End-of-life Care Practice Research Articles

Trends in place of death in a small developing country: a population-level study using death certificate data

BackgroundValuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in...

Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings.

To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. A qualitative study based on grounded theory developed by Corbin and Strauss. Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. The core category, "guiding the rebuilt care community to assist the dying resident" comprised five categories: "assessing the resident's stage," "harmonizing care with the dying process," "rebuilding a care community," "helping community members care for the resident," and "encouraging community members to give meaning." The participants were described as "traditional village elders" who werethe integral members of the care community, as well as guides who helped and encouraged the community. Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents' uncertainties and vulnerabilities as well as their cultural backgrounds. This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

End of life care practice and symptom management outcomes of nursing home residents with dementia: secondary analyses of IQUARE trial.

End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6months of life, and to compare these patterns of care between residents with dementia who died within 6months and those who survived longer. Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6months of follow-up were more likely to be identified with a formal "end-of-life" status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.

Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study

PurposeIn Korea, hospice palliative care (HPC) provision for cancer patients has increased recently. However, whether end of life (EoL) care practices have improved along with the development of HPC is unclear. We intended to investigate the changes in EoL care practices and their association with HPC referral.Materials and MethodsRetrospective medical record review of adult cancer patients who died at National Cancer Center Korea from 1 January 2009 to 31 December 2014 was performed. Changes of EoL practices including chemotherapy within 2 weeks from death, death in intensive care unit (ICU), documentation of “do not resuscitate (DNR)” within 7 days from death and referral to HPC from 2009 to 2014 were analyzed as well as the association between referral to HPC and other practices.ResultsA total of 2,377 cases were included in the analysis. Between 2009 and 2014, referral to HPC increased and DNR documentation within 7 days from death decreased significantly. Cases for chemotherapy within 2 weeks from death and death in ICU didn’t change over the study period. Patients referred to HPC were less likely to receive chemotherapy within 2 weeks from death, die in ICU and document DNR within 7 days from death.ConclusionDuring the study period, EoL practices among cancer patients partly changed toward less aggressive in our institution. HPC referral was associated with less aggressive cancer care at the EoL. Policies to promote EoL discussion are necessary to improve the EoL practices of cancer patients.

Conflict Experienced by Nurses Providing End-of-life Care in Emergency Departments in Japan.

Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.

Open-Ended Responses to Bereaved Surveys: Best Practices from the Veterans Health Administration and Kaiser Permanente (QI710)

1.Recognize opportunities to collect and/or use existing qualitative self-reported data in their practice settings for quality improvement.2.Discuss how self-reported data can be used to educate administrators and non-palliative care clinicians about end-of-life care. The U.S. Veterans Health Administration’s (VA) Bereaved Family Survey (BFS) is administered to the next-of-kin of Veterans who die in VA hospitals; Kaiser Permanente (KP) recently piloted an abridged version of the BFS, adapted items for its members across inpatient and outpatient settings. Narrative responses to 2 BFS open-ended questions informed identification of best end-of-life practices. We compared VA and KP BFS narrative responses to identify best care practices across 2 large integrated delivery systems. Content analysis of: Is there anything else that you would like to share about either:1.The patient’s care during his/her last month of life?2.How the care could have been improved for the patient? A sample of responses to VA’s and 1,463 responses to KP’s open-ended questions were reviewed to identify best practices. Responses confirmed the quantitative BFS structured content (i.e., multiple-choice items) and generally supported its domains. However, unique processes of care emerged. For example, using music therapy to calm and sooth Veterans was identified in the VA sample. Data suggests opportunities and specific approaches for improving quality of life at the end of life. Other processes of care to emerge from both data sets included frequent and timely updates to family and loved ones on patients’ clinical status as death nears. Among KP responses, it was noted that families appreciate more frequent and timely interaction with clinicians with respect to early information sharing and dialogue about end-of-life process, what to expect, and how they can help their loved one. Analysis of qualitative data affirmed the domain structure and comprehensive nature of the BFS. It also provided unique insights into best end of life care practices.

End-of-Life Care in Neonatal Intensive Care Units from an Asian Perspective: An Integrative Review of the Research Literature.

Background: End-of-life (EOL) care in neonatal intensive care units (NICUs) can vary depending on religious beliefs of health care providers and families as well as the sociocultural environment. Although guidelines exist for EOL care in NICUs, most are based on Western studies, and little is known about such care in Asian countries, which have different religious and social background. Objective: This review synthesized empirical research to reveal the state of the science on infant EOL care in Asian countries. Design: This was an integrative review. Setting/Subjects: Data were collected from studies identified in CINAHL, Embase, PsycINFO, and PubMed. The search was limited to current empirical studies involving infant EOL care in Asian countries and published in English between 2007 and 2016. Results: Of 286 studies initially identified, 11 empirical studies conducted in Hong Kong, India, Israel, Japan, Mongolia, Taiwan, and Turkey were included in the review. Four themes were captured: factors influencing decision making, trends in decision making, practical aspects of EOL care, and health care providers' preparation. In most NICUs, health care providers controlled decisions regarding use of life-sustaining treatment, with parents participating in decision making no more than 60% of the time. Although care decisions were gradually changing from "do everything" for patient survival to a more palliative approach, comfort care at the EOL was chosen no more than 63% of the time. Conclusion: While infant EOL care practice and research vary by country, few articles address these matters in Asia. This integrative review characterizes infant EOL care in Asia and explores cultural influences on such care.

