safety of the patient and family. It is possible to withdraw/withhold treatment in a patient's home and this is highly valued by the families.     

Communication of the death of a patient in hospices and nursing homes: A qualitative study

Purpose of the researchAnnouncing the death of a patient to another in hospices and nursing homes (NH) requires special skills, especially when the recipient is another resident. The aim of this study is to describe how hospice and NH staff deal with the communication regarding a patient's death, if this communication is perceived as a problem, and strategies implemented.Methods and sampleThe 55 health care workers (HCWs, 26 nurses and 29 auxiliary nurses) of two NHs and two hospices in Turin (Italy) were interviewed with a semi-structured interview exploring the residents' perception of need to receiving information on another patient's death, the experiences of having given this information in the last 6 months, and the strategies implemented. The interviews were analyzed using Colaizzi's method and researchers looked for the main themes and related subthemes.Key resultsSix themes were identified and grouped into 2 main themes: a. the choice to tell the truth or not, which may be influenced by: the patients' request for confirmation of the fate of the other resident, by patients' fear of death (“I will be next”), the relationships among the guests, and personal and group experiences; b. the need to share own feelings and the burden of deciding whether or not to inform the other residents and how to go about this.ConclusionsIf a structured discussion of experiences and reflection on cases is not implemented, HCWs may limit communication to bare information, lies, and adopt behaviors of avoidance and concealment.     

Exploration of Iranian intensive care nurses' experience of end‐of‐life care: a qualitative study*

Background: A challenge for intensive care nurses is providing the best possible care to patients in an end‐of‐life stage. The fact that some patients will die despite the efforts of the health care team can affect the psychological state of the nurses and families. Lack of attention to such an issue can bring about unpleasant consequences for both patients and nurses. Aim: Using a qualitative design, the aim is this article explores the experiences of intensive care nurses providing care for end‐of‐life patients. Methods: The data were collected through in‐depth interviews with a purposive sample of 10 nurses working at intensive care units (ICUs). Interviews were transcribed and finally analysed through the conventional content analysis. Findings: Two themes emerged out of the experience of providing care to the end‐of‐life patients. The findings revealed that for Iranian intensive care nurses providing care to such patients was accompanied by emotional burden and values and beliefs. Conclusion: The results of the study have increased the current knowledge over the experience of providing care to end‐of‐life patients at ICUs. It also has revealed the need for providing the nurses with psychological support, accommodating the possibility for offering a complete care, attending to and managing the conditions of the patient and their families and engaging nurses in decision making about end‐of‐life patients. Relevance to practice: Managers ought to provide specialized units for providing care to end‐of‐life patients. Nurses working on these units will require emotional support.     

Clinical, sociodemographic, and local system factors associated with a hospital death among cancer patients

Objective The study was conducted to examine factors associated with hospital deaths among a group of cancer patients.Patients and methods A retrospective chart review of the M. D. Anderson Cancer Center Tumor Registry was conducted. Participants were all adult cancer patients, residents of the State of Texas diagnosed and treated since January 1, 1990, and who died during the years 1999 and 2000. The study outcome was the site of death.Main results The inclusion criteria were met by 866 patients of whom 504 (58%) died in a hospital. The group included 489 (56%) men. A number of 641 (74%) were White, 104 (12%) Hispanic, 92 (11%) Black, and 29 (3%) of other origin. The majority, 501 (58%), had been diagnosed with stage IV disease, and the median survival time was 14 months. Multivariate logistic regression analysis showed patients diagnosed with hematologic cancers to be significantly more likely (p<0.001) of dying in hospitals, odds ratio [OR 2.88] and confidence interval [95% CI 1.79–4.63], women diagnosed with breast and gynecological cancers were significantly less likely (p=0.03) of dying at hospitals odds ratio [OR 0.64] and confidence interval [95% CI 0.42–0.96], when compared with patients diagnosed with other cancers. Lower household income per zip code of residency was marginally associated (p=0.06) with hospital deaths.Conclusions The study identified groups of cancer patients at risk of hospital death. These results should account when planning the allocation of hospital palliative care services as well as when informing policy decisions about health care financing and delivery of these services.We want to state that no financial support was provided for this study     

