DOI: https://doi.org/10.14710/nmjn.v10i3.31302

Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

*Reni Sulung Utami  -  Universitas Diponegoro, Indonesia
Ahmat Pujianto  -  Universitas Borneo Tarakan, Indonesia
Dody Setyawan  -  Universitas Diponegoro, Indonesia
Elsa Naviati  -  Universitas Diponegoro, Indonesia
Nana Rochana  -  Universitas Diponegoro, Indonesia
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Abstract

Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out.

Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC.

Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes.

Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions. 

Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.

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Keywords: Critical care nurse; end of life care; experience; intensive care unit
Funding: Faculty of Medicine, Diponegoro University

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  1. Abu Hasheesh, M. O., Abozeid, S. A. S., El-Said, S. G., & Alhujaili, A. D. (2013). Nurses’ characteristics and their attitudes toward death and caring for dying patients in a public hospital in Jordan. Health Science Journal, 7(4), 384–394
  2. Aslakson, R. A., Wyskiel, R., Thornton, I., Copley, C., Shaffer, D., Zyra, M., …, & Pronovost, P. J. (2012). Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: A qualitative exploration. Journal of Palliative Medicine, 15(8), 910–915. doi: 10.1089/jpm.2011.0481
  3. Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., …, & Balboni, T. A. (2013). Why is spiritual care infrequent at the end of life? spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology, 31(4), 461–467. doi: 10.1200/JCO.2012.44.6443
  4. Blackwood, B., Albarran, J. W., & Latour, J. M. (2011). Research priorities of adult intensive care nurses in 20 European countries: A Delphi study. Journal of Advanced Nursing, 67(3), 550–562. doi: 10.1111/j.1365-2648.2010.05512.x
  5. Brooks, L.A, Manias, E., & Nicholson, P. (2017). Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Australian Critical Care, 30, 161-166. doi: 10.1016/j.aucc.2016.08.001
  6. Carlson, E. B., Spain, D. A., Muhtadie, L., McDade-Montez, L., & Macia, K. S. (2015). Care and caring in the intensive care unit: Family members’ distress and perceptions about staff skills, communication, and emotional support. Journal of Critical Care, 30(3), 557–561. doi: 10.1016/j.jcrc.2015.01.012
  7. Cavaye, J., & Watts, J. H. (2010). End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives. Journal of Research in Nursing, 17(4), 317–326. doi: 10.1177/1744987110379531
  8. Chen, J., Lin, Y., Yan, J., Wu, Y., & Hu, R. (2018). The effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness: A systematic review. Palliative Medicine, 32(7), 1167–1179. doi: 10.1177/0269216318772267
  9. Coombs, M., Addington-Hall, J., & Long-Sutehall, T. (2012). Challenges in transition from intervention to end of life care in intensive care: A qualitative study. International Journal of Nursing Studies, 49(5), 519–527. doi: 10.1016/j.ijnurstu.2011.10.019
  10. Crump, S. K., Schaffer, M. A., & Schulte, E. (2010). Critical care nurses’ perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimensions of Critical Care Nursing, 29(6), 297–306. doi: 10.1097/DCC.0b013e3181f0c43c
  11. DeCato, T. W., Engelberg, R. A., Downey, L., Nielsen, E. L., Treece, P. D., Back, A. L., …, & Curtis, J. R. (2013). Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical Care Medicine, 41(6), 1405–1411. doi: 10.1097/CCM.0b013e318287f289
  12. Espinosa, L., Young, A., Symes, L., Haile, B., & Walsh, T. (2010). ICU nurses’ experiences in providing terminal care. Critical Care Nurse, 33(3), 273–281
  13. Fitriyani, N., Juniarto, A. Z., & Utami, R. S. (2018). Life quality of end of life patient’s family in intensive care units. Indonesian Journal of Nursing and Midwifery, 6(1), 16–24. Retrieved from http://ejournal.almaata.ac.id/index.php/JNKI
  14. Flannery, L., Peters, K., & Ramjan, L. M. (2020). The differing perspectives of doctors and nurses in end-of-life decisions in the intensive care unit : A qualitative study. Australian Critical Care, 33(4), 311–316. doi: 10.1016/j.aucc.2019.08.004
  15. Griffiths, I. (2019). What are the challenges for nurses when providing end-of-life care in intensive care units? British Journal of Nursing, 28(16), 1047–1052
  16. Hinderer, K. A. (2012). Reactions to patient death: The lived experience of critical care nurses. Dimensions of Critical Care Nursing, 31(4), 252–259. doi: 10.1097/DCC.0b013e318256e0f1
  17. Jin, J. (2013). Clinicians examine advances and challenges in improving quality of end-of-life care in the ICU. JAMA, 310(23), 2493–2495. doi: 10.1001/jama.2013.283830
  18. Kim, S., Savage, T. A., Song, M. K., Vincent, C., Park, C. G., Ferrans, C. E., & Cavanaugh, K. (2019). Nurses’ roles and challenges in providing end-of-life care in neonatal intensive care units in South Korea. Applied Nursing Research, 50, 151204. doi: 10.1016/j.apnr.2019.151204
  19. King, A., & Thomas, P. (2013). Phenomenological study of ICU nurses’experiences caring for dying patients. Western Journal of Nursing Research, 35(10), 1292–1308
