Perceptions of family members and heathcare professionals on the quality of dying and death in ICU of Hong Kong

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Perceptions of family members and heathcare professionals on the quality of dying and death in ICU of Hong Kong

 

Author: Chan, Hoi Yi
Title: Perceptions of family members and heathcare professionals on the quality of dying and death in ICU of Hong Kong
Degree: M.Sc.
Year: 2013
Subject: Intensive care nursing -- China -- Hong Kong.
Intensive care units -- Psychological aspects.
Hong Kong Polytechnic University -- Dissertations
Department: School of Nursing
Pages: ix, 117 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2644458
URI: http://theses.lib.polyu.edu.hk/handle/200/7118
Abstract: Background: ICU is a common place for the transition from curative interventions to the end of life care. In order to help healthcare professionals to manage the death in ICU and improve the quality of dying so as to achieve a "good" death, this is important to understand the quality of dying in ICU. Many research affords were made to identify the barriers of the end of life care, recommendations for quality improvement in the end of life care and to study the quality of dying and death in ICU. There was no attempt to study the quality of dying and identify the factors associated with it in Chinese population. Aim: The aim of the study was to examine the quality of dying and death of ICU patients from the perceptions of nurses and family members of dying patients. Design: This was a cross-sectional survey of nurses and family members conducted following the death of patients in an adult intensive care unit by using ICU-Quality of Dying and Death Questionnaire (ICU-QODD). Method: The study involved 36 deaths between July, 2012 and February, 2013. Demographic data of the patient, nurses, family members were collected. Within 48 hours after the patient's death, 2 nurses who provided care during the last 12-hour before the patient death were recruited and given the self-administer ICU QODD-healthcare professional. One month after the death, the designated family member was contacted and the self-administer ICU QODD-family member was sent by post. The differences of total quality scores and the individual items mean score among nurses and family members were analysed by Wilcoxon signed-rank. The frequency ratings of the ICU QODD items were further tested for correlation with the ICU QODD total score. For the dichotomous variables, which were those with "yes/no" as the answers, were assess using Mann-Whitney tests. For the frequency rating variables, which was treated as continuous variables, were assessed using Spearman's correlation coefficients.
Result: Seventeen cases obtained responses from both nurses and family members. Data of these 17 cases were further analysed. It was found that the overall quality of dying and death score were the same for nurses and family members (52/100). Significant differences between these groups were notably (p<0.05) on items: having religious/spiritual visit and conscious state at the moment of death. Four items were found to be related to higher quality of dying and death overall QODD score. These were 1) having discussion of wishes for end of life care (p=0.027), 2) having control of pain (r=0.514, p=0.035), 3) breath comfortably (r=0.541, p= 0.035) and 4) maintaining dignity and self-respect (r=0.592, p= 0.012). Conclusion: Family members and nurses gave moderate quality rating to the dying and death in ICU. Based on the family members and nurses' ratings, the study identified several items which related to higher quality of dying and death. These were symptoms management, discussion of end of life care wishes and maintaining dignity and self respect. Suggested interventions were based on these items to improve the quality of dying and death in the local ICU. Since it was the first study about quality of dying and death in Hong Kong, further studies are needed to collect more comprehensive views about the quality of care as well as quality of dying in local ICUs with larger sample sizes. Thereby, factors that are associated with higher quality of dying and death can be identified.

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