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Emotional intelligence in neonatal intensive care unit nurses - decreasing moral distress in end-of-life care and laying a foundation for improved outcomes: an integrative review

LACEFIELD LEWIS, Stephanie
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 250-256

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Thème : Soins.

FIN VIE ; NEONATALOGIE ; SOIN INTENSIF ; INFIRMIERE ; EMOTION ; SOIN INFIRMIER ; DETRESSE PSYCHOLOGIQUE

End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)–structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.

Origine : journals.lww.com

Development of a clinical guide for identifying spiritual distress in family members of patients in the intensive care unit

ROZE DES ORDONS, Amanda L. ; SINCLAIR, Shane ; SINUFF, Tasnim ; GRINDROD-MILLAR, Kathleen ; STELFOX, Henry T.
JOURNAL OF PALLIATIVE MEDICINE, 02/08/2019, Pagination inconnue

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Thème : Psychologie, psychanalyse.

DETRESSE PSYCHOLOGIQUE ; SPIRITUALITE ; SOIN INTENSIF ; FAMILLE ; GUIDE ; SOUTIEN ; BESOIN

Background: Spirituality is important for many family members of patients in the intensive care unit (ICU). Clinicians without training in spiritual care experience difficulty identifying when family members are experiencing distress of a spiritual nature.
Objective: The purpose of this study was to develop a guide to help clinicians working in the ICU identify family members who may benefit from specialized spiritual support.
Design: ross-sectional study.
Setting/Subjects: A national sample of spiritual health practitioners, family members, and ICU clinicians.
Subjects: A panel of 21 spiritual health practitioners participated in a modified Delphi process to achieve consensus on items that suggest spiritual distress among family members of patients in the ICU through three rounds of remote review followed by an in-person conference and a final round of panelist feedback. Feedback on the final set of items was obtained from an end-user group of four family members and six ICU clinicians.
Measurements: A total of 220 items were iteratively reviewed and rated by panelists. Forty-six items were identified as essential for inclusion and developed into a clinical guide, including an introduction (n = 1), definitions (n = 2), risk factors (n = 10), expressed concerns (n = 12), emotions (n = 7) and behaviors (n = 7) that may suggest spiritual distress, questions to identify spiritual needs (n = 6), and introducing spiritual support (n = 1).
Conclusions: We have developed an evidence-informed clinical guide that may help clinicians in the ICU identify family members experiencing spiritual distress.

Origine : PubMed

Integration of pediatric palliative care into cardiac intensive care - a champion-based model

MOYNIHAN, Katie M. ; SNAMAN, Jennifer M. ; KAYE, Erica C. ; MORRISON, Wynne E. ; DEWITT, Aaron G. ; SACKS, Loren D. ; THOMPSON, Jess L. ; HWANG, Jennifer M. ; BAILEY, Valerie ; LAFOND, Deborah A. ; WOLFE, Joanne ; BLUME, Elizabeth D.
Pediatrics, 08/2019, vol.144, n°2, Pagination inconnue

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Thème : Age de la vie, situations spécifiques liées à la fin de vie.

PEDIATRIE ; DEMARCHE PALLIATIVE ; SOIN INTENSIF ; MODELE

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.

Origine : PubMed

End-of-life decision-making for ICU patients with limited English proficiency - a qualitative study of healthcare team insights

BARWISE, Amelia K. ; NYQUIST, Christina A. ; ESPINOZA SUAREZ, Nataly R. ; JARAMILLO, Carolina ; THORSTEINSDOTTIR, Bjorg ; GAJIC, Ognjen ; WILSON, Michael E.
Critical care medicine, 05/08/2019, Pagination inconnue

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Thème : Soins.

