Renea L. Beckstrand|Nicole Lamoreaux|Karlen E. Luthy|Janelle L. B. Macintosh
Critical Care Nurses' Perceptions of End-of-Life Care Obstacles
Brigham Young University|Utah Valley Regional Medical Center
background nurses working intensive care units icus frequently care patients families end life eol providing highquality eol care important patients families yet icu nurses face many obstacles hinder eol care researchers identified various icu nurseperceived obstacles studies found addressing progress made last 17 years objective aims study determine common current obstacles eol care perceived icu nurses evaluate whether meaningful changes occurred since data first gathered 1998 methods quantitativequalitative mixed methods design used random geographically dispersed sample 2000 members american association criticalcare nurses surveyed results five obstacle items increased mean score rank compared 1999 data including 1 family understanding phrase lifesaving measures really means 2 providing lifesaving measures families requests despite patients advance directive listing care 3 family accepting patients poor prognosis 4 family members fighting use life support 5 enough time provide eol care nurse consumed lifesaving measures attempting save patients life five obstacle items decreased mean score rank compared 1999 data including 1 physicians differing opinion care patient 2 family friends continually call nurse rather calling designated family member 3 physicians evasive avoid families 4 nurses deal angry families 5 nurses knowing patients wishes regarding continuing tests treatments conclusions obstacles eol care perceived critical care nurses still exist familyrelated obstacles increased time obstacles related families may easily overcome family dealing dying family member icu likely previously experienced similar situation basis current top 5 obstacles recommendations possible areas focus include 1 improved health literacy assessment families followed earlier directed appropriate specific eol information 2 improved physicianteam communication 3 ensuring patients wishes followed written general patient familycentered care using clear open eol communication regarding wishes desires patients families physicians nurses help decrease common obstacles thus improving quality eol care provided dying patients families