Knowledge of,and participation in,advance care planning: A cross-sectional study of acute and critical care nurses’ perceptions

BackgroundNurses have a core role in facilitating discussions and enacting decisions about end-of-life issues for patients in hospitals. Nurses’ own knowledge and attitudes may influence whether they engage in meaningful end-of-life conversations with patients.AimsTo determine in a sample of nurses working in acute and critical care hospital wards:1) their knowledge of advance care planning, including the authority of substitute decision-makers and legal validity of advance directives;2) their own participation in advance care planning decision-making practices; and3) associations between nurses’ socio-demographic characteristics; clinical expertise; and knowledge and behaviour in relation to advance care planning practices.DesignQuestionnaire-based, cross-sectional study.Setting and participantsThe study was conducted with 181 registered and enrolled nurses employed in acute and critical care wards of three metropolitan hospitals in Australia.ResultsNurses were least knowledgeable about items relating to the authority of medical (56%) and financial (42%) substitute decision-makers. Few nurses had prepared advance directives (10%) or appointed medical (23%) or financial (27%) decision-makers, when compared to discussing end-of-life wishes (53%) or organ donation (75%). Overall, 15% of nurses had not engaged in any advance care planning practices. Nurses who had cared for 11–30 dying patients in the last six months were more likely to have an increased knowledge score. Older nurses were more likely to participate in a greater number of advance care planning practices and an increase in shifts worked per week led to a significant decrease in nurses’ participation.ConclusionNurses have a key role in providing advice and engaging dying patients and their families in advance care planning practices. Nurses’ own knowledge and rates of participation are low. Further education and support is needed to ensure that nurses have an accurate knowledge of advance care planning practices, including how, when and with whom wishes should be discussed and can be enacted.     

Health care providers’ perception,knowledge, barriers and practice of kangaroo care for preterm baby in Indonesia

This study explored the health care providers' perception, knowledge, barriers and practice of Kangaroo Mother Care (KMC) for premature infants. Total of 111 participants working in NICU and Perinatology wards from four hospitals in Central Java, Indonesia were recruited to this study. The participants were invited to complete the four sections of the Kangaroo Mother Care Questionnaire. Generally they have been practicing KMC with good perception even with deficient knowledge about KMC. Yet the health care providers perceived high barriers to practice KMC and perceived uncomfortable practicing KMC in certain situation. KMC practice in Indonesia need to be highly promoted to be practiced and campaigned thus the health care providers’ negative perception could be reduced as well as educate them to be more confident practicing KMC with adequate knowledge.     

Intensive care physicians’ attitudes concerning distribution of intensive care resources

Objective To evaluate the attitudes of Israeli intensive care physicians regarding intensive care unit (ICU) triage issues.Design An opinion survey using questionnaires similar to those used in a previous study in the United States.Setting and participants Forty-three physicians, members of the Israel Society of Critical Care Medicine (45%).Results Important factors for admission to the last ICU bed were: small likelihood of surviving hospitalization, irreversibility of acute disorder, nature of chronic disorders and the physicians personal attitude. Most respondents would admit a patient with a predicted survival of a few weeks (70%) or a patient whose quality of life would be poor according to the physicians (98%) or patients (77%) definition, to the last ICU bed. The personal attitude of the respondents and their own view of the patients quality of life were considered as important as the quality of life as viewed by the patient. Israeli physicians tended to refuse patient admission into the ICU more than their US counterparts. Most Israeli physicians refused to discharge an ICU patient in order to admit another, despite bed shortage.Conclusions The attitudes of Israeli intensive care physicians towards distribution of ICU resources differ from those of their United States counterparts; they are more paternalistic and comply less with requests for admission. Such attitudes are comparable to those expressed by some European intensive care physicians, highlighting the existence of diversity in the factors important to physicians decision-making.     

Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks

Purpose

Commonly used terms such as “supportive care,” “best supportive care,” “palliative care,” and “hospice care” were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms.

Methods

We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched.

Results

Nine of 32 “SC/BSC,” 25 of 182 “PC,” and 12 of 42 “HC” articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. “SC” focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, “HC” focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both “PC” and “SC/BSC” were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for “SC/BSC,” “PC,” and “HC,” respectively. “SC/BSC” was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings.

Conclusion

We identified defining concepts for “SC/BSC,” “PC,” and “HC” and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.     

Insurance policies and perceived quality of primary care among privately insured patients: do features of managed care widen the racial, ethnic, and language-based gaps?

