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Critical Care Nurses Perceptions in End-of-Life Situations
Forsyth Technical Community College
Literature Review
It is estimated between 70 and 80 percent of any population will die in an
institutional setting (Tan, Low, Yap, Lee, Pang, & Wu 2006). The majority of those will be in a hospital setting. Intensive Care Nurses play a vital role in the care of many of these patients. The literature reviewed for this paper contains research on the process of caring for dying patients in three different yet vital methods. The first conducted a written survey of the nursing staff in a hospital that employed and treated a large multicultural population. Participants were given a set of conditional statements and were allowed to answer by utilizing a Likert scale ranging from Strongly Agree to Strongly Disagreeing with the statement. The second research was completed by allowing volunteers from the ICU nursing field to participate in focus group sessions. The moderator provided an opening by asking the group to think of a critical care patient that the nurse had recently cared for and then guided the open discussion about their experience. The third was a purely empirical research program. The researchers reviewed the patient’s medical files and attempted to determine the patients “Turning Point”. This phrase is utilized to describe when the patient’s care turns from treatment or rehabilitation care to holistic and palliative (Jakobsson, Bergh, & Ohlen, 2007).
All three-research programs yielded information concerning how Intensive Care Nurses relate to the patients. This paper will explore what those findings were and how we can use them to ...
... middle of paper ...
...e should be professional training on how best to effectively communicate with them. Research reveals that honest medical conditions explained in easy to understand language is primarily the best approach. This should be delivered in a compassionate way.
References
Jakobsson, E., Bergh., Ingrid, B., Ohlen,. J. (2007). The turning point: identifying end-
of-life care in everyday health practice. Contemporary Nurse 27 (1). 107-117.
Popejoy, L. L., Brandt, L. C., Mary, B., Linda, A., (2009). Intensive care unit nurse
perceptions of caring for the dying. Journal of Hospice and Palliative Nursing
11 (3), 179-184.
Tan, J., Low, A., Yap, P., Lee, A., Weng., S,. Yingjuan, W. (2006, May). Caring for
dying patients and those facing death in an acute-care hospital in Singapore.
Journal of Gerontological Nursing. 17-23.
In the Intensive Care Unit (ICU), patients are being monitored very closely while their vital signs, their neurological status, and their physical status are being managed with strong medications, lifesaving machines, and the clinical knowledge and skills of trained ICU nurses. Outside of the ICU, it is essential for staff nurses to identify the patient that is clinically deteriorating and in need of urgent intervention.
Nurses are both blessed and cursed to be with patients from the very first moments of life until their final breath. With those last breaths, each patient leaves someone behind. How do nurses handle the loss and grief that comes along with patients dying? How do they help the families and loved ones of deceased patients? Each person, no matter their background, must grieve the death of a loved one, but there is no right way to grieve and no two people will have the same reaction to death. It is the duty of nurses to respect the wishes and grieving process of each and every culture; of each and every individual (Verosky, 2006). This paper will address J. William Worden’s four tasks of mourning as well as the nursing implications involved – both when taking care of patients’ families and when coping with the loss of patients themselves.
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
The purpose of this theory is to express the nurses’ influences, actions, and outcomes with regard to caring for critically ill patients (McEwen, 2014). The synergy model for patient care was created
It is found that nurses report that their most uncomfortable situations come with prolonging the dying process and some struggle with ethical issues by doing so (Seal, 2007). Studies have shown that implementation of the RPC program and educating nurses have increased the nurses’ confidence in discussing end-of-life plans (Austin, 2006). With confidence, the nurse is able to ask the right questions of the patient and make sure that the patient’s wishes are upheld in the manner that they had wanted, such as to not resuscitate or to make sure their spiritual leader is present when passing (Austin,
(2008). Therapeutic Relationships In Critical Care Nursing: A Reflection On Practice. Academic Journal of Nursing in Critical Care, 138-143. Retrieved November 13, 2014.
