End-of-Life Decision-Making in Pediatric and Neonatal Intensive Care Units in Croatia-A Focus Group Study among Nurses and Physicians.

Filip Rubic,Branimir Peter,Julije Mestrovic,Boris Filipovic-Grcic,Kristina Lah Tomulic,Lovorka Brajkovic,Bojana Nevajdic,Milivoj Novak,Marko Curkovic,Ana Borovecki

doi:10.3390/medicina58020250

Abstract

Background and Objectives: Working in pediatric and neonatal intensive care units (ICUs) can be challenging and differs from work in adult ICUs. This study investigated for the first time the perceptions, experiences and challenges that healthcare professionals face when dealing with end-of-life decisions in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) in Croatia. Materials and Methods: This qualitative study with focus groups was conducted among physicians and nurses working in NICUs and PICUs in five healthcare institutions (three pediatric intensive care units (PICUs) and five neonatal intensive care units (NICUs)) at the tertiary level of healthcare in the Republic of Croatia, in Zagreb, Rijeka and Split. A total of 20 physicians and 21 nurses participated in eight focus groups. The questions concerned everyday practices in end-of-life decision-making and their connection with interpersonal relationships between physicians, nurses, patients and their families. The constant comparative analysis method was used in the analysis of the data. Results: The analysis revealed two main themes that were the same among the professional groups as well as in both NICU and PICU units. The theme “critical illness” consisted of the following subthemes: the child, the family, myself and other professionals. The theme “end-of-life procedures” consisted of the following subthemes: breaking point, decision-making, end-of-life procedures, “spill-over” and the four walls of the ICU. The perceptions and experiences of end-of-life issues among nurses and physicians working in NICUs and PICUs share multiple common characteristics. The high variability in end-of-life procedures applied and various difficulties experienced during shared decision-making processes were observed. Conclusions: There is a need for further research in order to develop clinical and professional guidelines that will inform end-of-life decision-making, including the specific perspectives of everyone involved, and the need to influence policymakers.

Highlights

Caring for a critically ill child in the context of an intensive care unit (ICU) is a cognitively and emotionally challenging task [1,2,3]
The analysis revealed two main themes that were the same in both professional groups, as well as in both neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) units: critical illness and end of life
The perceptions and experiences of end-of-life issues among nurses and physicians working in NICUs and PICUs in the Republic of Croatia share multiple common characteristics

Summary

Introduction

Caring for a critically ill child in the context of an intensive care unit (ICU) is a cognitively and emotionally challenging task [1,2,3]. The most challenging of all issues that occur within neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) are those related to end of life [1,2,4,6,12,13]. The literature signals that this could be a critical factor in the high and growing incidence of burnout among healthcare professionals in NICUs and PICUs, which has a significant and detrimental influence on the quality and safety of care, as well as on different patient, family member and health professional outcomes [2,4,19]. Materials and Methods: This qualitative study with focus groups was conducted among physicians and nurses working in NICUs and PICUs in five healthcare institutions (three pediatric intensive care units (PICUs) and five neonatal intensive care units (NICUs)) at the tertiary level of healthcare in the Republic of Croatia, in Zagreb, Rijeka and Split. Conclusions: There is a need for further research in order to develop clinical and professional guidelines that will inform end-of-life decision-making, including the specific perspectives of everyone involved, and the need to influence policymakers

Methods

Results

Discussion

Conclusion