CONTEXT: Little is known about whether some features of managed care widen disparities in patients' evaluations of primary care. OBJECTIVES: We investigated whether the magnitudes of racial and ethnic/language-based differences in patients' evaluations of the quality of primary care vary by capitation and gatekeeping. DESIGN: We used a telephone survey of a representative sample of the US noninstitutionalized population, Community Tracking Study Household Survey 1998-1999, and Followback Survey of respondents' insurance administrators. SETTING AND PARTICIPANTS: Our sample was privately insured adults who saw a physician at least once during the year preceding the interview and whose last visit was to a primary care physician. MAIN OUTCOME MEASURES: We measured patients' evaluations of (1) how well the physician listened, (2) how well the physician explained, and (3) how thorough and careful the physician was during the last visit. RESULTS: Significant white-minority differences emerge more often in plans using capitation or gatekeeping than in other plans. The gaps in patients' evaluations of their primary care providers' (PCP) explanations and thoroughness between whites and Hispanics interviewed in English are larger when the PCP is capitated than when the PCP is not capitated. The gap in the evaluations of their PCP's explanations by whites and Hispanics interviewed in English is larger in plans that require referrals for specialist visits than in other plans. The magnitude of racial and ethnic/language-based gaps for Hispanics interviewed in Spanish, blacks, and Native American/Asian/Pacific Islanders do not differ by capitation and gatekeeping. CONCLUSION: English-speaking Hispanics' perceptions of the quality of primary care may be more dissimilar from whites' when capitation or gatekeeping are used than when these policies are not used.     

Intensive care nurses’ experiences and perceptions of delirium and delirium care

ObjectiveTo explore nurses’ experiences and perceptions of delirium, managing delirious patients, and screening for delirium, five years after introduction of the Confusion Assessment Method for Intensive Care into standard practice.Research design and settingTwelve nurses from a medical-surgical intensive care unit in a large teaching hospital attended two focus group sessions. The collected qualitative data was thematically analysed using Braun and Clarke’s framework (2006).FindingsThe analysis identified seven themes: (1) Delirium as a Secondary Matter (2) Unpleasant Nature of Delirium (3) Scepticism About Delirium Assessment (4) Distrust in Delirium Management (5) Value of Communication (6) Non-pharmacological Therapy (7) Need for Reviewed Delirium Policy.ConclusionNurses described perceiving delirium as a low priority matter and linked it to work culture within the intensive care specialty. Simultaneously, they expressed their readiness to challenge this culture and to promote the notion of providing high-quality delirium care. Nurses discussed their frustrations related to lack of confidence in assessing delirium, as well as lack of effective therapies in managing this group of patients. They declared their appreciation for non-pharmacological interventions in treatment of delirium, suggested improvements to current delirium approach and proposed introducing psychological support for nurses dealing with delirious patients.     

Researching continuity of care: can quality of life outcomes be linked to nursing care?

Research that informs nursing interventions across the care continuum is vital, especially with shortened hospital stays. Measuring Quality of Life (QOL) and Health Related Quality of Life (HRQOL) helps identfy health status improvements, but fails to provide insight into the effectiveness of nursing interventions aimed at continuity of care. Four research examples illustrate the need for complementary, qualitative studies of what patients and their families think, feel, need and want. These indicate a need to reconceptualise the research agenda in terms of the complexity and settings of nursing practice, and the need for informational as well as statistical significance.     

How does executive staff of home care nursing services estimate the situation of palliative care?

Experts criticise heavily the current situation of palliative care in the home care setting in Germany. They claim that the education in palliative care of all involved professional groups should be improved and specialized services should be adjusted. Only few is known in this context about the perspectives and attitudes of nursing staff, who is significantly involved in palliative care. Therefore, interviews with executive stuff of home care nursing services in the Federal State of Brandenburg were performed in the context of an evaluative opinion survey. 88 of 100 planned interviews took place. The nursing services estimated the current situation predominantly good. This does not support the experts' opinions found in the literature. Nevertheless, the respondents saw serious needs for improvements, in particular concerning psycho-social issues. Although palliative patients numerically seem to be in the background of every day work life, great interest in further qualification and new concepts of care was shown. So far, only few home care nursing services employ palliative care-trained staff.     

Socioeconomic status,severity of disease and level of family members’ care in adult surgical intensive care patients: the prospective ECSSTASI study

Background  

Low socioeconomic status (SES) is associated with increased mortality from cardiovascular disease, cancer and trauma. However, individual-level prospective data on SES in relation to health outcomes among critically ill patients admitted to intensive care units (ICU) are unavailable.