Need help from ICU RNs PLEASE!

HouTx, BSN, MSN, EdD · Apr 4, 2016

End of Life care is a great topic but you may be a bit off-base. ICU is very expensive with strict admission and discharge criteria in place to make sure it is not abused - e.g. physician or family want "more" available nursing time. In most facilities, EOL patients who are not actively receiving any 'heroic' interventions may not qualify for ICU - they would be discharged to a more appropriate setting such as palliative care or hospice.

Perhaps you'd get a better response rate by addressing a different target audience?

Sun0408, ASN, RN · Apr 4, 2016

Terminal weans are done a lot in the ICU. If they survive past a few hours they are usually moved to a different floor and out of the ICU. Hospice or comfort care only pts rarely stay in the ICU. Hope this helps you

Here.I.Stand, BSN, RN · Apr 8, 2016

I'll answer, but am on my phone so will get to it a bit later. It'll be easier to c&p and type out answers on an actual keyboard. :)

indygirl526, ASN, RN · Apr 8, 2016

Pts in ICU unless they die right away or soon are sent to a med/surg or palliative care unit. I work on palliative care and we get many ICU pts.

Here.I.Stand, BSN, RN · Apr 8, 2016

Do you have experience giving end of life care to patients in an ICU setting? Yes

What is your gender? Female

What is your age? 36-40

How many years of experience do you have in an ICU setting? 6-10

What is your highest level of nursing education? BSN

Do you work in a rural or urban hospital? Urban

Have you faced barriers when providing end of life care to patients in the ICU? Yes

Barriers to Patient Care â€“ please choose a number on the scale based on how much it has impacted the end of life care you have given patients.

0 is no impact, 3 is some impact, and 6 is high impact.

1. Patient is unconscious and is unable to make own decisions about medical treatment: 6, because then families are left to decide what to do

2. High stress or moral stress when providing care: 3

3. Patient/family/caregiver lack of understanding of end of life care or current prognosis: 6!!!!! Families who want to press forward no matter what the prognosis is by far the biggest barrier

4. Regulatory restriction of pain management/symptom management: 0 -- our MDs order as much pain/sx management meds as the pt needs. I have never in 13 years total nursing been told my an MD/NP that they can't up the meds because of regulatory restrictions.

5. Self-knowledge deficit of end of life care: 0 -- EOL care in the ICU is usually what the lay public terms "pulling the plug." (Actually, we pull the tube, not the plug.) I'm pretty comfortable with how we do EOL care. If the pt doesn't die within the next few hours, we transfer him/her to a room on the floors. It's not nearly as varied as, say, home hospice nursing.

6. Poor Communication; either provider â€“ patient â€“ caregiver or provider â€“ provider 6 -- lots of times I feel like our providers tap dance around the inevitable. I remember one care conference I sat in on, the pt had had a brain stem stroke, and the MD was telling the family that if she survived, she'd need someone to feed her. I interjected, "Just to clarify, you mean she'll be tube fed? Not that her family or caregivers will be feeding her food with a spoon?" The MD: "Oh yes, for course." Many times, I've felt like the dr just didn't give them a very accurate picture of the prognosis, and it creates a lot of futile care

7. Emotional responsiveness and attachment to the patient: 0 -- I do sometimes have to take five because watching the distraught family makes me feel sad and I can feel tears in my eyes, (EOL care in my ICU is generally because heroic measures have failed. It's not a dx the pt has had for months to years) but I don't feel emotionally attached.

8. Cultural barriers between patient and nurse: 3-minus -- only once has this happened. The kid was completely anoxic and had a GCS of 4. Family were devout Muslim, and felt that any inaction on our part was tantamount to murder, including making DNR. That and they had to get permission from a religious leader who was thousands of miles away (apparently their local imam couldn't?)

