Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Princess Aisha bint AL-Hussein College of Nursing and Health Science, Al-Hussein Bin Talal University, Maan, Jordan.
BMC Palliat Care. 2024 Aug 30;23(1):217. doi: 10.1186/s12904-024-01543-y.
Despite increasing interest in quality end-of-life care (EOLC), critically ill patients often receive suboptimal care. Critical care nurses play a crucial role in EOLC, but face numerous barriers that hinder their ability to provide compassionate and effective care.
An integrative literature review was conducted to investigate barriers impacting the quality of end-of-life care. This review process involved searching database like MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, and ScienceDirect up to November 2023. Search strategies focused on keywords related to barriers in end-of-life care and critical care nurses from October 30th to November 10th, 2023. The inclusion criteria specified full-text English articles published between 2010 and 2023 that addressed barriers perceived by critical care nurses. This integrative review employs an integrated thematic analysis approach, which combines elements of deductive and inductive analysis, to explore the identified barriers, with coding and theme development overseen by the primary and secondary authors.
Out of 103 articles published, 11 articles were included in the review. There were eight cross-sectional descriptive studies and three qualitative studies, which demonstrated barriers affecting end-of-life care quality. Quality appraisal using the Mixed Method Appraisal Tool was completed by two authors confirmed the high credibility of the selected studies, indicating the presence of high-quality evidence across the reviewed articles. Thematic analysis led to the three main themes (1) barriers related to patients and their families, (2) barriers related to nurses and their demographic characteristics, and (3) barriers related to health care environment and institutions.
This review highlights barriers influencing the quality of end of life care perceived by critical care nurses and the gaps that need attention to improve the quality of care provided for patients in their final stages and their fsmilies within the context of critical care. This review also notes the need for additional research to investigate the uncover patterns and insights that have not been fully explored in the existing literature to enhance understanding of these barriers. This can help to inform future research, care provision, and policy-making. Specifically, this review examines how these barriers interact, their cumulative impact on care quality, and potential strategies to overcome.
尽管人们对高质量的临终关怀（EOLC）越来越感兴趣，但危重病患者通常仍得不到最佳的治疗。重症监护护士在 EOLC 中起着至关重要的作用，但他们面临着许多障碍，这阻碍了他们提供富有同情心和有效的治疗的能力。
进行了一项综合文献综述，以调查影响临终关怀质量的障碍。这个综述过程包括搜索数据库，如 MEDLINE、Cochrane 中央对照试验注册中心、CINAHL、EBSCO 和 ScienceDirect，截止到 2023 年 11 月。搜索策略集中在与临终关怀障碍和重症监护护士相关的关键词上，时间为 2023 年 10 月 30 日至 11 月 10 日。纳入标准规定了 2010 年至 2023 年期间发表的全文为英文的文章，这些文章涉及重症监护护士所感知到的障碍。本综合综述采用综合主题分析方法，该方法结合了演绎和归纳分析的元素，以探讨确定的障碍，主要和次要作者对编码和主题开发进行监督。
在发表的 103 篇文章中，有 11 篇文章被纳入综述。其中有八篇是横断面描述性研究，三篇是定性研究，这些研究表明存在影响临终关怀质量的障碍。由两位作者完成的使用混合方法评估工具进行的质量评估证实了所选研究的高可信度，表明在综述的文章中存在高质量的证据。主题分析导致了三个主要主题：（1）与患者及其家属有关的障碍，（2）与护士及其人口统计学特征有关的障碍，以及（3）与医疗保健环境和机构有关的障碍。
本综述强调了影响重症监护护士感知的临终关怀质量的障碍，以及需要关注的差距，以改善重症患者在其生命末期及其家属的护理质量。本综述还指出需要进行更多的研究，以调查现有文献中尚未充分探讨的模式和见解，以增强对这些障碍的理解。这有助于为未来的研究、护理提供和决策提供信息。具体而言，本综述考察了这些障碍是如何相互作用的，它们对护理质量的累积影响，以及克服这些障碍的潜在策略。