  20. Kisorio, L. C., & Langley, G. C. (2016). Intensive care nurses’ experiences of end-of-life care. Intensive and Critical Care Nursing, 33, 30–38. doi: 10.1016/j.iccn.2015.11.002
  21. Levin, T. T., Moreno, B., Silvester, W., & Kissane, D. W. (2010). End-of-life communication in the intensive care unit. General Hospital Psychiatry, 32(4), 433–442. doi: 10.1016/j.genhosppsych.2010.04.007
  22. Mathew, J. E., Azariah, J., George, S. E., & Grewal, S. S. (2015). Do they hear what we speak? Assessing the effectiveness of communication to families of critically ill neurosurgical patients. Journal of Anaesthesiology, Clinical Pharmacology, 31(1), 49–53. doi: 10.4103/0970-9185.150540
  23. Morgado, P., & Cerqueira, J. J. (2018). Editorial: The impact of stress on cognition and motivation. Frontiers in Behavioral Neuroscience, 12, 326. doi: 10.3389/fnbeh.2018.00326
  24. Muni, S., Engelberg, R. A., Treece, P. D., Dotolo, D., & Randall, J. (2011). The influence of race / ethnicity and socioeconomic status on end-of-life care in the intensive care unit. CHEST Journal, 139(5), 1025–1033. doi: 10.1378/chest.10-3011
  25. Ozga, D., Woźniak, K., & Gurowiec, P. J. (2020). Difficulties perceived by ICU nurses providing end-of-life care: A Qualitative Study. Global Advances in Health and Medicine, 9, 1–8. doi: 10.1177/2164956120916176
  26. Pereira, S. M., Fradique, E., & Hernandez-Marrero, P. (2018). End-of-life decision making in palliative care and recommendations of the Council of Europe: Qualitative secondary analysis of interviews and observation field notes. Journal of Palliative Medicine, 21(5), 604–615. doi: 10.1089/jpm.2017.0403
  27. Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., & Hood, K. (2013). How death anxiety impacts nurses’ caring for patients at the endof life: A review of literature. The Open Nursing Journal, 7, 14–21
  28. Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (Tenth). Philadelphia: Wolters Kluwer Health
  29. Ranse, K., Yates, P., & Coyer, F. (2016a). End-of-life care practices of critical care nurses: A national cross-sectional survey. Australian Critical Care, 29(2), 83–89. doi: 10.1016/j.aucc.2015.07.001
  30. Ranse, K., Yates, P., & Coyer, F. (2016b). Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision. Intensive & Critical Care Nursing: The Official Journal of the British Association of Critical Care Nurses. doi: 10.1016/j.iccn.2015.11.003
  31. Rochmawati, E., Wiechula, R., & Cameron, K. (2018). Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study. Nursing and Health Sciences, 20(2), 231–237. doi: 10.1111/nhs.12407
  32. Ryan, L., & Seymour, J. (2013). Death and dying in intensive care: Emotional labour of nurses. End of Life Journal, 3(2), 1–9
  33. Safitri, A., Trisyani, Y., & Iskandar, A. A. (2017). An exploration of nurse experience in caring for end of life care client and family in critical care setting in Indonesian context. Journal of Advances in Health and Medical Sciences, 3(2), 53-62. doi: 10.20474/jahms-3.2.2
  34. Sandi, C. (2013). Stress and cognition. Wiley Interdisciplinary Reviews. Cognitive Science, 4(3), 245–261. doi: 10.1002/wcs.1222
  35. Sinclair, S., Beamer, K., Hack, T. F., Mcclement, S., Bouchal, S. R., Chochinov, H. M., & Hagen, N. A. (2017). Sympathy, empathy, and compassion: A grounded theory study of palliative care patients ’ understandings, experiences, and preferences. Palliative Medicine, 31(5), 437–447. doi: 10.1177/0269216316663499
  36. Vincent, J.-L., Marshall, J. C., Ñamendys-Silva, S. A., François, B., Martin-Loeches, I., Lipman, J., …, & Sakr, Y. (2014). Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine, 2(5), 380–386. doi: 10.1016/S2213-2600(14)70061-X
  37. Wessner, P. B. (2018). Last chance to care : An autoethnography of end-of-life care in Indonesia. The Qualitative Report, 23(9), 2238–2250
  38. Willemse, S., Smeets, W., Van Leeuwen, E., Nielen-Rosier, T., Janssen, L., & Foudraine, N. (2020). Spiritual care in the intensive care unit: An integrative literature research. doi: 10.1016/j.jcrc.2020.01.026
  39. Williams, B. R., Lewis, D. R., Burgio, K. L., & Goode, P. S. (2012). Next-of-Kin’s perceptions of how hospital nursing staff support family presence before, during, and after the death of a loved one. Journal of Hospice & Palliative Nursing, 14(8), 541–550. doi: 10.1097/NJH.0b013e31825d2af1
  40. Witt Sherman, D., & Free, D. C. (2015). Culture and spirituality as domains of quality palliative care. In M. Matzo & W. S. Deborah (Eds.), Palliative Care Nursing (4th ed., pp. 91–2015). New York: Springer Publishing Company. doi: 10.1891/9780826196361.0005
  41. Zhang, B., Nilsson, M. E., & Prigerson, H. G. (2013). Factors important to patients’ quality-of-life at the end-of-life. Arch Intern Med, 172(15), 1133–1142. doi: 10.1001/archinternmed.2012.2364.Factors
  42. Zomorodi, M., & Lynn, M. R. (2010). Critical care nurses’ values and behaviors with end-of-life care: perceptions and challenges. Journal of Hospice & Palliative Nursing, 12(2), 89–96. doi: 10.1097/NJH.0b013e3181cf7cf6

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