PRISE DECISION ; FIN VIE ; SOIN INTENSIF ; RECHERCHE QUALITATIVE ; COMMUNICATION ; RELATION PERSONNEL SOIGNANT PATIENT ; MIGRANT

OBJECTIVES: Research indicates that the increasing population of over 25 million people in the United States who have limited English proficiency experience differences in decision-making and subsequent care at end of life in the ICU when compared with the general population. The objective of this study was to assess the perceptions of healthcare team members about the factors that influence discussions and decision-making about end of life for patients and family members with limited English proficiency in the ICU.
DESIGN: Qualitative study using semistructured interviews with ICU physicians, nurses, and interpreters.
SETTING: Three ICUs at Mayo Clinic Rochester.
SUBJECTS: Sixteen ICU physicians, 12 ICU nurses, and 12 interpreters.
INTERVENTION: None.
MEASUREMENTS AND MAIN RESULTS: We conducted 40 semistructured interviews. We identified six key differences in end-of-life decision-making for patients with limited English proficiency compared with patients without limited English proficiency: 1) clinician communication is modified and less frequent; 2) clinician ability to assess patient and family understanding is impaired; 3) relationship building is impaired; 4) patient and family understanding of decision-making concepts (e.g., palliative care) is impaired; 5) treatment limitations are often perceived to be unacceptable due to faith-based and cultural beliefs; and 6) patient and family decision-making styles are different. Facilitators of high-quality decision-making in patients with limited English proficiency included: 1) premeeting between clinician and interpreter; 2) interpretation that communicates empathy and caring; 3) bidirectional communication of cultural perspectives; 4) interpretation that improves messaging including appropriate word choice; and 5) clinician cultural humility.
CONCLUSIONS: End-of-life decision-making is significantly different for ICU patients with limited English proficiency. Participants identified several barriers and facilitators to high-quality end-of-life decision-making for ICU patients and families with limited English proficiency. Awareness of these factors can facilitate interventions to improve high-quality, compassionate, and culturally sensitive decision-making for patients and families with limited English proficiency.

Origine : PubMed

Selecting the best instrument to measure family perceptions of end-of-life communication in intensive care units

CHEN, Chiahui ; MEIER, Scott T.
The American journal of hospice and palliative care, 07/08/2019, Pagination inconnue

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Thème : Soins.

OUTIL ; PERCEPTION ; FAMILLE ; FIN VIE ; COMMUNICATION ; SOIN INTENSIF

BACKGROUND: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments' psychometric properties and determine which best measures family-clinician communication in the ICU.
METHOD: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties.
INSTRUMENTS: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician-Family Caregiver Communication, and Quality of Communication (QOC).
RESULTS: Reliability estimates were high (= 0.79) in all 3 instruments. The QOC’s convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families’ treatment response in randomized control trials.
CONCLUSION: Quality of Communication is the most suitable instrument to measure family's perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family-clinician communication and data about how to improve EOL care in ICUs.

Origine : PubMed

Spiritual distress in family members of critically ill patients - perceptions and experiences

ROZE DES ORDONS, Amanda L. ; STELFOX, Henry T. ; SINUFF, Tasnim ; GRINDROD-MILLAR, Kathleen ; SMIECHOWSKI, Jennifer ; SINCLAIR, Shane
JOURNAL OF PALLIATIVE MEDICINE, 13/08/2019, Pagination inconnue

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Thème : Soins.

DETRESSE PSYCHOLOGIQUE ; SPIRITUALITE ; FAMILLE ; ACCOMPAGNEMENT ; RECHERCHE QUALITATIVE ; SOIN INTENSIF

Background: Spiritual distress among family members of patients in the intensive care unit (ICU) has not been well characterized. This limits clinicians' understanding of how to best offer support.
Objective: To explore how family members experience spiritual distress, and how it is recognized and support offered within the ICU context.
Design: A qualitative study involving interviews and focus groups between May 2016 and April 2017.
Setting/Subjects: Family members of ICU patients (n = 18), spiritual health practitioners (n = 10), and an interprofessional group of clinicians who work in the ICU (n = 32).
Measurements: Transcribed data were analyzed using interpretive description.
Results: The experience of spiritual distress was variably described by all three groups through concepts, modulators, expressions and manifestations, and ways in which spiritual distress was addressed. Concepts included loss of meaning, purpose and connection, tension in beliefs, and interconnected distress. Modulators were related to the patient and family context, the ICU context, and the relational context. Expressions and manifestations were unique and individual, involving verbal expressions of thoughts and emotions, as well as behavioral manifestations of coping. Clinical strategies for addressing spiritual distress were described through general principles, specific strategies for discussing spiritual distress, and ways in which spiritual support can be offered.
Conclusions: Our study provides a rich description of how spiritual distress is experienced by family members of ICU patients, and how spiritual health practitioners and clinicians recognize spiritual distress and offer support. These findings will help inform clinician education and initiatives to better support families of critically ill patients.