The nurse becomes the confidant, the guide through the darkness, a source of comfort for those experiencing the trauma of losing a child. To successfully fulfill these nursing roles, in addition to roles that must be fulfilled to meet other patient’s needs, one must acknowledge their own definition of death and educate themselves on cultural and societal norms associated with death and dying. It is important to identify one’s own definition of death and dying but also understand that one’s preference does not define the death experience for others. The individuality and uniqueness of each death experience means that one definition of death may be hard for one to accomplish. It is important to maintain an open mind, nonjudgmental spirit, and impartiality for the cultures and practices of others surrounding death and dying. A culturally competent nurse is not only responsible for acknowledging the cultural norms of others but also respecting and educating themselves about the death rituals of their patient’s culture and providing the family with as many resources to safely and effectively fulfill their cultural practices. Education is empowering for the nurse who is navigating the death and dying process. Education often supplements ones credibility with the dying patient and their family which can ease overall anxiety and further promote ones role as a patient advocate and provider of
The many concepts are very complex and have many dimensions. Concepts developed by Leininger, Watson, Gaut, Benner and Wrubel, Ihde, and many more were discussed and how they relate to ICU nurses and their caring practices. It is stressed in this article that ICU nurses have an important role of making sure they have insight into their specific behaviors so that nursing practices can be developed. Once these nursing practices are developed, ICU nurses can successfully care for their critically ill patients. Wilkin (2003) claims that caring is a, “dual component of attitudes/values and activities, which create an ongoing challenge for the ICU nurses” (p.
As a nursing student, I have had some exposure to death during patient care. My first encounter with direct death was witnessing a patient after attempted resuscitation efforts die in the emergency department. As I observed others reactions, I noticed I was the only one who seemed fazed by the preceding events and the end result, although I didn’t show it outwardly. During my Aging and End of life clinical rotation, I have been exposed to a near death experience with a family and I had the rewarding experience of forming a relationship with the patient’s wife during the short hour I was in their home. From reading the accounts in this book, it confirmed to me the importance of catering to the needs of the family and the dying as an important issue to address as they are critical to overall care.
In the nurse-patient relationship, there are three phases that help the relationship develop. Craven and Hirnle (2009) describe the first phase, orientation, “consists of introductions and agreement between nurse and client about their mutual roles and responsibilities” (p. 329). It is in this orientation phase that first impressions are made a...
Westhead, C. (2007). Perioperative Nursing Management of the Elderly Patient. Canadian Operating Room Nursing Journal, 25(3), 34-41. Retrieved from http://gateway.library.qut.edu.au/login?url=http://search.proquest.com.ezp01.library.qut.edu.au/docview/274594603?accountid=13380.
The field of nursing provides one the opportunity to make a difference in the lives of others. Nurses interact directly with patients at times of hardship, vulnerability, and loss. The nursing profession has been around for decades. Due to the contribution from historical leaders in nursing, the nurse’s role has progressed over time. Although the roles of nurses have evolved throughout the years, one thing has remained the same: the purpose in giving the best patient care.
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The type of research study, sample size, variables, intervention, measurement method, findings, and conclusion are all mentioned in the abstract. Statement of the Problem The problem explored in the article was stated as a problem statement. In this article, the authors explain the stressful situations of families having loved ones die in the intensive care unit. They also state that this problem is very important because there is poor communication between staff, physicians, and surrogates in the plan of care for end-of-life measures (Lautrette et al., 2007).
The nurse stated during the interview that “holding the hand of the patient just diagnosed with a terminal illness” (Appendix A) is difficult and requires a variety of techniques to face the situation. There are many ways to approach a dying patient, and one study identified four themes that help nurses in creating a “’curtain of protection’ to mitigate the grieving process and allow them to provide supportive nursing care” (Gerow et al., 2010). Of the four approached, there is one that appears to make the greatest impact on the nurse; the fact that initial patient deaths are formative. In this case, a study found that “significant death experiences early in a nurse’s career set the foundation for how the nurse began caring for future dying patients” (Gerow et al., 2010), which was further explained as the fact that those who had enough support and mentorship early on in their nursing practice were more likely to not be emotionally damaged by the event, and were able to better approach similar situations in the future. I plan on implementing this strategy in the future by surrounding myself with colleagues and mentors within my practice that I am comfortable confiding in whenever I happen to be struggling. A strong support network is key for maintaining proper emotional health, which is important for a nurse to have when working with vulnerable patients and providing competent