Nurses’ Experience in Providing Transitional Care in Families of Critically and Terminally Ill Patients Deciding to Terminate Treatment: A Case Study
Keywords:
transitional care, qualitative study, families of critically and terminally ill patients, reatment termination decision, nursesAbstract
Objective: To explore the experience of nurses who provided transitional care in the families of critically and terminally ill patients who decided to terminate treatment
Design: Descriptive qualitative case study
Methodology: A total of 16 nurses were selected by means of purposive sampling to be the study informants, based on these criteria: 1) prior experience in caring for at least one family who had decided to terminate treatment, in accord with the hospital’s guideline; and 2) willingness to participate in the study. Data were collected between August 2019 and May 2020, via in-depth interviews with 10 of the nurses and via one focus group discussion with the other six. Elo and Kyngäs’s content analysis method was employed for data analysis. Trustworthiness of the study was established using Lincoln and Guba’s guideline.
Results: According to the study, the participating nurses’ experience was divided into two stages: before and after the patients’ treatment termination decisions. Before treatment termination decisions, the nurses: 1) build a good rapport and confdence; 2) regularly provide information; and 3) coordinate meetings for family members. After treatment termination decisions, nursing care included: 1) communicating the patients’ decisions; 2) protecting the patients’ rights; 3) controlling the patients’ distressful symptoms; 4) coordinating ongoing care; 5) helping the patients to die peacefully; and 6) providing psychological support for the patients’ relatives. Two types of factors were found to affect the nurses’ transitional care in the treatment termination situation. The care-system-related factors were: 1) initial preparation of the patients and their families; 2) provision of suffcient information for the families; 3) support by the palliative care teams; and 4) presence of a clear guideline. The main family-related factor concerned mutual consent by family members. Finally, the nurses’ feelings arising from caring for these patients were: 1) delight in having made some merits; 2) moral guilt; and 3) moral conflict.
Recommendations: The study findings could increase an understanding of the role of nurses in providing transitional care in the families of critically and terminally ill patients who have made a decision to terminate life-sustaining treatment and of main factors facilitating a smooth transition. These fndings can promote development of smooth transitional palliative care, in order to raise the quality of death in terminal patients and improve the quality of life amongst family members.
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References
Downar J, Delaney JW, Hawryluck L, Kenny L. Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med. 2016;42(6):1003-17. doi: 10.1007/s00134-016-4330-7.
Sprung CL, Truog RD, Curtis JR, Joynt GM, Baras M, Michalsen A, et al. Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-ofLife Practice for Patients in Intensive Care Units (WELPICUS) study. Am J Respir Crit Care Med. 2014;190(8):855-66. doi: 10.1164/rccm. 201403-0593CC.
Lobo SM, De Simoni FHB, Jakob SM, Estella A, Vadi S, Bluethgen A, et al. Decision-making on withholding or withdrawing life support in the ICU: a worldwide perspective. Chest. 2017;152(2):321-9. doi: 10.1016/j.chest.2017.04.176.
National Health Broad. Operational defnition on palliative care for Thais 2020. Bangkok: Royal Gazette; 2020. (in Thai)
Ferrell BR. Transitions. J Hosp Palliat Nurs. 2021;23(2):109-10. doi: 10.1097/NJH.0000000000000740.
Fringer A, Hechinger M, Schnepp W. Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis. BMC Palliat Care. 2018;17(1):22. doi: 10.1186/s12904-018-0275-7.
Kirby E, Broom A, Good P. The role and signifcance of nurses in managing transitions to palliative care: a qualitative study. BMJ open. 2014;4(9):e006026. doi: 10.1136/bmjopen-2014-006026.
Ranse K, Bloomer M, Coombs M, Endacott R. Family centred care before and during life-sustaining treatment withdrawal in intensive care: a survey of information provided to families by Australasian critical care nurses. Aust Crit Care. 2016;29(4):210–6. doi: 10.1016/j.aucc.2016.08.006.
Arbour RB, Wiegand DL. Self-described nursing roles experienced during care of dying patients and their families: a phenomenological study. Intensive Crit Care Nurs. 2014;30(4):211-8. doi: 10.1016/j.iccn.2013.12.002.