Origine : PubMed

Survey on barriers to critical care and palliative care integration

KYEREMANTENG, Kwadwo ; BECKERLEG, Weiwei ; WAN, Cynthia ; VANDERSPANK-WRIGHT, Brandi ; SUTHERLAND, Stephanie ; HARTWICK, Michael ; GRATTON, Valérie ; SARTI, Aimee J. ; D'EGIDIO, Gianni
The American journal of hospice and palliative care, 15/08/2019, Pagination inconnue

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Thème : Médecine.

DEMARCHE PALLIATIVE ; QUALITE SOIN ; FIN VIE ; ACCES SOIN ; SOIN INTENSIF

PURPOSE: It has been shown that integrating palliative care (PC) in intensive care unit (ICU) improves end-of-life care (EOLC), but very few Canadian hospitals have adopted this practice. Our study aims to evaluate the perceived quality of EOLC at participating institutions and explore barriers toward ICU-PC integration.
MATERIALS AND METHODS: A self-administered questionnaire was developed by a multidisciplinary team. Survey items were extracted from published quality indicators in EOLC and barriers to ICU-PC integration. The study took place at 2 academic institutions. Participants consisted of physicians and nurses, ICU administrators, and allied health workers.
RESULTS: An overall response of 45% was achieved. Of total, 85% of the respondents were ICU nurses. The following main themes were identified: (1) There is a poor presence of PC in the ICU and 78% of respondents felt that increasing ICU-PC integration will improve quality of EOLC; (2) the main barrier to integration was unrealistic patient and/or family expectations; and (3) criteria-triggered consultation to PC was the most feasible way to achieve integration.
CONCLUSION: Our findings indicate that the majority of respondents perceive that the presence of PC in ICU will improve EOLC. Future quality improvement initiatives can focus on developing a set of criteria for triggering PC consults.

Origine : PubMed

"You helped me keep my head above water" - experience of bereavement research after loss of a loved one in the ICU : insights from the ARREVE study

LAURENT, Alexandra ; REIGNIER, Jean ; LE GOUGE, Amélie ; COTTEREAU, Alice ; ADDA, Mélanie ; ANNANE, Djillali ; AUDIBERT, Juliette ; BARBIER, François ; BARDOU, Patrick ; BOURCIER, Simon ; BOURENNE, Jeremy ; BOYER, Alexandre ; BRENAS, François ; DAS, Vincent ; DESACHY, Arnaud ; DEVAQUET, Jérôme ; FEISSEL, Marc ; GANSTER, Frédérique ; GARROUSTE-ORGEAS, Maïté ; GRILLET, Guillaume ; GUISSET, Olivier ; HAMIDFAR-ROY, Rebecca ; HYACINTHE, Anne-Claire ; JOCHMANS, Sebastien ; JOURDAIN, Mercé ; LAUTRETTE, Alexandre ; LEROLLE, Nicolas ; LESIEUR, Olivier ; LION, Fabien ; MATEU, Philippe ; MEGARBANE, Bruno ; MERCERON, Sybille ; MERCIER, Emmanuelle ; MESSIKA, Jonathan ; MORIN-LONGUET, Paul ; PHILIPPON-JOUVE, Bénédicte ; QUENOT, Jean-Pierre ; RENAULT, Anne ; REPESSE, Xavier ; RIGAUD, Jean-Philippe ; ROBIN, Ségolène ; ROQUILLY, Antoine ; SEGUIN, Amélie ; THEVENIN, Didier ; TIROT, Patrice ; VINATIER, Isabelle ; AZOULAY, Elie ; ROBERT, René ; KENTISH-BARNES, Nancy
Intensive care medicine, 12/08/2019, vol.45, n°9, p. 1252-1261

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Thème : Deuil et travail du deuil.

