LIFE AND DEATH IN ICU: NURSING CARE TO SMOOTH TRANSITIONS FOR PATIENTS AND FAMILY

Abstract

Background Nurses are the clinicians closest to the patients in daily monitoring of processes and adaptations: assessing, intervening with treatments and evaluating the outcomes. Nurses evaluate all physiological abnormalities, emotional instabilities as well as spiritual requirements regarding religious beliefs, cultural rituals and family relationships. Aim This thesis examines the context, purpose, significance of life threatening and end-of- life situations in critical care and demonstrates the integral work of nurses in calming, organizing and making sense of intensive care unit life and death conditions. Program of work The body of work reported in this thesis comprises a collection of work resulting in the creation of an end of life care bundle. Each segment of the bundle is organized into evidenced-based critical junctures. The first critical juncture is an appraisal of responsiveness of patient’s disease process to curative interventions applied in the ICU. The second critical juncture looks at shared decision making, coping with conflicts, and using verbal and non-verbal communication. The third critical juncture analyses consensus, how to accomplish this task addressing moral, cultural and religious issues. Critical juncture number four discusses comfort care including spiritual practices and therapeutic relationships. The fifth critical juncture involves family care and nurses’ role in providing cultural competencies and examples of family focused interventions to assist this population with the grieving process. The sixth critical juncture looks at various aspects of end of life care and assuring a good death. The final critical juncture proposes post intensive care follow up and using family support groups as a tool for coping. Conclusions This work incorporates scientific rational into critical junctures to create an end of life care bundle.