Nurse family member perceptions of patient death and nursing care after withdrawal of life-sustaining treatment

Abstract

<p><strong>Purpose/Aims:</strong> This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).</p>

<p><strong>Rationale:</strong> Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.</p>

<p><strong>Background:</strong> Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient death, with nurses rating quality lower than family or physicians.</p>

<p><strong>Methods: </strong>This descriptive study examined the perceptions of nursing care and patient quality of death and dying using the family member version of the Quality of Death and Dying (QODD) instrument and Family Satisfaction in the ICU (FS-ICU). Qualitative data related to the nurse family member experience was elicited through additional open-ended questions.</p>

<p><strong>Findings:</strong> Respondents (N=17) tended to view the quality of patient death somewhat favorably with a total QODD mean score of 60.75 (SD = 21.05) on a scale of 1-100. Results also indicated a moderate level of satisfaction with care within the ICU, with a total FS-ICU mean score of 67.75 (SD = 21.51) on a scale of 1-100. The FS-ICU care subscale total mean score was 67.82 (SD = 21.05), while the FS-ICU decision-making subscale mean score was 69.30 (SD = 23.48), indicating the highest level of satisfaction was with decision making within the ICU. Qualitative extreme positive and negative data supported total QODD, total FS-ICU, and FS-ICU subscale scores. In comparison to previous research, nurse family member satisfaction with care and perceptions of quality of patient death and dying tended to align with nurse rather than family member scores.</p>

<p><strong>Implications:</strong> Nurse family members perceive the quality of care and patient death and dying differently than non-nursing family members. To improve their experience of EOL care, further examination of the particular needs of nurse family members is warranted.</p>