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Critical Care Nurses’ Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years

Beckstrand, Renea L. PhD, RN, CCRN, CNE; Hadley, Kacie Hart BS, RN; Luthy, Karlen E. DNP, FNP-c, FAAN; Macintosh, Janelle L. B. PhD, RN

Dimensions of Critical Care Nursing: July/August 2017 - Volume 36 - Issue 4 - p 264–270
doi: 10.1097/DCC.0000000000000252
Research DIMENSION

Background: Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients.

Objectives: The purposes of this study were to collect CCNs’ current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published.

Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and “on the same page,” not allowing families to override patients’ wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation.

Conclusion: Critical-care nurses’ suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

Renea L. Beckstrand, PhD, RN, CCRN, CNE, is a professor at Brigham Young University College of Nursing, Provo, Utah. In addition to teaching, she works as a staff nurse in the CVICU at Utah Valley Hospital, Provo, Utah.

Kacie Hart Hadley, BS, RN, is a graduate student in the Family Nurse Practitioner Master Program at Brigham Young University College of Nursing. She also works as a staff RN on the CPCU at Utah Valley Hospital, Provo, Utah.

Karlen E. Luthy, DNP, FNP-c, FAAN, is an associate professor, Brigham Young University College of Nursing, Provo, Utah. She also works as a Family Nurse Practitioner.

Janelle L. B. Macintosh, PhD, RN, is an associate professor, Brigham Young University College of Nursing, Provo, Utah. She is an expert in qualitative research.

This study was funded, in part, by the College of Nursing, Brigham Young University.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Renea L. Beckstrand, PhD, RN, CCRN, CNE, Brigham Young University, College of Nursing, 422 SWKT, PO Box 25432, Provo, UT 84602 (renea@byu.edu).

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