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Critical Care NursesQualitative Reports of Experiences With Family Behaviors as Obstacles in End-of-Life Care

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

doi: 10.1097/DCC.0000000000000310
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Background Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care.

Methods A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed.

Results Sixty-seven EOL obstacle experiences surrounding issues with families’ behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients.

Conclusions In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.

Renea L. Beckstrand, PhD, RN, CCRN, CNE, is professor, Brigham Young University College of Nursing, Provo, UT.

Caitlin Mallory, BS, RN, is graduate student, NSTICU, Utah Valley Hospital, Provo.

Janelle L. B. Macintosh, PhD, RN, is associate professor, Brigham Young University College of Nursing, Provo, Utah.

Karlen E. Luthy, DNP, FNP-c, FAAN, is associate professor, Brigham Young University College of Nursing, Provo, Utah.

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

The authors have disclosed that they have no significant relationships 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, College of Nursing, Brigham Young University, 422 SWKT, PO Box 25432, Provo, UT 84602 (enea@byu.edu).

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