Facilitators and barriers in end of life care

The population consisted of 37 ICU qualified trained nurses, ICU experienced nurses, and enrolled nurses working in the specific ICU. The researcher purposively selected a sample of 14 participants. In this study, data was collected by means of face-to-face in-depth interviews, using an interview guide. Using semi-structured inter participants’ experience of facilitators and barriers to end-of-life care (EOLC) in the specific ICU. The researcher used Tesch’s eight-step method to analyze the data. The study found that Emotional stress; cultural differences; no clear directives/guidelines; poor communication; rigid visiting hours; no signed consent for DNR, and ineffective teamwork were barriers pertaining to end-of-life care. Communication; informed consent and shared decision-making in healthcare, particularly in end-of-life care; informed consent for EOLC; open visitation; allowing cultural practices; fair and transparent staff allocation; effective teamwork, and a multidisciplinary approach were facilitators pertaining to end-of-life care. The findings and recommendations should assist nurses caring for end-of-life patients in adult ICUs to prevent barriers and promote facilitators pertaining to end-of-life care to ensure quality care.

本研究的研究对象为37名在特定重症监护室（Intensive Care Unit，ICU）工作的经ICU资质培训护士、资深ICU护士及注册护士。研究者采用目的性抽样法选取了14名研究参与者。本研究借助访谈提纲，通过面对面深度访谈的方式收集数据，以半结构化访谈形式探究特定ICU内参与者在临终关怀（End-of-Life Care，EOLC）中面临的促进因素与阻碍因素。研究者采用特施（Tesch）八步分析法对采集的数据进行分析。本研究发现，阻碍临终关怀开展的因素包括：情绪应激、文化差异、缺乏明确的操作规范与指南、沟通不畅、探视时间僵化、未签署不心肺复苏（Do Not Resuscitate，DNR）知情同意书以及团队协作效率低下。而有助于临终关怀开展的促进因素则包括：良好的沟通、医疗场景下的知情同意与共同决策（尤其针对临终关怀场景）、临终关怀相关知情同意、开放探视制度、尊重文化习俗、公平透明的人员配置、高效的团队协作以及多学科协作模式。本研究的结果与建议可帮助成人ICU中照护临终患者的护士规避临终关怀的阻碍因素，强化促进因素，从而保障临终关怀的服务质量。