The management of critically ill patients at end-of-life (EOL) is concerned with shifting the focus of care from curing disease to maximizing comfort and ensuring the needs of the patient and family (Carey & Cosgrove 2006). Despite the availability of a wide range of EOL care studies, there appears to be inadequate knowledge of how best intensive care nurses can cope and provide ethical, quality, humane, holistic and comfort care for the dying patients including these patients’ family members in the ICU.
Purpose: To develop best practice guidelines for end-of-life care for intensive care nurses in adult intensive care units at three tertiary level III hospitals in Gauteng province.
Objectives: 1) To search and analyze for quality research discourse on EOL care by means of a systematic review, 2) To search for evidence on EOL care through interviews with family members, interviews with critically ill patients and focus group discussions with intensive care nurses. 3) To develop best practice guidelines for intensive care nurses on EOL care. 4) To verify the tentative best practice guidelines using an Appraisal of Guidelines Research and Evaluation (AGREE) II instrument.
Design: Both quantitative and qualitative approaches were used to achieve the aim of the study. Systematic review, semi structured interviews and focus group discussions were utilized during data collection in the various steps of the study. During data analysis, meta-synthesis was utilized for systematic review; Tesch’s (1992) eight steps of analysis were used for semi structured interviews whereas the long-table approach was used to analyze transcripts from focus groups. The process of guideline development was divided into three stages: Stage I involved the search for quality research evidence on EOL care (this was conducted in 4 steps: In step 1, a systematic review of both qualitative and quantitative articles on EOL care was conducted yielding 23 articles, step 2 included individual interviews with 17 purposively selected family members, step 3 involved individual interviews with 16 purposively selected critically ill patients whereas step 4 included three focus group discussions with 24 purposively selected intensive care nurses). Stage II involved development of best practice guidelines in form of recommendations by means of synthesising and integrating conclusions from stage I. stage III involved verification of the guidelines by four purposively selected verifiers using the AGREE II instrument.
Findings: The main findings obtained from the four steps in stage I of the study were as follows: step 1) the findings from systematic review were grouped as factors that enable or
complicate EOL care, patients’/family members’/nurses’ experiences of EOL care and decision making processes at EOL. Step 2) Five major themes emerged from the experiences of family members on EOL care. These included: “most of the time we are in darkness”, “emotional support”, “involvement”, “you feel you should see her face more often” and “spiritual support”. Step 3) Five major themes were identified from the experiences of critically ill patients on comfort care and they included: “being in someone’s shoes”, “communication”, “trust”, “presence” and “religion and spirituality”. Step 4) Focus group discussion with the intensive care nurses led to five major themes including: “difficulties we get”, “discussion and decision making”, “support for patients”, support for families” and support for nurses. Conclusions drawn from stage I provided evidence for the development of best practice guidelines. Based on the conclusions drawn, guidelines developed were divided into three categories related to: communication, caring and negative aspects impacting on EOL care. The tentative guidelines were verified by a panel of four experts. The verifiers’ feedback, recommendations, criticisms and suggestions were analysed and incorporated into the guidelines.
Conclusions: Guidelines were developed to inform nursing practice, nursing management and nursing education. Communication recommendations focused on how to effectively communicate as a health care team as well as instituting communication strategies in dealing with dying patients and their families. Caring recommendations were intended to promote quality care for patients and families at EOL and more so, the care needed by nurses in order for them to continue rendering holistic nursing care. Negative factors impacting on EOL care reflected on what need to be improved so as to ensure quality EOL care. In general, the guidelines were rated to be of high quality and were recommended for use by the verifiers.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/14310 |
| Date | 25 March 2014 |
| Creators | Kisorio, Leah Chepkoech |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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