RECHERCHE ; DEUIL ; PARTICIPATION ; SOIN INTENSIF ; SOUTIEN DEUIL ; PERSONNE ENDEUILLEE

PURPOSE: Bereavement research has helped to improve end-of-life practices in the ICU. However, few studies have explored bereaved relatives experience of research participation in this context. We aimed to explore the experience of bereaved relatives' participation in the ARREVE study which included three telephone follow-up calls to complete several quantitative tools.
METHODS: Volunteer relatives who participated in the 12-month follow-up call completed a questionnaire about research participation that included ten open-ended questions so that respondents could use their own words and thoughts. These open-ended questions were analyzed using qualitative analysis that examines themes within the data.
RESULTS: 175/311 relatives completed the questionnaire. Three themes were derived from the thematic analysis: (1) struggling: reactivation of emotional distress associated with the ICU experience and the loss is frequent, specifically during the 1st follow-up call. (2) Resilience: as time goes by, research participation becomes increasingly positive. The calls are a help both in giving meaning to the relatives' experience and in accepting the loss. (3) Recognition: research calls can compensate for the absence of support during bereavement.
CONCLUSION: Although some emotional difficulties must be acknowledged, bereavement research is overall associated with benefits, by facilitating emotional adjustments, meaning-making and resilience. Lack of support and social isolation during bereavement are frequent experiences, revealing that support strategies for bereaved relatives should be developed after the loss of a loved one in the ICU.

Origine : PubMed

A national VA palliative care quality improvement project for improving intensive care unit family meetings (ICU-FMs)

AKGUN, Kathleen M. ; GRUENEWALD, David A. ; SMITH, Dawn ; WERTHEIMER, Debra ; LUHRS, Carol
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 20/08/2019, Pagination inconnue

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Thème : Soins.

DEMARCHE QUALITE ; DEMARCHE PALLIATIVE ; REUNION ; FAMILLE ; SOIN INTENSIF

BACKGROUND: We sought to increase intensive care unit-family meeting (ICU-FM) documentation in the electronic health record in Veterans Affairs (VA) hospitals.
MEASURES: Primary outcomes were proportion of VA decedents with ICU-FM and Bereaved Family Survey-Performance Measure (BFS-PM) scores of "excellent".
INTERVENTION: Quality Improvement (QI) project, clinical champion and ICU-FM templates, were implemented in nine participating VA facilities. ICU-FMs and BFS-PM were determined in decedents between 2011-2018.
OUTCOMES: ICU-FM increased from 3% to 28% in participating vs. 5% to 6% in non-participating facilities over time. Participating facilities were 5-fold more likely to have ICU-FMs among ICU decedents (OR=5.69, [4.45-7.28]). Facility-wide excellent BFS-PM scores increased by 19% in participating vs. non-participating facilities at the end of the observation period (OR=1.19, [1.10-1.30] but no difference between groups was observed in patients who died in the ICU.
CONCLUSIONS: Increasing ICU-FMs is necessary but not sufficient to improve family-reported satisfaction following an ICU death.

