RELATED LITERATURES

1. A study of the lived experiences of registered nurses who have

provided end-of-life care within an intensive care unit.
Authors: Holms, Natalie; Milligan, Stuart; Kydd, Angela:
Background: End-of-life care (EOLC) in the intensive care unit (ICU) has
received little attention in the literature in comparison to the considerable amount
of existing literature available on EOLC in other areas of nursing. The ethos of the
ICU is to preserve life, but as many patients die in this environment, EOLC should be
an integral part of the ICU nurses role. This qualitative study explored the
experiences of ICU nurses who had provided EOLC to patients and their families.
Method: Participants were purposively recruited within one local ICU (n=5). A semistructured interview format was used to guide in-depth interviews. Findings: The
themes identified from the interview analysis were; use of integrated care systems,
communication, the environment, education and training, staff distress.
Conclusions: The findings suggest that ICU nurses do not feel adequately prepared
to give proficient EOLC. Those who felt more confident in EOLC had learned what to
do over time. Appropriate training, support and improved communication between
staff, patients and families is necessary for good EOLC in ICUs.

2. Providing end-of-life care in the intensive care unit: Issues that

impact on nurse professionalism.
Authors: Bloomer, Melissa J.; O'Connor, Margaret
With death a frequent event in intensive care units how, people die and the
impact on family and staffs is becoming increasingly recognised as an issue
requiring significant attention. Caring for a dying patient in these environments
challenges the dominant ethos of seeking to cure critically ill patients. Family
members require particular care as they keep vigil with their loved one and this
forms a major area of work and concern for nurses. Mortality rates are higher in
intensive care units than in most other settings and this impacts on staff. This paper
builds on a qualitative exploratory study utilising focus groups that was undertaken
to describe how nurses support family members during and after a death in the
intensive care unit. This study identified issues that challenged the nurses' ability to
maintain professionalism and the ways in which nurses ensured self-care. They
highlighted organisational constraints, support for families and for their nursing
colleagues as important issues for discussion.

3. End-of-life care in the intensive care unit: A patient-based

questionnaire of intensive care unit staff perception and relatives
psychological response
Authors: Christiane S Hartog, Daniel Schwarzkopf, Niels C Riedemann, Ruediger
Pfeifer, Albrecht Guenther, Kati Egerland, Charles L Sprung, Heike Hoyer, Jochen
Gensichen and Konrad Reinhart
Abstract
Background: Communication is a hallmark of end-of-life care in the intensive care
unit. It may influence the impact of end-of-life care on patients relatives. We aimed
to assess end-of-life care and communication from the perspective of intensive care
unit staff and relate it to relatives psychological symptoms. Design: Prospective
observational study based on consecutive patients with severe sepsis receiving endof-life care; trial registration. Setting/participants: Four interdisciplinary intensive
care units of a German University hospital. Responsible health personnel
(attendings, residents and nurses) were questioned on the day of the first end-of-life
decision (to withdraw or withhold life-supporting therapies) and after patients had
died or were discharged. Relatives were interviewed by phone after 90 days.
Results: Overall, 145 patients, 610 caregiver responses (92% response) and 84
relative interviews (70% response) were analyzed. Most (86%) end-of-life decisions
were initiated by attending and only 2% by nurses; 41% of nurses did not know
enough about end of-life decisions to communicate with relatives. Discomfort with
end-of-life decisions was low. Relatives reported high satisfaction with decisionmaking and care, 87% thought their degree of involvement had been just right.
However, 51%, 48% or 33% of relatives had symptoms of post-traumatic stress
disorder, anxiety or depression, respectively. Predictors for depression and posttraumatic stress disorder were patient age and relatives gender. Relatives
satisfaction with medical care and communication predicted less anxiety (p =
0.025). Conclusion: Communication should be improved within the intensive care
unit caregiver team to strengthen the involvement ofnurses in end-of-life care.
Improved communication between caregivers and the family might lessen relatives
long-term anxiety.
REFERENCES:
MAIN JOURNAL:
Doucette, E., Killackey, T., Brandys, D., Coulter, A., Daoust, M., Lynsdale, J., & ...
Shamy-Smith, E. (2014).
Silent witnesses: Student nurses perspectives of advocacy and end-of-life
care in the intensive care unit. Dynamics, 25(4), 17-21.
Related Literatures:
Holms, N., Milligan, S., & Kydd, A. (2014). A study of the lived experiences of
registered nurses who have
provided end-of-life care within an intensive care unit. International Journal Of
Palliative Nursing, 20(11), 549-556. doi:10.12968/ijpn.2014.20.11.549

Bloomer, M. J., & O'Connor, M. (2012). Providing end-of-life care in the intensive care
unit: Issues that
impact on nurse professionalism. Singapore Nursing Journal, 39(3), 25-30.
Hartog, C. S., Schwarzkopf, D., Riedemann, N. C., Pfeifer, R., Guenther, A., Egerland,
K., & ... Reinhart, K.
(2015). End-of-life care in the intensive care unit: A patient-based
questionnaire of intensive care unit staff perception and relatives
psychological response. Palliative Medicine, 29(4), 336-345.
doi:10.1177/0269216314560007