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Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context.

Brooks, Laura, Manias, Elizabeth and Nicholson, Patricia 2016, Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context., Australian critical care, In Press, pp. 1-6, doi: 10.1016/j.aucc.2016.08.001.

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Title Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context.
Author(s) Brooks, Laura
Manias, ElizabethORCID iD for Manias, Elizabeth
Nicholson, PatriciaORCID iD for Nicholson, Patricia
Journal name Australian critical care
Season In Press
Start page 1
End page 6
Total pages 6
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016
ISSN 1036-7314
Keyword(s) Collaboration
End-of-life care
Intensive care
Shared-decision making
Summary BACKGROUND: Patients admitted to Australian intensive care units are often critically unwell, and present the challenge of increasing mortality due to an ageing population. Several of these patients have terminal conditions, requiring withdrawal of active treatment and commencement of end-of-life (EOL) care. OBJECTIVES: The aim of the study was to explore the perspectives and experiences of physicians and nurses providing EOL care in the ICU. In particular, perceived barriers, enablers and challenges to providing EOL care were examined. METHODS: An interpretative, qualitative inquiry was selected as the methodological approach, with focus groups as the method for data collection. The study was conducted in Melbourne, Australia in a 24-bed ICU. Following ethics approval intensive care physicians and nurses were recruited to participate. Focus group discussions were discipline specific. All focus groups were audio-recorded then transcribed for thematic data analysis. RESULTS: Five focus groups were conducted with 11 physicians and 17 nurses participating. The themes identified are presented as barriers, enablers and challenges. Barriers include conflict between the ICU physicians and external medical teams, the availability of education and training, and environmental limitations. Enablers include collaboration and leadership during transitions of care. Challenges include communication and decision making, and expectations of the family. CONCLUSIONS: This study emphasised that positive communication, collaboration and culture are vital to achieving safe, high quality care at EOL. Greater use of collaborative discussions between ICU clinicians is important to facilitate improved decisions about EOL care. Such collaborative discussions can assist in preparing patients and their families when transitioning from active treatment to initiation of EOL care. Another major recommendation is to implement EOL care leaders of nursing and medical backgrounds, and patient support coordinators, to encourage clinicians to communicate with other clinicians, and with family members about plans for EOL care.
Language eng
DOI 10.1016/j.aucc.2016.08.001
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Elsevier
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Document type: Journal Article
Collection: School of Nursing and Midwifery
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Created: Mon, 10 Oct 2016, 11:47:24 EST

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