Origine : PubMed

Thinking about strengths in end-of-life nursing practice - the case of intensive care unit nurses

VANDERSPANK-WRIGHT, Brandi ; WRIGHT, David Kenneth ; MCMILLAN, Kim
International Journal of Palliative Nursing, 08/2019, vol.25, n°8, p. 378-385

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Thème : Soins. Cote : 00.07INT

SOIN INTENSIF ; INFIRMIERE ; PRATIQUE PROFESSIONNELLE ; SOIN INFIRMIER ; FIN VIE ; AIDANT ; DEMARCHE PALLIATIVE ; PERSONNE AGEE

BACKGROUND: The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context.
AIM: To stimulate a reflective examination of intensive care nursing practice with respect to end-of-life care.
METHODS: The work of contemporary nursing scholar Laurie Gottlieb is used to perform a strengths-based relational ethical examination of previously published literature that describes critical care nurses' experiences of providing end-of-life care in the ICU.
FINDINGS: This literature suggests that the relational ethical value of authentic engagement, which is fundamental to the disciplinary ethos of expert palliative care nursing, is reflected in the everyday practice of intensive care nurses whose patients die while under their care.
CONCLUSION: A strengths-based approach can make visible the relational ethical practice of critical care nurses who care for dying patients and their families in the ICU.

Origine : PubMed

Listen to me

LALANI, Hussain S. ; TATE, Tyler
JOURNAL OF PALLIATIVE MEDICINE, 02/2019, vol.22, n°2, p. 228-229

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Thème : Soins. Cote : 00.07JOU

TEMOIGNAGE ; ETUDIANT ; MEDECINE ; SOIN INTENSIF ; DEMARCHE PALLIATIVE ; CONSULTATION

Pas de résumé.

Origine : liebertpub.com (Atypon

Predictors of depression and anxiety in family members 3 months after child's admission to a pediatric ICU

IWATA, Masayuki ; HAN, Soojeong ; HAYS, Ross ; DOORENBOS, Ardith Z.
The American journal of hospice and palliative care, 30/06/2019, Pagination inconnue

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Thème : Soins.

DEPRESSION ; ANXIETE ; FAMILLE ; SOIN INTENSIF ; PEDIATRIE ; MODELE ; ADMISSION

OBJECTIVES: Family members of children admitted to intensive care units (ICUs) suffer from severe stress, which sometimes results in long-term psychological problems. We aimed to identify associations between demographic and psychosocial variables at early stages of a child's admission to the ICU and depression and anxiety in family members at approximately 3 months after admission. We also explored predictive models for depression and anxiety at 3 months after admission.
METHODS: This study is a secondary analysis of data from a previous clinical trial of palliative care for family members in ICUs, in which 380 family members of 220 children reported demographic and psychosocial status at approximately 1 week after ICU admission (baseline), at discharge from the ICUs, and at 3 months after the child's admission to the ICU. Clinical data were extracted from the children's medical records. We used linear regression models and stepwise linear regression for the analyses.
RESULTS: After controlling for significant confounders of gender (female) and child mortality, worse psychological status at baseline, represented by reported depression, anxiety, and acute stress symptoms, was associated with more severe depression and anxiety at 3 months. Also, a better family relationship at baseline was associated with lower depression and anxiety at 3 months.
CONCLUSION: We suggest a need to screen family members of children admitted to the ICU with validated scales and intervening with those at high risk of depression and anxiety.

Origine : PubMed

Critical care nurses' perceptions of parenteral and enteral nutrition at the end-of-life in South Korea

SEOL, Eun-Mi ; KOH, Chin Kang ; KIM, Eun Kyung
JOURNAL OF PALLIATIVE CARE, 18/07/2019, Pagination inconnue

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Thème : Soins.

REPUBLIQUE DE COREE ; SOIN INTENSIF ; PERCEPTION ; NUTRITION ENTERALE ; NUTRITION PARENTERALE ; FIN VIE ; ETHIQUE SOIN ; QUESTIONNAIRE