Peden-McAlpine C, Liaschenko J, Traudt T, GilmoreSzott E. Constructing the story: how nurses work with families regarding withdrawal of aggressive treatment in ICU – a narrative study. Int J Nurs Stud. 2015;52(7): 1146-56. doi: 10.1016/j.ijnurstu.2015.03.015.
Vanderspank-Wright B, Efstathiou N, Vandyk AD. Critical care nurses› experiences of withdrawal of treatment: a systematic review of qualitative evidence. Int J Nurs Stud. 2018;77:15-26. doi: 10.1016/j. ijnurstu.2017.09.012.
Nupinit W, Nilmanat K, Mutchim Y. Selective factors related to intensive care units’ registered nurses’ competency in caring for terminally ill patients. Journal of Thailand Nursing and Midwifery Council. 2017;32(4):94-109. (in Thai)
Maeroh N, Kongsuwan W, Yodchai K. Barriers in providing palliative care in intensive care units: nurses’ experiences. Songklanagarind Journal of Nursing. 2017;37(3):74-82. (in Thai)
Peerakavee N, Udchumpisai M. Decision making experiences of critical care nurses during transition from advanced life support to end-of-life care. Journal of Nursing Science & Health. 2020;43(2): 13-24. (in Thai)
Miller JJ, Morris P, Files DC, Gower E, Young M. Decision conflict and regret among surrogate decision makers in the medical intensive care unit. J Crit Care. 2016;32:79-84. doi: 10.1016/j.jcrc.2015. 11.023.
Kaewmafai J, Piyawattanapong S. Development of supporting guidelines for surrogate decision makers on end-of-life treatment for older people admitted at medical unit in a tertiary care hospital. Journal of Nursing and Health Care. 2014;32(1): 127-36. (in Thai)
Mark NM, Rayner SG, Lee NJ, Curtis JR. Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: a systematic review. Intensive Care Med. 2015; 41(9):1572-85. doi: 10.1007/s00134-015-3810-5.
Yin RK. Case study research: design and methods. Los Angeles, CA: Sage; 2014.
Brogan P, Hasson F, McIlfatrick S. Lessons learnt: examining the use of case study methodology for nursing research in the context of palliative care. J Res Nurs. 2019;24(6):446-59. doi: 10.1177/1744987119867737.
Thammachote P, Nilmanat K, Khaw T, Chuaytaen T, Sae-chit K. Clinical situation of withdrawal treatment in palliative care patients Songkhla: Songkhla hospital; 2021 [ September]. Available from: https://www.skhospital.go.th/wp-content/uploads/2021/01/journal-20210129.pdf. (in Thai)
Morse JM. Strategies for sampling. Qualitative nursing research: A contemporary dialogue, Rev ed. Thousand Oaks, CA, US: Sage Publications, Inc; 1991. p. 127-45.
Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, Calif: Sage Publications; 1985.
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15. doi: 10.1111/j.1365-2648.2007.04569.x.
Metaxa V, Anagnostou D, Vlachos S, Arulkumaran N, van Dusseldorp I, Bensemmane S, et al. Palliative care interventions in intensive care unit patients – a systematic review protocol. Syst Rev. 2019;8(1): 148. doi: 10.1186/s13643-019-1064-y.
Taylor IHF, Dihle A, Hofsø K, Steindal SA. Intensive care nurses› experiences of withdrawal of lifesustaining treatments in intensive care patients: a qualitative study. Intensive Crit Care Nurs. 2020; 56:102768. doi: 10.1016/j.iccn.2019. 102768.
Brooks LA, Manias E, Nicholson P. Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Aust Crit Care. 2017; 30(3):161-6. doi: 10.1016/j.aucc.2016.08.001.
Shahsavari H, Zarei M, Aliheydari Mamaghani J. Transitional care: concept analysis using Rodgers’ evolutionary approach. Int J Nurs Stud. 2019;99: 103387. doi: 10.1016/j.ijnurstu.2019.103387.
Hayes M, Oakjones-Burgess K, Subhas S, Checkley W, Brower R. Nursing perceptions and satisfaction with terminal extubation in the medical intensive care unit: phase I of a quality improvement project. Chest. 2014;146:726A
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