Factors That Influence Attitudes Toward End-of-Life Care Among Medical Students: Nationwide Survey for Fourth-Year Korean Medical Students.

Positive attitudes for end-of-life (EOL) care along with adequate education are key factors for the provision of quality EOL care. This national study was conducted to identify the factors that influence attitudes toward EOL care on medical students. An anonymous survey was designed and administered to fourth-year medical students at all 41 medical schools in Korea. Topics related to EOL care were assessed in classroom teaching, bedside teaching, and feedback experiences during clinical clerkships. Seven questions for self-rated attitudes and affecting factors were analyzed toward EOL care. With a response rate of 49.2%, the median number of topics recognized by the students as having been delivered was 5 of 11 topics in classroom lectures and 1 of 8 topics in clinical experience. Although few (21.2%) participants indicated that they felt ready for EOL care practice, nevertheless, most felt that they should have adequate knowledge of and preparation for clinical competency in EOL care. Several parameters including respondent's demographics and exposure to EOL care topics in classroom and in bedside teaching influenced the responses to all 7 attitude questions. However, having more than 1 bedside experience was the only factor positively affecting all attitudinal measures. Clinical experience related to EOL care seems to be the utmost priory in fostering positive attitudes and competency among medical students.

End-of-Life Practices in Rural South India: SocioCultural Determinants.

Introduction:End of life care of terminally ill is a sensitive topic in our socio cultural ethos. In a country where Euthanasia policies are widely debated, dignified death is a desired form of death. Euthanasia literally means “good death”. In India the debate still continues on practices related to euthanasia and its legalization until recently when the verdict on the passive euthanasia has been passed by the supreme court. In addition, lack of an effective palliative care system has led to complex situations towards the end of life. Globally, it is estimated that palliative care is needed in 40-60% of all deaths. However there is no training or facility to meet this demand.Methodology:A focus group discussion (FGD) was carried out among 22 residents in a rural area of Tamilnadu to identify the social and cultural determinants of end of life care practices. A FGD guide was prepared and after an informed consent the study was undertaken. An in depth interview was carried out among a sub group of participants.Results:The FGD and the IDI revealed several end of life practices in the rural areas such as Thalaikoothal, Feeding the ill with holy water and sand etc. The study also revealed the major determinants leading to such practices such as the social, and cultural beliefs in addition to economical and emotional factors.Conclusion:Several factors determine the end of life decisions in a family ranging from economical to social and cultural factors. While we are examining these factors, it is important to strengthen the palliative care provision in the country by building capacity and integrating it in primary care.

A national survey of medical students and educators at Korean medical schools, examining the impact of end-of-life care education provided to Korean medical students based on their attitudes.

55 Background: This study explored the current state of end-of-life (EoL) care education provided to Korean medical students and their self-rated attitudes toward EoL-related education. Methods: An anonymous survey was given to fourth year medical s tudents and the principle EoL care educators at all 41 Korean medical schools. The medical educators were asked to identify the EoL care-related topics that they usually teach students. Both students and medical educators completed seven items regarding self-perceived attitudes. Results: In total, 23 medical educators (56.1%) and 1,545 medical students (46.3%) responded. Of nine topics related to EoL care, the most frequently taught topics were delivering bad news (100%) and managing physical symptoms (74.1%), whereas setting treatment goals was taught the least frequently (37.0%). Approximately half of the educators taught the withdrawal of life-sustaining devices (59.3%), death and dying (55.6%), and advanced directives (55.6%). When the medical students were dichotomized into groups taught at least six topics (n = 815) versus five or fewer topics (n = 729), the group taught at least six topics expressed more satisfaction with EoL care education and they considered EoL care-related issues during their clerkship rotations. They also had fewer negative answers when they were asked about their readiness to practice EoL care. Conclusions: EoL education is inadequate for Korean medical students. However, medical students who were more fully instructed in this topic reported self-rated competency regarding EoL care-related issues. Further research should develop an education system that provides sufficient knowledge and training in EoL care for Korean medical students.