PURPOSE: The purpose of this study was to explore the perceptions of critical care nurses regarding the withdrawal or withholding of enteral nutrition (EN) and parenteral nutrition (PN) at the end-of-life, which is not allowed according to the current law in South Korea.
METHODS: This was a cross-sectional study utilizing a self-report survey. The participants in the study were 141 nurses working in the intensive care units of a tertiary university hospital. The critical care nurses' general attitudes about EN and PN at the end-of-life were measured using the questionnaires developed by Lubart, Leibovitz, and Habot. The nurses responded to additional questions on whether withdrawal or withholding of EN or PN at the end-of-life should be legally allowed.
RESULTS: The mean scores of the general attitude items on EN ranged between 3.03 and 3.35 on a 5-point Likert scale where a value of 1 represents "strongly disagree" and a value of 5 represents "strongly agree," while those for PN ranged between 2.89 and 3.65. Respecting attitudes toward EN and PN, critical care nurses had more negative attitudes about stopping PN than EN. Regarding attitudes about whether patients should be legally able to refuse EN, 34.3% agreed, while 25.7% disagreed. For PN, 40.0% agreed, while 24.3% disagreed.
CONCLUSION: Discussions about making the withdrawal and withholding of artificial nutrition legal should be initiated. Moreover, education regarding evidence about the outcomes of EN and PN during end-of-life care and up-to-date clinical guidelines about it should be provided.

Origine : PubMed

Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? - results from a systematic review with narrative synthesis

RIBEIRO, André Filipe ; MARTINS PEREIRA, Sandra ; GOMES, Barbara ; NUNES, Rui
PALLIATIVE MEDICINE, 12/07/2019, Pagination inconnue

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Thème : Médecine.

DEMARCHE PALLIATIVE ; SOIN INTENSIF ; PEAU

BACKGROUND: Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care.
AIM: To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration.
DESIGN: A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676).
DATA SOURCES: Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.'s tool was used for quality appraisal.
RESULTS: A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients' comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units.
CONCLUSION: This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.

Origine : PubMed

Improving end-of-life care in the intensive care unit - clinician's experiences with the 3 wishes project

NEVILLE, Thanh H. ; AGARWAL, Neha ; SWINTON, Marilyn ; PHUNG, Peter ; XU, Xueqing ; KAO, Yuhan ; SEO, Jiyeon ; GRANONE, Maria C. ; HJELMHAUG, Kristen ; HAINJE, Jessica ; PAVLISH, Carol ; CLARKE, France ; COOK, Deborah J.
JOURNAL OF PALLIATIVE MEDICINE, 08/07/2019, p. 1-7

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Thème : Soins. Cote : e00.07JOU

FIN VIE ; SOIN INTENSIF ; PROJET SOIN ; PREFERENCE ; PATIENT

Background: End-of-life (EOL) care is an important aspect of practice in the intensive care unit (ICU), where approximately one of every five patients may die.
Objective: The objective of this study was to describe clinicians' experiences with the 3 Wishes Project (3WP) and understand the influence of the project on care in the ICU.
Design: The 3WP is a palliative care intervention in which clinicians elicit and implement final wishes for patients dying in the ICU; it had been implemented for seven months at the time of this study. This mixed-methods study includes quantitative data from clinician surveys and qualitative data from clinician focus groups.
Setting: A 24-bed medical ICU in a tertiary academic center.
Subjects: Perspectives of 97 clinicians working in the ICU during the study period were obtained by self-administered surveys. Five focus groups with 25 nurses and 5 physicians were held, digitally recorded, transcribed, and analyzed.
Measurements and Results: During the 7-month period, 67 decedents and their families participated in the 3WP. The overarching concept identified through analysis of the survey and focus group data is that the 3WP improves EOL care in the ICU, which was supported by three main themes: (1) The 3WP facilitates meaningful EOL care; (2) The 3WP has a positive impact on nurses and physicians; and (3) clinicians observe a positive influence of the 3WP on families.
Conclusions: This patient-centered and family-partnered intervention facilitates meaningful EOL care, favorably impacting the ICU team and positively influencing family members.

Origine : PubMed

Burnout - caring for critically ill and end-of-life patients with cancer

PATTISON, Natalie ; DRONEY, Joanne ; GRUBER, Pascale
Nursing in critical care, 22/07/2019, Pagination inconnue

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Thème : Psychologie, psychanalyse.

