A qualitative meta‐synthesis investigating the experiences of the patient's family when treatment is withdrawn in the intensive care unit. (20th July 2020)

• Record Type: Journal Article
• Authors: Coventry, Alysia; Ford, Rosemary; Rosenberg, John; McInnes, Elizabeth
• Is Part Of: Journal of advanced nursing. Volume 76:Number 9(2020)
• Page Start: 2222
• Page End: 2234
• Publication Date: 2020-07-20
• Subjects: end of life -- family -- intensive care -- nursing -- qualitative synthesis; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14416
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aim: To synthesize qualitative studies of patients' families' experiences and perceptions of end‐of‐life care in the intensive care unit when life‐sustaining treatments are withdrawn. Design: Qualitative meta‐synthesis. Data sources: Comprehensive search of 18 electronic databases for qualitative studies published between January 2005 ‐ February 2019. Review Method: Meta‐aggregation. Results: Thirteen studies met the inclusion criteria. A conceptual 'Model of Preparedness' was developed reflecting the elements of end‐of‐life care most valued by families: 'End‐of‐life communication'; 'Valued attributes of patient care'; 'Preparing the family'; 'Supporting the family'; and 'Bereavement care'. Conclusion: A family‐centred approach to end‐of‐life care that acknowledges the values and preferences of families in the intensive care unit is important. Families have unmet needs related to communication, support, and bereavement care. Effective communication and support are central to preparedness and if these care components are in place, families can be better equipped to manage the death, their sadness, loss, and grief. The findings suggest that health professionals may benefit from specialist end‐of‐life care education to support families and guide the establishment of preparedness. Impact: Understanding the role and characteristics of preparedness during end‐of‐life care will inform future practice in the intensive care unit and may improve family member satisfaction with care and recovery from loss. Nurses are optimally positioned to address the perceived shortfalls in end‐of‐life care. These findings have implications for health education, policies, and standards for end‐of‐life care in the intensive care unit. Abstract : 目的: 为了定性综合研究患者家属对重症监护室停止生命支持治疗时提供临终关怀的感受和看法 设计: 定性综合集成研究 数据来源: 全面检索2005年1月至2019年2月间发布的18个定性研究电子数据库 评估方法: 综合集成 结果: 13项研究符合入选标准。建立了一个概念性的'准备模型', 反映了家属最重视的临终关怀要素:'临终沟通';'患者护理的价值属性';'让家属做好准备';'支持家属';以及'丧亲护理'。 结论: 以家庭为中心的临终关怀方法确认了重症监护室家属的价值和偏好是很重要的。家属在沟通、支持和丧亲护理方面的需求没有得到满足。有效的沟通和支持是准备工作的核心, 如果这些护理组成部分实行到位, 家属可以更好地处理死亡、他们的悲伤情绪、损失和悲痛情绪。研究结果表明, 卫生专业人士可以从专业的临终关怀教育中受益, 以支持家庭并指导建立准备。 影响: 了解临终关怀期间准备工作的作用和特点, 将为今后在重症监护室的实践工作提供参考, 并可能提高家属对护理的满意度和从损失中恢复的满意度。护士处于最佳位置, 可以解决临终关怀工作中明显的不足之处。这些研究结果对重症监护室临终关怀的健康教育、政策和标准均有启示意义。