NICU Nurses' Suggestions for Improving End-of-Life Care Obstacles

BackgroundNeonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. ObjectiveThe objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs. MethodsSuggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions. ResultsA total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between healthcare teams, (3) ending futile care earlier, (4) realistic and honest physician communications to families, (5) providing a “good death,” (6) improved nurse staffing, (7) need for EOL education, (8) earlier entry into hospice/palliative care, (9) availability of ancillary staff, and (10) allowing parents more time to prepare for death. ConclusionsDespite the variety of obstacles encountered in providing EOL care to dying infants and their families, NICU nurses can influence environmental factors, help improve communication, and use self-assessment tools to identify current EOL care practices.

How We Should Assess the Delivery of End-Of-Life Care in General Practice? A Systematic Review.

The majority of end-of-life (EOL) care occurs in general practice. However, we still have little knowledge about how this care is delivered or how it can be assessed and supported. (i) To review the existing evaluation tools used for assessment of the delivery of EOL care from the perspective of general practice; (ii) To describe how EOL care is provided in general practice; (iii) To identify major areas of concern in providing EOL care in this context. A systematic review. Systematic searches of major electronic databases (Medline, EMBASE, PsycINFO, and CINAHL) from inception to 2017 were used to identify evaluation tools focusing on organizational structures/systems and process of end-of-life care from a general practice perspective. A total of 43 studies representing nine evaluation tools were included. A relatively restricted focus and lack of validation were common limitations. Key general practitioner (GP) activities assessed by the evaluation tools were summarized and the main issues in current GP EOL care practice were identified. The review of evaluation tools revealed that GPs are highly involved in management of patients at the EOL, but there are a range of issues relating to the delivery of care. An EOL care registration system integrated with electronic health records could provide an optimal approach to address the concerns about recall bias and time demands in retrospective analyses. Such a system should ideally capture the core GP activities and any major issues in care provision on a case-by-case basis.

Talking about the end - involving service users in an end-of-life care quality improvement initiative in a residential care setting

Introduction: Staff members in a residential setting for older people participated in a quality improvement initiative to improve end of life care practices within their facility. As part of this initiative, staff members sought to create a genuine culture of involvement for service users, and staff. Talking about end of life care is a difficult topic. It is recognised that in practice, there is generally very poor communication around end of life issues and care (Quinlan & O'Neill, 2013). This is particularly true where service users have cognitive impairment or dementia. A novel approach to involving service users was required in this setting to ensure that their views were accurately represented. Objectives: The purpose of this project was to adopt an integrated care approach to a quality improvement initiative in a residential setting, putting service user outcomes and experience at the centre of the change process. Specifically: - To involve service users, particularly those whose voices are seldom heard, in the review and development of end of life care practices - To empower service users to develop and own a unique vision for good end of life care in their residential centre Method: A focus group consisting of 9 service users was convened. Participants were considered for inclusion based on the following criteria: - Alert enough to attend group session - Adequate health and ambulatory ability (walking; in wheelchair/high support chair) - Participants were not automatically excluded on the basis of cognitive status or communication impairment. Where communication could be supported in the group by a skilled moderator (as predicted by specialist Speech & Language Therapy assessment), service users were invited to participate The group was facilitated by a Senior Grade Speech & Language Therapist (SLT), and SLT Assistant. Results: Service users with dementia, cognitive impairment and communication impairments were successfully supported to directly communicate their views on end of life care. The focus group method served to empower service users, as evidenced by: - Service users developing their own unique end of life symbol - Service users requesting that the focus group meetings continue on a regular basis to allow them to explore other topics relevant to their care. Service users will determine and direct themes for future meetings. Discussion: The Irish National Strategy for Service User Involvement highlights service user input as a key element in the delivery of patient centred care. It is vital that the needs and preferences of residents who have difficulty communicating are actively sought, and every effort is made to support them to communicate their views directly (HIQA, 2016). With the appropriate methods and communication facilitation strategies, service users with dementia and cognitive impairment can be supoorted to express their views, even with regard to more challenging topics. A focus group method can create an accepting, non-threatening environment for service users. The need for skilled facilitators is of paramount importance in supporting individuals with dementia and cognitive impairment. As specialists in communication, SLTs are ideally placed to adapt, modify and support communication.

Enhancing Care of Aged and Dying Prisoners: Is e-Learning a Feasible Approach?

Prisons and jails are facing sharply increased demands in caring for aged and dying inmates. Our Toolkit for Enhancing End-of-life Care in Prisons effectively addressed end-of-life (EOL) care; however, geriatric content was limited, and the product was not formatted for broad dissemination. Prior research adapted best practices in EOL care and aging; but, delivery methods lacked emerging technology-focused learning and interactivity. Our purposes were to uncover current training approaches and preferences and to ascertain the technological capacity of correctional settings to deliver computer-based and other e-learning training. An environmental scan was conducted with 11 participants from U.S. prisons and jails to ensure proper fit, in terms of content and technology capacity, between an envisioned computer-based training product and correctional settings. Environmental scan findings focused on content of training, desirable qualities of training, prominence of "homegrown" products, and feasibility of commercial e-learning. This study identified qualities of training programs to adopt and pitfalls to avoid and revealed technology-related issues to be mindful of when designing computer-based training for correctional settings, and participants spontaneously expressed an interest in geriatrics and EOL training using this learning modality as long as training allowed for tailoring of materials.

Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison

ABSTRACTPrisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care—including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.

Trend in and Correlates of Undergoing Radiotherapy in Taiwanese Cancer Patients' Last Month of Life

ContextA significant proportion of cancer patients at end of life (EOL) undergo radiotherapy, but this evidence is not from nationwide population-based studies. ObjectivesThe aims of this population-based study were to investigate the trend in undergoing radiotherapy among Taiwanese cancer patients' last month of life (EOL radiotherapy) in 2001–2010 and to identify factors associated with EOL radiotherapy. MethodsThis was a population-based retrospective cohort study analyzing data from Taiwan's national death registry, cancer registry, and National Health Insurance claims for EOL radiotherapy using multilevel generalized linear mixed modeling. Participants were Taiwanese cancer patients (N = 339,546) who died in 2001–2010. ResultsOverall, 8.59% (7.97%–9.85%) of patients underwent EOL radiotherapy with a decreasing trend over time. Correlates of EOL radiotherapy included male gender, younger age, residing in less urbanized areas, diagnosis of lung cancer, metastatic disease, death within two years of diagnosis, and without comorbidities. Cancer patients were more likely to undergo EOL radiotherapy if they received primary care from medical oncologists and pediatricians, in a nonprofit, teaching hospital with a larger case volume of terminally ill cancer patients, and greater EOL care intensity. ConclusionApproximately one-tenth of Taiwanese cancer patients underwent EOL radiotherapy with a decreasing trend over time. Undergoing EOL radiotherapy was associated with demographics, disease characteristics, physician specialty, and primary hospital's characteristics and EOL care practice patterns. Clinical and financial interventions should target hospitals/physicians that tend to aggressively treat at-risk cancer patients at EOL to carefully evaluate the appropriateness and effectiveness of using EOL radiotherapy.

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review.

BackgroundMultiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.MethodsTo explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014.ResultsThe search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.ConclusionsThis review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.

Nurses' care practices at the end of life in intensive care units in Bahrain.

The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

Critical care nurses’ practices in the provision of end-of-life care

Introduction - To improve the care that dying patients and their families receive and to support nurses in the provision of this care, it is important that the end-of-life care (EOLC) practices of critical care nurses are identified. Limited research has identified the actual EOLC practices of critical care nurses. Objectives - To identify critical care nurses’ EOLC practices and the frequency of these practices. Methods - A convenience sample of ACCCN members was invited to complete an online survey. Items on the survey were measured on a 5-point rating scale where 1=never and 5=always. Descriptive analyses and exploratory factor analysis was undertaken on survey responses from 392 critical care nurses (response rate 25%). Results - Six EOLC practice areas were identified: information sharing, environmental modification, emotional support, patient and family centred decision making, symptom management and spiritual support. The items most frequently undertaken were information sharing and environmental modification practices including answering questions (M=4.61, SD=0.58) and placing chairs around the bed (M=4.73, SD=0.51), whilst items least frequently undertaken were emotional support practices, such as encourage the family to reminisce (M=3.72, SD=0.87). Conclusion - Critical care nurses’ engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified EOLC practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end-of-life and their family. These practices arguably require less emotional engagement by the nurse. Nurses must be adequately prepared and supported to provide comprehensive care in all areas of EOLC practice.

Factors associated with critical care nurses’ engagement in end-of-life care practices

Introduction - Critical care nurses frequently engage in the provision of end-of-life care (EOLC). Identification of factors associated with specific EOLC practices can inform practice development to improve the care that patients and their families receive and support nurses in the provision of this care. Objectives - To identify factors associated with critical care nurses’ engagement in six areas of EOLC practice: Information sharing, environmental modification, emotional support, patient and family centred decision making, symptom management and spiritual support. Methods - Using data obtained from a national survey of 392 critical care nurses (response rate 25%), univariate general linear models were built for each EOLC practice area. Results - Findings revealed that more positive scores on scales reflecting palliative values and support for patient and family preferences were associated with more frequent engagement in the EOLC practices examined in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family decision making and emotional support of patients and their families. Contextual factors had a limited influence as explanatory variables. Conclusions - Critical care nurses’ personal values are at the core of their practice intentions. Development of positive values among nurses towards EOLC can thus contribute to quality care for patients and their families. Additionally, education opportunities to enhance preparation and strategies that assist critical care nurses to support patient and family preferences will contribute to increased participation in the EOLC practice areas identified in this study.