EPUISEMENT PROFESSIONNEL ; CANCEROLOGIE ; SOIN INTENSIF ; FIN VIE ; DEMARCHE PALLIATIVE ; PERSONNEL SANTE

BACKGROUND: Critical care and palliative care professionals treat and support seriously ill patients on a daily basis, and the possibility of burnout may be high. The consequences of burnout can include moral injury and distress, and compassion fatigue, which are detrimental to both care and staff.
AIMS AND OBJECTIVES: To explore the incidence of moral distress in areas at high risk of burnout in a large cancer centre and to explore possible measures for addressing moral distress.
DESIGN: A cross-sectional survey.
METHODS: The Maslach Burnout Inventory was administered to critical care, critical care outreach, and palliative care teams in a specialist tertiary cancer centre. Open questions on supportive measures were also included. Burnout data were categorised into three domains of emotional exhaustion, depersonalization and personal accomplishment, and free-text analysis was conducted on the open-question data.
RESULTS: A total of 63 professionals responded across the teams (45% response rate). A low level of burnout was observed in the emotional exhaustion domain; depersonalization was higher in the critical care professionals; and overall, personal accomplishment was higher than normative scores. Free-text analysis highlighted three categories of responses: Debriefing, Managing emotional well-being, and Valuing individuals. There was a need to proactively recognize issues; undertake more debriefs; and open forums regarding cases, particularly with difficult deaths. Engaging all professionals, support to deal with families, and mandatory moral distress and resilience training were suggested, alongside a focus on team building through external activities such as group relaxation sessions and walks.
CONCLUSIONS: This study demonstrated a relatively low incidence of emotional exhaustion and depersonalization, and a slightly higher sense of personal accomplishment than normative scores despite staff working in an environment where high levels of burnout were expected.
RELEVANCE TO CLINICAL PRACTICE: Staff highlighted possible solutions to reduce burnout, which included debriefing, managing emotional well-being, and valuing individuals.

Origine : PubMed

Challenges in delivering bad news in a multi-ethnic intensive care unit - an ethnographic study

VAN KEER, Rose-Lima ; DESCHEPPER, Reginald ; HUYGHENS, Luc ; BILSEN, Johan
Patient education and counseling, 28/06/2019, Pagination inconnue

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Thème : Soins.

ANNONCE ; SOIN INTENSIF ; ETHNOGRAPHIE ; ETHNICITE ; COMMUNICATION ; MILIEU URBAIN ; BELGIQUE

OBJECTIVE: During critical care, physicians are frequently confronted with bad-news communication because of patients' frail conditions. Delivering bad news is not easy, certainly not when patients from ethnic minority groups are involved. In this study we investigate the delivery of bad news in a multi-ethnic critical care context.
METHODS: Ethnographic fieldwork in one intensive care unit of a multi-ethnic urban hospital in Belgium. Data were collected through negotiated interactive observation, in-depth interviews and from reading patients' medical records. Data were thematically analysed.
RESULTS: Bad-news communication was primarily dominated by physicians. Patients' and relatives' input and other professionals' involvement in the communication was limited. Staff encountered ethno-cultural related difficulties, firstly, in choosing suitable conversation partner(s); secondly, in choosing the place of conversations and thirdly, in the information exchange. Staff usually tried to address these problems themselves on the spot in a quick, pragmatic way. Sometimes their approaches seemed to be more emotion-driven than well thought-out.
CONCLUSION: Delivering bad news in a multi-ethnic intensive care unit has a number of specific difficulties. These can have negative consequences for parties involved.
PRACTICE IMPLICATIONS: The challenges of an adequate delivery of bad news need a team-approach and a well thought-out protocol.

Origine : PubMed

End-of-life care in the pediatric intensive care unit - a survey in Japan

SEINO, Yusuke ; KUROSAWA, Hiroshi ; SHIIMA, Yuko ; NIITSU, Takehiro
Pediatrics international, 27/06/2019, Pagination inconnue

Document en ligne

Thème : Age de la vie, situations spécifiques liées à la fin de vie.

