• BACKGROUND Providing appropriate end-of-life care has become a primary concern of nurses and the public. The highly technological critical care environment may not facilitate such care. • OBJECTIVE To collect suggestions from critical care nurses for improving end-of-life care in intensive care units. • METHODS A geographically dispersed, random sample of 1409 members of the American Association of Critical-Care Nurses was sent a 72-item survey on perceptions of end-of life care. The survey included a request for suggestions on ways to improve end-of life care. • RESULTS Of the 861 critical care nurses who responded to the survey, 485 offered 530 suggestions for improving end-of-life care. Providing a “good death” was the major theme; specific suggestions included ways to help ensure death with dignity and peace. Barriers to providing good deaths included nursing time constraints, staffing patterns, communication challenges, and treatment decisions that were based on physicians’ rather than patients’ needs. Suggestions for providing a good death included facilitating dying with dignity; not allowing patients to be alone while dying; managing patients’ pain and discomfort; knowing, and then following, patients’ wishes for end-of-life care; promoting earlier cessation of treatment or not initiating aggressive treatment at all; and communicating effectively as a healthcare team. Educational initiatives for professionals and the public were also suggested. • CONCLUSIONS Implementation of specific suggestions provided by experienced critical care nurses might increase the quality of end-of-life care, facilitating a good death for intensive care patients. (American Journal of Critical Care. 2006;15:38-46)

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Providing a “Good Death”: Critical Care Nurses’ Suggestions for Improving End-of-Life Care

Our objective was to discuss obstacles and barriers to effective communication and collaboration regarding end-of-life issues between intensive care unit nurses and physicians. To evaluate practical interventions for improving communication and collaboration, we undertook a systematic literature review. An increase in shared decision making can result from a better understanding and respect for the perspectives and burdens felt by other caregivers. Intensive care unit nurses value their contributions to end-of-life decision making and want to have a more active role. Increased collaboration and communication can result in more appropriate care and increased physician/nurse, patient, and family satisfaction. Recommendations for improvement in communication between intensive care unit physicians and nurses include use of joint grand rounds, patient care seminars, and interprofessional dialogues. Communication interventions such as use of daily rounds forms, communication training, and a collaborative practice model have shown positive results. When communication is clear and constructive and practice is truly collaborative, the end-of-life care provided to intensive care unit patients and families by satisfied and engaged professionals will improve markedly.

Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward.

Objectives:The need for better understanding of end-of-life care has never been greater. Debate about recent U.S. healthcare system reforms has highlighted that end-of-life decision-making is contentious. Providing compassionate end-of-life care that is appropriate and in accordance with patient wis

Patient and healthcare professional factors influencing end-of-life decision-making during critical illness: a systematic review.

End-of-Life Care in the ICU: Treatments Provided When Life Support Was or Was Not Withdrawn

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673601069604.pdf

Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study

ObjectiveTo examine the relationship between intensive care unit (ICU) healthcare workers' confidence and their decision to withdraw life support.DesignCross-sectional survey of Canadian intensivists, ICU housestaff, and bedside nurses. Respondents chose the level of care (from comfort measures only

Allan Spanier

Papers

Confidence in life-support decisions in the intensive care unit: A survey of healthcare workers

New method to prevent epidural catheter adapter disconnection.