Providing end-of-life care to patients: critical care nurses' perceived obstacles and supportive behaviors.
BACKGROUND
Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited.


OBJECTIVE
To measure critical care nurses' perceptions of the intensity and frequency of occurrence of (1) obstacles to providing end-of-life care and (2) supportive behaviors that help in providing end-of-life care in the intensive care unit.


METHODS
An experimental, posttest-only, control-group design was used. A national, geographically dispersed, random sample of members of the American Association of Critical-Care Nurses was surveyed.


RESULTS
The response rate was 61.3%, 864 usable responses from 1409 eligible respondents. The highest scoring obstacles were frequent telephone calls from patients' family members for information, patients' families who did not understand the term lifesaving measures, and physicians disagreeing about the direction of a dying patient's care. The highest scoring supportive behaviors were allowing patients' family members adequate time alone with patients after death, providing peaceful and dignified bedside scenes after death, and teaching patients' families how to act around a dying patient.


CONCLUSIONS
The biggest obstacles to appropriate end-of-life care in the intensive care unit are behaviors of patients' families that remove nurses from caring for patients, behaviors that prolong patients' suffering or cause patients pain, and physicians' disagreement about the plan of care.
Beckstrand
Renea L
RL
Brigham Young University, Provo, Utah, USA.
Kirchhoff
Karin T
KT
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003422:Critical Care / Q000379:methods* / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009732:Nursing Care; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology; D011368:Professional-Family Relations; D013041:Specialties, Nursing; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000523:psychology