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Dying ICU dignity

Amanda Su, Lindsay Lief, David Berlin, Zara Cooper, Daniel Ouyang, John Holmes, Renee Maciejewski, Paul K Maciejewski, Holly G Prigerson
CONTEXT: Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU. OBJECTIVES: The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. METHODS: From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences...
February 17, 2018: Journal of Pain and Symptom Management
Jennifer B Seaman, Amber E Barnato, Susan M Sereika, Mary Beth Happ, Judith A Erlen
OBJECTIVE: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. BACKGROUND: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. METHODS: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation...
January 2017: Heart & Lung: the Journal of Critical Care
Helena Kisvetrová, David Školoudík, Eva Joanovič, Jana Konečná, Zdeňka Mikšová
PURPOSE: Providing high-quality end-of-life care is a challenging area in intensive care practice. The aim of the current study was to assess the practice of registered nurses (RNs) with respect to dying care and spiritual support interventions in intensive care units (ICUs) in the Czech Republic (CR) and find correlations between particular factors or conditions and the frequency of NIC interventions usage. DESIGN AND METHODS: A cross-sectional, descriptive study was designed...
March 2016: Journal of Nursing Scholarship
Almir Galvão Vieira Bitencourt, Maira Pereira Dantas, Flávia Branco Cerqueira Serra Neves, Alessandro de Moura Almeida, Rodrigo Morel Vieira de Melo, Ligia Carvalho Albuquerque, Tiana Mascarenhas Godinho, Sydney Agareno, José Mário M Teles, Augusto M C Farias, Otavio H Messeder
BACKGROUND AND OBJECTIVES: There is a growing tendency of looking for "dying with dignity", rather than to prolong death and suffering of terminal patients on intensive care units (ICU). This study aims to evaluate medical practices that suggest therapeutic limitation (TL) in patients who died in an adult ICU. METHODS: A retrospective exploratory study was carried out to evaluate medical records of patients who died in a general adult ICU of a private hospital in Salvador-BA, between January and August of 2003, after at least 24 hours from the admission...
June 2007: Revista Brasileira de Terapia Intensiva
Deborah Cook, Graeme Rocker
The traditional goals of intensive care are to reduce the morbidity and mortality associated with critical illness, maintain organ function, and restore health. Despite technological advances, death in the intensive care unit (ICU) remains commonplace. Death rates vary widely within and among..
June 26, 2014: New England Journal of Medicine
Deborah Borowske
A key factor in nurses' experiencing moral distress is their feeling of powerlessness to initiate discussions about code status, EOL issues, or patients' preferences. Moreover, nurses encounter physicians who give patients and their families a false picture of recovery or, worse, block EOL discussions from occurring. Since its release in 1995, the landmark study of almost 10,000 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported a widespread gap with physicians' discussions in honest prognosis and EOL issues...
March 2012: Critical Care Nursing Clinics of North America
James E Szalados
End-of-life care in the ICU generally encompasses both the withholding and withdrawal of life support and the administration of palliative care. There is little practical distinction in the specific technology or life-support modality that is limited or removed with respect to the subsequent medical, ethical, or legal analysis. The important ethical issues pertinent to end-of-life care in the ICU at the point-of-life support discontinuation are: (1) the distinction between allowing patients to die in accordance with their wishes and causing them die, (2) the fine line between respecting a patient's wish to die with dignity and control and the risk of subsequent allegations of euthanasia or physician-assisted suicide, and (3) the adjunctive use of medications that simultaneously provide comfort but also may hasten death...
April 2007: Critical Care Clinics
Joanna K Hunter, Tamsin Dean, Jenny Gowan
In 2002, a study was undertaken at St Thomas' Hospital to ascertain whether nurses felt adequately prepared in caring for patients in the intensive care unit (ICU) during the withdrawal of treatment (WoT) process (Dean, 2002). The study concluded that nurses on the ICU were unclear of the process and lacked confidence and knowledge of WoT. This study inspired the establishment of a WoT steering group to address the many issues involved in this process.
February 9, 2006: British Journal of Nursing: BJN
Richard A Mularski, Carlton E Heine, Molly L Osborne, Linda Ganzini, J Randall Curtis
STUDY OBJECTIVES: To explore the quality of the dying experience and associations to higher quality ratings for people who died in an ICU. DESIGN: Retrospective study using medical record review and surveys of family members with the Quality of Dying and Death (QODD) instrument. SETTING: Four ICUs affiliated with a university and a Veterans Affairs Medical Center. PARTICIPANTS: Ninety-four family members of 38 ICU decedents...
July 2005: Chest
Cari R Levy, E Wesley Ely, Kate Payne, Ruth A Engelberg, Donald L Patrick, J Randall Curtis
OBJECTIVE: We compared perceptions of the quality of dying and death in the ICU across nurses, resident physicians, attending physicians, and family members. The aim was to obtain a surrogate assessment of the quality of the dying process and examine differences in the perceptions of different types of raters. DESIGN: Cross-sectional survey of family members and ICU clinicians conducted following the death of enrolled patients. SETTING: Two medical ICUs at academic tertiary care medical centers...
May 2005: Chest
G S Wlody
The passage of the Oregon Death With Dignity Act on November 8, 1994, heralded a wake-up call for healthcare professionals. Oregon, the first state to systematically "ration care" was thought to be a fertile ground for testing new and, some say, radical concepts in healthcare and government. Although the act was not implemented because it was tied up in legal action until February 1997, the fact that more than 50% of the voters in Oregon voted for it mandates that healthcare providers listen to their patients...
October 1997: Critical Care Nurse
K Hermanns, F Salomon
No studies are available so far on the way dying and death in the ICU are perceived by relatives of the patients. It is also not clear in how far the current criticism of intensive care medicine stems from these relatives. These problems were investigated by sending a self-developed 48-item questionnaire to relatives of patients who had died in the ICU. The questions centred on the following subjects: Communication and information structures Perception of the ICU and emotional reaction Assessment of treatment Dying and death in the ICU...
April 1993: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
R W Chang, D J Bihari
A very difficult clinical problem facing surgeons is knowing when further treatment is futile and no longer appropriate in a patient who has developed severe complications after surgery and is being treated in an intensive care unit. It is now possible to prolong the process of dying among such patients. This results in unnecessary pain and loss of dignity for the patient, anguish and distress for the patient's relatives and is dehumanizing for the clinical and nursing staff. It has also tremendous implications in the use of limited health care resources...
April 1994: Der Unfallchirurg
S G Stern, J P Orlowski
OBJECTIVE: To assess changes in the terminal care of critically ill patients before and after the institution of do-not-resuscitate (DNR) order policies, and policies on the care of the hopelessly ill. DESIGN: Retrospective chart review that comprises the following groups: 82 consecutive deaths from 1981 to 1982, representing our older practice pattern of frequent utilization of terminal resuscitative efforts (group A); 37 consecutive deaths between June and December 1987, the 6-month period immediately preceding the adoption of the DNR policy (group B); and 61 consecutive deaths in calendar year 1988 after the DNR policy went into effect (group C)...
September 1992: Critical Care Medicine
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