Research Article
Staff perception of obstacles and facilitators when providing end of life care in critical care units of two teaching hospitals: A survey design

https://doi.org/10.1016/j.iccn.2019.04.003Get rights and content

Abstract

Objective

To determine perceptions of Jordanian critical care staff about obstacles and facilitators to end-of-life care.

Research methodology

The “National Survey of Critical Care Nurses’ Perceptions of End-of-Life Care” was adapted and distributed to 143 critical care nurses (n = 110) and physicians (n = 33) in two Jordanian hospitals. Nurses and physicians completed items about perceived obstacles to end-of-life care. Nurses only completed items about facilitators to end-of-life care.

Results

The overall response rate was 72.7% (n = 104/143). Seventy–six nurses (69.1%) and 28 physicians (84.5%) responded. Nurses and physicians agreed that the highest scoring obstacles were: ‘family members who do not understand what life-saving measures mean’ and the ‘poor design of critical care units’. Other highly scoring obstacles related to clinicians’ behaviours, characteristics and attitudes. Nurses perceived the highest scoring facilitator was ‘family members who accepted that the patient was dying’.

Conclusion

There is a need to further explore the issues underlying perceptions about clinicians’ behaviours, which were perceived to be key barriers to quality end-of-life care and to find acceptable solutions that fit with Islamic culture. It is the first time that the survey has been used to gather perceptions of doctors and nurses in a non-western culture.

Introduction

End-of-life care (EOLC) in critical care units is challenging (Coombs et al., 2017, Kisorio and Langley, 2016). Physicians experience uncertainty in decision-making (Blomberg and Sahlberg-Blom, 2007, McCann et al., 2013), and problems related to prognostication, delivering bad news and communication with families and colleagues (Ahern et al., 2012, Piers et al., 2014, McAndrew and Leske, 2015). For nurses, Espinosa et al. (2008) provide a systematic review of 22 studies (13 quantitative and nine qualitative) highlighting: lack involvement in EOLC planning, disagreement with physicians, lack of knowledge, unrealistic expectations from families, staff shortages and environmental problems. One of the studies reviewed by Espinosa et al. (2008) designed a tool (The National Survey of Critical Care Nurses’ Perception of End-of-life Care) to measure American critical care nurses’ perceptions of obstacles and supportive behaviours in EOLC (Beckstrand and Kirchhoff, 2005). The biggest obstacles perceived were: behaviours of patients’ families that removed nurses from caring for patients, behaviours that prolonged patients’ suffering, and physicians’ disagreement about the plan of care.

This paper reports a study that employed the survey of critical care nurses’ perception of EOLC in Jordanian critical care units. The study is drawn from a mixed methods project which also employed qualitative interviews. It aimed to understand staff experiences about the transition to, and provision of EOLC (Almansour, 2015).

Section snippets

Aim

To determine Jordanian critical care staffs’ perceptions of the intensity and frequency of obstacles and facilitators in providing EOLC.

Design

We used an exploratory, descriptive survey design, employing an existing questionnaire (Beckstrand and Kirchhoff, 2005) previously employed only with nurses. We adapted the survey for measuring nurses’ and physicians’ perceptions about the intensity (i.e. importance or magnitude) and frequency of obstacles to EOLC and nurses’ perceptions about intensity and

Demographic data

Data of 104 critical care staff including 76 nurses (69.1% response rate) and 28 physicians (84.5% response rate) were collected and analysed. Table 1 reports the demographic characteristics of the respondents.

Obstacles

Nurses and physicians perceived that the most intense obstacle to EOLC was: “family members not understanding what life-saving measures really mean” (Nurses: M = 4.12 ± 0.93; Physicians: M = 3.92 ± 1.32) (see Table 2). Nurses and physicians agreed on another five items in their top ten

Discussion

This study determined the views of Jordanian critical care staff about the intensity and frequency of obstacles and facilitators to EOLC using an existing survey tool. It is the first time that the survey has been used to gather perceptions of doctors and nurses in a non-western culture. We found that nurses and physicians agreed that the most intense and frequent obstacles to EOLC relate to misunderstandings of family members and the poor physical design of units making it difficult to support

Limitations

Comparability with other research may have been limited by changes made to the survey, and the responses to the survey do not necessarily reflect the views of all critical care staff in Jordan. Some staff perceived the survey as being too long and the sample may reflect only the views of those highly motivated to take part.

Conclusion

The findings from this survey suggest a need for international evidence to inform the implementation of palliative care in critical care units and to explore ways to adapt the physical environment to preserve the privacy of patients and family members. There is a need to further explore the issues underlying perceptions about clinicians’ behaviours and family communication, which Jordanian staff perceived to be key barriers to quality EOLC and to find acceptable solutions to these that fit with

Funding

This work was supported by the University of Jordan, Jordan.

Conflicts of interest

None.

References (23)

  • S. Heaston et al.

    Emergency nurses’ perceptions of obstacles and supportive behaviors in end-of-life care

    J. Emerg. Nurs.

    (2006)
  • L.C. Kisorio et al.

    End-of-life care in intensive care unit: family experiences

    Intensive Crit. Care Nurs.

    (2016)
  • R.D. Piers et al.

    Inappropriate care in European ICUs: confronting views from nurses and junior and senior physicians

    Chest J.

    (2014)
  • S.P. Ahern et al.

    Critically ill patients and end-of-life decision-making: the senior medical resident experience

    Adv. Health Sci. Educ.

    (2012)
  • A. Al-Awamer et al.

    Developing a palliative care service model for Muslim Middle Eastern countries

    Support. Care Cancer

    (2014)
  • I.M.A. Almansour

    Transitioning Towards End-of-life Care in Jordanian Critical Care Units: Health Care Professionals’ Perspectives

    (2015)
  • R.A. Aslakon et al.

    The changing role of palliative care in the ICU

    Crit. Care Med.

    (2014)
  • R.L. Beckstrand et al.

    Providing end-of-life care to patients: critical care nurses’ perceived obstacles and supportive behaviors

    Am. J. Crit. Care

    (2005)
  • R.L. Beckstrand et al.

    Critical care nurses’ perceptions of end-of-life care obstacles: comparative 17-year data

    Dimensions Critic. Care Nurs.

    (2017)
  • K. Blomberg et al.

    Closeness and distance: a way of handling difficult situations in daily care

    J. Clin. Nurs.

    (2007)
  • M.A. Coombs et al.

    Managing risk during care transitions when approaching end of life: a qualitative study of patients’ and health care professionals’ decision making

    Palliat. Med.

    (2017)
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