Basic Informations

C.V

Master Title

CRITICAL CARE NURSES’ ATTITUDES AND PRACTICES TOWARDS THE CARE OF DYING PATIENTS

Master Abstract

SUMMARY Critical care death represents the majority of hospital's deaths, with more than half a million death each year. Critical care nurses are well positioned to help patients and families during this difficult transition period. "Being with" patients and families in addition to "doing things" to them enables critical care nurses to provide the holistic care that is central to nursing. To provide quality care at the end of life, nurses must not only possess the knowledge and skills to provide this care, but must also develop the attitudes and interpersonal competence to provide compassionate care, therefore caring behaviors of nurses could affect the quality of care. Caring for dying patients is most stressful to nurses who must constantly attend patients, whereas other providers can visit and then walk away. It is important to acknowledge one’s own attitudes toward death and dying in order to better understand patients’ needs at the end of life. Once nurses understand their own attitudes about death and dying, they can work to improve the way they handle situations. The aim of this study was to determine critical care nurses' attitudes and practices toward care for dying patients. The study was conducted in the critical care units of Alexandria Main University Hospital (University Hospital) namely the Casualty ICU unit I (12 beds), General ICU unit III (15 beds), Triage intensive care unit (8 beds) and Gamal Abdel Naser insurance hospital namely General ICU of Gamal Abdel Naser insurance hospital which contains 8 beds. A convenience sample of 100 critical care nurses who are involved in providing direct care for critically ill patient in the previous settings were included in the study. Nurses were distributed as follows: 49 nurses from unit I, 20 nurses from unit III, 26 nurses from triage, and 5 nurses from ICU of Gamal Abd-Elnaser insurance hospital. Two tools were used by the researcher to collect data of this study. The first tool is “Critical Care Nurses’ attitudes toward dying patients’ Structured Interview”. This tool was developed by Frommelt (15), modified and translated in to Arabic by the researcher. It was used to assess attitudes of critical care nurses toward dying patient. It includes statements that reflect nurses 'feelings and reactions while caring for dying patients as giving nursing care to the dying persons is a worthwhile learning experience, dying patients should be given nursing care such as bathing and turning, dying patients should be given honest answers about their conditions, nurses should permit dying patients to have flexible visiting schedules and the family should be involved in the physical care of the dying patients. The second tool is “Critical care nurses’ practices toward dying patients' observational checklist”. This tool was developed by the researcher after reviewing the relevant literatures (3, 7). It was used to assess practices of critical care nurses toward dying patients. This tool covered 100 items distributed into 3 main broad categories which are physiological support, Safety and psychological care and communication. Physiological support items include 7 main categories which are monitoring, establish/maintain normal fluid balance, nutritional needs, establishing/ maintaining aeration & oxygenation, provision of skin care, provision of hygienic care and care of invasive device. Safety items include 2 main categories which are maintaining comfort/ pain relief and protection from infection. In addition to, the above tool nurses' socio-demographic data was developed by the researcher to collect data such as age, educational level, job title, and years of working experience in the ICU. The main results of the present study are: In relation to nurses' characteristics, the current study showed that, the majority of the study participants were at the age group of 20 to 30 years old and more than two third of them are females. More than two third of them held a bachelor degree in nursing, and more than one quarter held a diploma degree. As for, nurses' experience; nearly two third of the study participants had experience less than one year. In relation to critical care nurses attitudes toward dying patients the current study showed that two third of the study participants had good total attitude score, while one third of them had moderate total attitude score. Critical care nurses, attitude toward dying patients in relation to (cognitive domain). The current study showed that all of the study nurses agreed that giving nursing care to the dying persons is a worthwhile learning experience and the most of them agreed that it is beneficial for the dying patients to verbalize his/her feelings. It can be also noticed that more than two thirds of the study subjects agreed that addiction to pain relieving medication should not be a concern when dealing with dying patients. Critical care nurses, attitude toward dying patients (affective domain). The current study revealed that the vast majority of the study nurses agreed that the nurses would hope the dying patients they caring for dies when they are not present. On the other hand the vast majority of the study nurses didn’t afraid of giving care for dying patients and more than two thirds of the study nurses want the dying patients talk to them about their feelings. Critical care nurses, attitude toward dying patients families. The current study revealed that all of the study nurses had a positive attitude as they agreed that families need emotional support to accept the behavioral changes of their dying patients. It can be also noticed that almost of the study nurses agreed that nursing care for the dying patient’s families should continue throughout the period of grief and bereavement, families should be concerned about helping their dying patients make the best things of his/her remaining life and nursing care should be extended to the families of the dying patients. In relation to critical care nurses practices toward dying patients the current study showed that nearly two thirds of the study nurses had poor practices score while one third of the study nurses had moderate practice scores. In addition there is negligence to emotional and psychological condition of dying patients as evidenced by observing that all of the study nurses didn’t assess psychological needs, introduce self to patient, orienting patient to time, place and person, explaining procedure, repeating statements that instill hope, touching patient in supportive manner, understand patients' feelings or call patient by his/her preferred name. In relation to, the relation between total critical care nurses attitudes scores and their demographic data. The current study revealed that there is no statistical significant relationship exists between critical care nurses' age, years of experience and educational level and their attitudes, it also revealed that female nurses had more positive attitude toward care of dying patients than males nurses and found to be statistically significant. As for, the relation between total critical care nurses practices scores and their demographic data, the current study revealed that there is statistical significant relationship exists between critical care nurses' years of experience, current position and level of education and their practices. As regarding, the correlation between total critical care nurses’ practices scores and their total attitude scores. The current study revealed that there is no statistical significant correlation between critical cares nurses total practice score and their total attitude score. The following recommendations are suggested: • End of life education must be incorporated into both undergraduate studies and staff development in healthcare institutions. • Educating undergraduate nursing students about care of dying patients and dying patients’ bills of rights. • Provide educational training on death and dying through continuing education units, hospital in-service training, or basic nursing courses. • Fostering nurses to attend workshops about care of dying patients to clarify their further role in nursing care. • Creating support systems for nurses who care for dying patients such as allowing more frequent breaks and time for debriefing after exceptionally sad or difficult deaths. • Facilitating open visitation in the adult intensive care environment to allow flexibility for patients and families. • Appointing a spokesperson for the family who can communicate to others, in order to increase the nurse's time available for patient care. • Nurse to patient ratio shouldn’t exceed 1: 1 to prevent overload. • Assigning nurses on dying patients should be rotatory instead of assigning the same nurses to dying patients. • Incorporating the results of the current study into interventions that enhance critical care nurses attitudes and practices toward care of dying patients. • Developing educational programs to educate healthcare providers about the quality end-of-life care. • Observing critical care nurses practices toward dying patients. • Assess critical care nurses attitudes toward dying patients on large samples. • Including patients' families in future studies to obtain their perceptions with regard to end of life care as it currently exists in the CCU.

PHD Title

PHD Abstract