Music during after‐death care: a focus group study

Background: The intensive care unit (ICU) is not only a place to recover from injuries incurred during accidents and from serious illness. For many patients, it is also a place where they might die. Nursing care does not stop when a patient dies; rather, it continues with the care of the deceased and with family support. The aims of this study were (1) to explore the experiences and attitudes of nurses towards the use of ambient music in the ICU during after‐death care and (2) to describe the feedback nurses received from relatives when music was used during the viewing. Method: A qualitative design employing focus group interviews was used. Three focus group interviews with 15 nurses were conducted. All the interviews were audiotaped, transcribed verbatim and analysed using qualitative content analysis. Findings: Six main categories of attitudes emerged from the analysis: (1) different attitudes among nurses towards the use of music; (2) music affects the atmosphere; (3) music affects emotions; (4) use of music was situational; (5) special choice of music and (6) positive feedback from the bereaved. Conclusion: This study demonstrates that music might be helpful for nurses during after‐death care as well as for the care of the relatives. Relevance to clinical practice: Including ambient music in an after‐death care programme can help nurses show respect for the deceased as the body is being prepared. Music played during the viewing may be a way of helping relatives in their time of grieving. It may ease the situation by making that event special and memorable. However, standardizing this intervention does not seem appropriate. Rather, the individual nurse and the family must decide whether music is to be used in a particular situation.     

Perspectives regarding what constitutes a “good death” among Thai nurses: A cross‐sectional study

Palliative care is a crucial component in improving peoples' end‐of‐life period. It is important to understand the wishes of people at the end of life and the perceptions of their healthcare providers regarding these wishes. As nurses play a key role in patient care, in this study we set out to determine nurses' perceptions regarding what constitutes a “good death”, comparing what they thought their older patients would prefer to their own preferences for their own end‐of‐life care. Questionnaires asking about various options of end‐of‐life care were distributed to nurses, and they were asked how they thought older people would respond to each of the questions and what their own preferences would be if they were terminally ill. In total, 656 participants were enrolled and they rated relief from suffering as the most important component, both for themselves and for those in their care. More than 80% of nurses agreed with all of the statements on the questionnaire. However, some of the nurses' preferences for their own end of life differed from those they expected their patients to value.     

End-of-life care in UK critical care units--a literature review

Aim: To appraise literature concerning end‐of‐life care (ELC) in adult critical care units in the UK in order to improve clinical practice. Objective: To understand the interplay between legal and ethical, political, societal aspects of ELC for sustainable quality care. Background: Significant changes in health care policy for the critically ill patient have occurred since 1999. Simultaneously, the government is committed to improving care for the dying by integrating the palliative care ethos across the National Institutes of Health (NHS) to include non‐cancer sufferers. Death continues to be a feature of critical illness, particularly following the decision to withhold/withdraw life‐prolonging treatments. Search strategy: A search of MEDLINE, BNI, CINAHL and PSYCinfo using key words revealed very few results; consequently, the search was broadened to include ASSIA, King’s Fund, TRIP, Healthstar, NHS Economic Evaluation Data, Cochrane, professional journals and government documents. Conclusions: The literature reveals a paradigm shift from critical to palliative care, in other words, from a reductionist approach to a more humanistic approach in the acute setting. When treatment is deemed futile, quality ELC involving the assessment, ongoing assessment and care after death becomes the new goal for the critical care team. To practice ELC competently, nurses require organizational and educational support at local and national levels. Relevance to clinical practice: Although medico‐legal decision‐making is not part of their professional role, critical care nurses have an extraordinary opportunity to make a difference to the dying patient and their family and their acceptance of death.     

Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study

ObjectiveComparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015.MethodologyThis was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015.SettingInternational e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient.SubjectsIntensive care physicians and nurses, no interventions were performed.MeasurementsA 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made.ResultsA total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II.ConclusionBased on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.