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Hospitals Lack Policies on End-of-Life Care, Say
Nurses
Jan. 9, 2006 - Despite increased national attention
on end-of-life issues, only one in four U.S. hospitals has patient care
policies addressing end-of-life or palliative care, according to a new
study of hospitals and critical care units conducted by the American
Association of Critical-Care Nurses.
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As recent cases have shown, conflicts involving
end-of-life care can become ethically complex and hotly debated -- and
often without patients' wishes being honored, says the AACCN.
Added challenges to delivering quality end-of-life
care in hospital critical care units may include a lack of formal
training among caregivers about end-of-life issues such as pain
management and life-support withdrawal, inadequate counsel on how to
deal with high emotions in families and caregivers, and an inconsistent
provision of legal and ethical information about such end-of-life
matters.
"Hospitals need evidence-based guidelines for
providing appropriate care, whether aggressively life-saving or
palliative and end-of-life care," said Justine Medina, RN, MS, co-editor
of the AACN Protocols for Practice: Palliative Care and End-of-Life
Issues in Critical Care," which is scheduled for release in February
2006.
"Expert nursing care has the potential to greatly
reduce the burden and distress of those at life's end and the ability to
offer support for the many physical, psychological, social, and
spiritual needs of patients and their families," adds Medina
This AACN protocol educates critical care
clinicians, educators and researchers on how to effectively manage
patients' pain and symptoms, family issues and intervention, withholding
and withdrawing life support, communication and conflict resolution. The
protocol includes a state-of-the-science review that provides guidance
to critical care nurses while acknowledging that limited, evidence-based
research exists.
The AACN National Critical Care Survey found that
nongovernment, not-for-profit institutions are less likely to have any
end-of live care policies, and end-of-life protocol is somewhat more
prevalent in urban than in suburban facilities. Among those critical
care units enacting end-of-life policies, smaller hospitals (with
100-300 operating beds) were more likely to use hospice services in the
unit than were larger hospitals.
The survey is the first ever to collect
comprehensive data on nurse staffing, policies, and practices
specifically for critical care units. It was developed to provide vital
information and important benchmarks against which hospitals can compare
their institutions and critical care units. Data was collected from 300
critical care units in 120 hospitals across the nation.
Findings pertinent to the continued national
nursing shortage also emerged:
● The majority of respondents said staffing had
not been optimal at least 25 percent of the time in terms of the match
between patients' acuity and the nurses' skill level and mix.
● The mean nurse vacancy rate in critical care
units was 11.8 percent.
● On average, it takes 66 days to fill a vacant
nursing position in a critical care unit.
● 70 percent of respondents reported that
patients are discharged or transferred with higher acuity than a year
ago.
● 9 percent of units responding reported closing
beds for more than 30 days because of staff shortages.
"Nurses are intimately involved in all aspects of
end-of-life care, and we encourage them to work closely with their
physicians and healthcare administration colleagues to adopt more
widespread policies supporting quality end-of-life care," said Debbie
Brinker, RN, MSN, CCRN, CCNS, president, AACN.
A summary of the survey findings was published in
the January 2006 issue of the American Journal of Critical Care and is
available at ajcc.aacnjournals.org. The full report is available for $99
($75 for AACN members) at
http://www.aacn.org.
About Source:
Representing the interests of more than 400,000
acute and critical care nurses, the American Association of
Critical-Care Nurses is the largest specialty nursing organization in
the world. Its headquarters are located in Aliso Viejo, Calif. Founded
in 1969, the association has more than 240 chapters in the U.S. and
abroad and is working toward a healthcare system driven by the needs of
patients and their families, where critical care nurses make their
optimal contribution. Complete information about AACN is available at
http://www.aacn.org.
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