FIN VIE ; PEDIATRIE ; SOIN INTENSIF ; JAPON ; PRATIQUE PROFESSIONNELLE ; BESOIN FORMATION

BACKGROUND: End-of-life (EOL) care is an important topic in critical care medicine, but EOL discussions with families can be difficult and stressful for intensivists. This study aimed to clarify the current practices and barriers facing pediatric intensive care unit (PICU) EOL care and to identify the requisites for excellent PICU EOL care in Japan.
METHODS: A survey was conducted in 29 facilities across Japan in 2016. The questionnaire consisted of 19 multiple-choice questions and 1 open-ended question.
RESULTS: Twenty-seven facilities responded to the survey. Only 19% had educational programs on EOL care for fellows or residents. Although 21 hospitals (78%) had a multidisciplinary palliative care team, only 8 of these teams were involved in EOL care in PICUs. Mental health care for healthcare providers provided by a psychiatrist was rare (4%). The free comments were categorized as individual, team, environment, legal/ethics, or culture. Commonly raised individual issues included "lack of experience and knowledge about EOL care," "fear of making the decision to end care," and "reluctance to be involved in EOL care because of its complex process." Team issues included "insufficient frequency of conferences" and "non-multidisciplinary approach." Legal and ethics issues were "lack of legal support" and "fear of lawsuits."
CONCLUSIONS: This study is the first to investigate current conditions and barriers in PICU EOL care in Japan. Most of the facilities involved were not satisfied with current practices. The results indicate the need for relevant educational programs as well as the importance of multidisciplinary and legal support.

Origine : PubMed

Emotional intelligence in neonatal intensive care unit nurses - decreasing moral distress in end-of-life care and laying a foundation for improved outcomes: an integrative review

LEWIS, Stephanie Lacefield
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 250-256

Thème : Psychologie, psychanalyse.

NEONATALOGIE ; SOIN INTENSIF ; COPING ; DETRESSE PSYCHOLOGIQUE ; FIN VIE ; INFIRMIERE

Parents’ wishes for what they had or had not done and their coping after their infant’s or child’s neonatal intensive care unit/pediatric intensive care unit/emergency department death

CAICEDO, Carmen ; BROOTEN, Dorothy ; YOUNGBLUT, JoAnne ; DANKANICH, Julia
JOURNAL OF HOSPICE AND PALLIATIVE NURSING, 08/2019, vol.21, n°4, p. 333-343

Thème : Soins.

PARENT ; COPING ; MORT ; ENFANT ; NEONATALOGIE ; PEDIATRIE ; SOIN INTENSIF ; SERVICE URGENCES ; RECHERCHE QUALITATIVE ; RESSENTI

This qualitative study asked 70 mothers and 26 fathers 3 open-ended questions on what they wish they had and had not done and on coping 2, 4, 6, and 13 months after their infant’s/child’s neonatal intensive care unit/pediatric intensive care unit/emergency department death. Mothers wished they spent more time with the child, chosen different treatments, advocated for care changes, and allowed the child his or her wishes. Fathers wished they had spent more time with the child and gotten care earlier. Mothers wished they had not agreed to child’s surgery/treatment, taken her own actions (self-blame), and left the hospital before the death. Fathers wished they had not been so hard on the child, agreed with doctors/treatment, and taken own actions (self-blame). Religious activities, caring for herself, and talking about/with the deceased child were the most frequent mothers’ coping strategies; those of the fathers were caring for self and religious activities. Both mothers and fathers wished they had spent more time with their child and had not agreed to surgery/treatments. The most frequent coping was caring for themselves, likely to care for the family and retain employment. Nurses must be sensitive to parents’ need for time with their infant/child before and after death and to receive information on child’s treatments at levels and in languages they understand.

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ARRET THERAPEUTIQUE COMMUNICATION DEMARCHE PALLIATIVE ETATS-UNIS ETUDE RETROSPECTIVE FAMILLE FIN VIE INFIRMIERE MEDECIN MORT NEONATALOGIE PEDIATRIE PRISE DECISION SOIN SOIN INTENSIF

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