Please list any other barriers you have faced when providing end of life care to patients in the ICU:

Maevish, ASN, RN · Apr 14, 2016

Hello! I am currently a senior nursing student and I am working on research for my thesis. If you are a critical care nurse I would really appreciate it if you took my survey, it should only take a few minutes.
Do you have experience giving end of life care to patients in an ICU setting?
Yes ___Y__ No ____
What is your gender? Male ______ Female __X_____
What is your age?
20-25_____
26-30_____
31-35___X__
36-40_____
41-45_____
46-50_____
51-55_____
56 + _____
How many years of experience do you have in an ICU setting?
0-5_____
6-10__X___
11-15_____
16-20_____
21 + _____
What is your highest level of nursing education?
Associate's __X___
Bachelor's _____
Master's _____
Doctorate _____
Do you work in a rural or urban hospital?
Rural _____
Urban *****__X___ (Sort of. It's the smallest hospital I've been to)
Have you faced barriers when providing end of life care to patients in the ICU?
Yes __x___ (somewhat. unsure what this means)
No _____
Barriers to Patient Care â€“ please choose a number on the scale based on how much it has impacted the end of life care you have given patients.
0 is no impact, 3 is some impact, and 6 is high impact.

1. Patient is unconscious and is unable to make own decisions about medical treatment: Depends on the family/DPOA if there's a document already made. Can still be difficult if there is a document and they don't agree with what the pt wishes. Usually 3, but sometimes 6

2. High stress or moral stress when providing care: 3 (depending on the situation)

3. Patient/family/caregiver lack of understanding of end of life care or current prognosis: 3 (again, it depends. It can be awful and it can be no problem at all).

4. Regulatory restriction of pain management/symptom management: 3

5. Self-knowledge deficit of end of life care: 3

6. Poor Communication; either provider â€“ patient â€“ caregiver or provider â€“ provider:3

7. Emotional responsiveness and attachment to the patient: 0 (only because those times are so few and far between. It's usually a blessing)

8. Cultural barriers between patient and nurse:3

Please list any other barriers you have faced when providing end of life care to patients in the ICU:

I had a doctor the other day suggest a morphine gtt for my pt because it would be "easier on the husband if he wasn't here all night again", intimating that it would be better to push her over the edge than to just keep her comfortable and let her husband sacrifice his rest for her (which he was gladly doing).

Families can also be horrible. They don't care to visit or keep in contact unless they're "loved one" dying will stop their social security checks or other income they receive. Usually the ethics committee will get involved at that point, but sometimes it drags on and on.

Sometimes, even though I started in Oncology, I'm wary of the amount of pain medicine prescribed, but I can use my nursing judgment and most of the time, if it's a chronic illness and they've been taking huge amounts at home, they can handle it.

P.S. As for the numbered/graded questions before, I feel bad for not giving a straight answer, but I was trying to go for the average. The answers I would give may be 100% different depending on the shift, the family, or the hospital I happen to be in. There's usually at least one issue in end of life cases (for me it's almost always a family member or two who need to be convinced that the pt isn't getting better and is suffering needlessly).

Hope your project went well!

xo

Maevish, ASN, RN · Apr 14, 2016

End of Life care is a great topic but you may be a bit off-base. ICU is very expensive with strict admission and discharge criteria in place to make sure it is not abused - e.g. physician or family want "more" available nursing time. In most facilities, EOL patients who are not actively receiving any 'heroic' interventions may not qualify for ICU - they would be discharged to a more appropriate setting such as palliative care or hospice.
Perhaps you'd get a better response rate by addressing a different target audience?

Until I came to this horrid little hospital I would've said the same thing, but they've given me numerous hospice/comfort care pts and I don't get it either. I'm used to big trauma ICU's like Highland in Oakland or UCDavis so this place is bizarre to me. Before this place I did get a ton of those pts in Oncology, of course, but also sometimes on Med/Surg.

But of course here, if someone is on BIPAP, they're automatically admitted to the ICU, so this place is definitely NOT the norm! haha

xo