Clinical Trial Details
— Status: Not yet recruiting
Administrative data
| NCT number |
NCT06285305 |
| Other study ID # |
kilis_2 |
| Secondary ID |
|
| Status |
Not yet recruiting |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
April 1, 2024 |
| Est. completion date |
June 1, 2024 |
Study information
| Verified date |
February 2024 |
| Source |
Kilis 7 Aralik University |
| Contact |
islam RA ELAGÖZ, MsC |
| Phone |
+905304096124 |
| Email |
islam.elagoz[@]kilis.edu.tr |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational [Patient Registry]
|
Clinical Trial Summary
This study aims to explore the attitudes and behaviors of nurses working in surgical
intensive care units (ICUs) towards end-of-life care, alongside identifying the barriers they
face in providing such care. Despite the universal need for end-of-life care, with an
estimated 56.8 million people requiring it annually, only a fraction receive adequate
services. The concept of a "good death" has evolved, now emphasizing patient and family
wishes, and aligning with clinical, cultural, and ethical standards. In the U.S., a
significant portion of deaths occur in hospitals, often involving surgical interventions in
the final stages of life. Nurses in ICUs play a crucial role in delivering end-of-life care,
making their attitudes and behaviors pivotal to the quality of care provided. Previous
studies have indicated a positive correlation between nurses' attitudes towards end-of-life
care and their ethical conduct in care delivery. However, research specifically focusing on
surgical ICU nurses and the challenges they encounter in end-of-life care is limited. This
study seeks to fill that gap, enhancing understanding of the factors that influence
end-of-life care in surgical ICUs and potentially guiding improvements in care practices and
policy.
Description:
End-of-life care aims to meet the physical, psychological, social, and spiritual needs of
patients approaching death and their families, helping people live as well as possible until
death, supporting decision-making about the last months of life, and ensuring a dignified
death (Filiz 2017). It also encompasses support provided to the family during the illness and
care after death to facilitate a healthier grieving process (Karakaya 2020). Every year, an
estimated 56.8 million people require end-of-life care, of which 25.7 million are in their
last year of life, yet only 14% receive this care (WHO 2020). Everyone has the right to die
in peace, just as they have the right to live in peace. The concept of a good death has
evolved from being perceived in the past based on different parameters, such as dying at
home, dying without pain, dying in a hospital, or dying accompanied by religious rituals
(Uğur 2020), to being generally perceived today as a death that is in accordance with the
wishes of patients and their families; and is compatible with clinical, cultural, and ethical
standards (Granda-Cameron 2012).
In the United States, approximately 2.5 million people die each year, with more than 60% of
these deaths occurring in hospitals, and about half of those dying in hospitals do so within
three days of admission to an intensive care unit (Cicarello 2003). Surgical intervention is
a common practice in the final stages of life, especially among hospitalized patients, with
an estimated one-third of patients undergoing surgery in the last month of their life (Taylor
2017). A study conducted by Özkan and Şahinoğlu in 2009 in Turkey found that the one-year
mortality rate in the surgical intensive care unit of a university hospital was 46% (Özkan
2009).
Nurses are responsible for the care of patients in the dying process in intensive care units.
Therefore, nurses working in intensive care units can encounter death at any moment (Yılmaz
2015). In this context, end-of-life care, which includes the patient and their family, is a
natural element of intensive care nursing (Filiz 2017).
An attitude is the storage in the mind of feelings, thoughts, and tendencies towards an
object (Yavuz Karamanoğlu 2022). Behavior is the actions and reactions shown by an individual
in response to situations (Cengiz 2020). Nurses are influenced by their individual attitudes
and behaviors while practicing their profession. The attitudes and personal characteristics
of nurses affect their professional competence (Karahan 2018). Therefore, the attitudes and
behaviors of nurses towards end-of-life care can affect the quality of life, decision-making
processes, and coping skills with death of patients and their families. A study showed that
the attitudes and behaviors of intensive care nurses towards end-of-life care are positively
related to their ethical attitudes in the care process (Efil 2023). Another study found that
nurses' attitudes and behaviors affect their levels of clinical decision-making (Erzincanlı
2021). A strong positive relationship was found between nurses' attitudes and behaviors
towards end-of-life care and their personal development, with self-actualized nurses having
more positive attitudes and behaviors towards end-of-life care (Cengiz 2020).
Another factor determining the quality and effectiveness of end-of-life care in intensive
care is the barriers to end-of-life care. These barriers can be related to the patient or
family members, such as communication problems, religious beliefs and cultural differences,
emotional and psychological stress experienced by family members. Institutional factors can
also affect the effectiveness of end-of-life care, such as restricted family access to
intensive care or lack of procedures related to end-of-life care. In addition,
clinician-related factors are important, such as inadequate communication skills, unrealistic
expectations about prognosis, or stress can affect the quality of end-of-life care
(Friedenberg 2011; Xu 2022).
Therefore, identifying the attitudes and behaviors of intensive care nurses towards
end-of-life care can be effective in understanding and solving problems that arise in nurses'
clinical decision-making processes, the quality of care provided to patients and their
families, and ethical issues in end-of-life care practices. Identifying educational and
research needs in this area will also be beneficial in developing nurses' decision-making
abilities and increasing their levels of dealing with ethical challenges. Additionally,
identifying barriers to end-of-life care; can facilitate the reduction of these barriers and
the implementation of measures in clinics.
The literature review shows studies examining factors affecting end-of-life care in intensive
care, nurses' decision-making processes, ethical issues, and factors related to nurses
(Erzincanlı 2021; Cicarello 2003; Yılmaz 2015; Kuşlu 2019; Ranse 2012; Harris 2014; Fridh
2014). However, the number of studies examining the attitudes and behaviors of nurses working
in surgical intensive care towards end-of-life care and the barriers to end-of-life care is
quite limited. The aim of this study is to examine the attitudes and behaviors of surgical
intensive care nurses towards end-of-life care and the barriers to end-of-life care.
