The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality ...of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.
Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences ...of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families.
Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult ...decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.
Life-sustaining therapy is commonly withdrawn in intensive care units, yet little is known about the perceptions of families when a critically ill patient dies after life-sustaining therapy is ...withdrawn.
The purpose of this investigation was to understand the experience of families when a family member had an unexpected life-threatening illness or injury and who died after life-sustaining therapy was withdrawn.
This investigation used a hermeneutic phenomenological approach. Interviews were conducted with family members after the patient's death. All interviews were transcribed with units of meaning and clusters, and then categories inductively determined. Methodological rigor was established.
A purposive sample of family members was recruited into the study from 3 intensive care units. Twenty-two family members participated in the study.
Six categories evolved from the analysis: preparing for the dying process, the dying environment, perceptions of patient comfort, the death vigil, essential aspects of care, and together as a family. Families described the death vigil as extremely difficult. Family members described several aspects of care as very meaningful to them during the dying process. Families described how important it was for the family to be together as a family during the dying process.
Critical care nurses care for dying patients and their families. Little is known about the feelings and experiences of critical care nurses and how they are affected when they provide end-of-life ...care. Study purpose was to understand lived experiences, responses, and feelings of critical care nurses providing end-of-life care. A descriptive phenomenological design with purposive sampling was used to recruit 19 critical care nurses who cared for dying patients and their families. Interviews were recorded and transcribed verbatim. Nurses were asked open-ended questions about experiences and responses while providing end-of-life care. Coliazzi's method of data analysis was used to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodological rigor was established. Responses included personalizing the experience, sadness, ageism, anger, frustration, relief, and stress. Factors contributing to clinicians' lived experience included previous experiences with death affecting how the experience was personalized among others. Critical care nurses may be unprepared for feelings and responses encountered during end-of-life care. Preparation for feelings and responses encountered during end-of-life care in nursing education and critical care orientation classes is essential. Future research should study optimal mentoring, teaching, and preparation for providing optimal end-of-life care. Study results have implications for practice, education, and research.
Aims and objectives
To understand the occurrence of interruptions within the culture of the medical nursing unit work environment.
Background
Interruptions may lead to errors in nursing work. Little ...is known about how the culture of the nursing work environment contributes to interruptions.
Design
A micro‐focused ethnographic study was conducted.
Method
Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow‐up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes.
Results
A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting.
Conclusions
Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system.
Relevance to clinical practice
Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue.
Invitation to grief in the family context Breen, Lauren J.; Szylit, Regina; Gilbert, Kathleen R. ...
Death studies,
03/2019, Letnik:
43, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, ...practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches.
Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of ...likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers. We also assessed surrogates' application of prognostic estimates to decisions regarding goals of care.
Single-center, survey-based, cross-sectional study.
Twenty-two-bed neurologic ICU at an urban, academic hospital.
Surrogate decision makers for patients admitted to the neurologic ICU.
Participants completed a survey containing five clinical vignettes describing patients with nontraumatic intracerebral hemorrhage. For each patient, numerical estimates of survival and functional independence were explicitly provided, based on the validated outcome risk stratification scale (intracerebral hemorrhage score) and the Prediction of Functional Outcome in Patients with Primary Intracerebral Hemorrhage score.
Participants were asked to make their own prognostic estimates, as well as to describe their preferred goals of care for each hypothetical patient. Respondent demographics were collected, and numeracy was assessed using a modified Lipkus 11-item scale. Poor numeracy was common (42 of 96 total subjects) in this relatively highly educated population. Most prognostic estimates (55%) made by surrogates were discordant with the provided estimates. High numeracy correlated with better concordance (odds ratio, 23.9 5.57-97.64; p < 0.001), independent of several factors, including level of education and religion. Numeracy also affected goals-of-care decisions made by surrogates.
Poor numeracy is common among surrogate decision makers in an intensive care setting and poses a barrier to communication between surrogates and clinicians regarding prognosis and goals of care.
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