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Published on: July 4, 2018
[Withdrawal of Life-Sustaining Treatment in the PICU From the Nursing Staff's Perspective: Integrative Review]
Britta Darchinger1,2, Jürgen Härlein2, Gabriele Fley2
1Kinder-Intensiv-Pflege-Station, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der LMU München, Deutschland.
Insights
Nurses face emotional challenges and role conflicts when withdrawing life-sustaining treatment in pediatric intensive care units. They require support and clear guidelines for their role in this sensitive process.
Area of Science:
- Pediatric Intensive Care Nursing
- End-of-Life Care
- Clinical Ethics
Background:
- Withdrawal of life-sustaining measures is a frequent event preceding death in critically ill children.
- The experiences and perspectives of nursing staff during this process have been underexplored.
- This process significantly impacts all individuals involved in pediatric intensive care.
Purpose of the Study:
- To explore how nurses experience the termination of life-sustaining measures in the pediatric intensive care unit (PICU).
- To delineate the specific role of nurses in the process of withdrawing life-sustaining treatment.
- To understand the emotional and professional challenges faced by nurses during treatment withdrawal.
Main Methods:
- An integrative review methodology was employed to synthesize existing literature.
- A comprehensive literature search was conducted across CINAHL, Medline, and PsycINFO databases in October 2022.
- The review included a synthesis of findings from three qualitative and five quantitative studies.
Main Results:
- Nurses' experiences are shaped by emotional confrontations, decision-making uncertainties, and collaboration challenges.
- Interactions with patients, families, and healthcare teams present significant difficulties.
- Nurses involved in decision-making experience intrarole conflicts due to their representative roles.
Conclusions:
- Pediatric nurses require enhanced support systems to manage the complexities of treatment withdrawal.
- Development of interprofessional guidelines for withdrawing life-sustaining measures is crucial.
- Further research is needed to precisely define nursing roles, skills, and decision-making involvement in pediatric end-of-life care.
Abstract:
Withdrawal of Life-Sustaining Treatment in the PICU From the Nursing Staff's Perspective: Integrative Review Abstract: Background: Withdrawal of life sustaining measures is a common mode of treatment prior to the death of a critically ill child and has implications for all involved. The perspective of nurses has not yet been considered in this context. Aim: How do nurses experience the termination of life-sustaining measures in the paediatric intensive care unit? What is their role in this process? Methods: An integrative review was conducted to answer the research question. The literature search was performed in October 2022 in the CINAHL, Medline and PsycINFO databases. Results: Three qualitative and five quantitative studies were included. The confrontation with emotions, uncertainties in the decision-making process, challenges and conflicts in collaboration, in interacting with those involved and in the provision of care determine the experience of nurses during treatment withdrawal. The nurses as involved in the decision-making process and representative of interests are influenced by intrarole conflicts. Conclusion: Nursing professionals need support to cope with their experiences in the context of treatment withdrawal in children. In addition to surveying the type and scope of support measures, interprofessional guidelines must be developed when life-sustaining measures are withdrawn. This includes future research to specify the role of nurses in treatment withdrawal and includes, for example, the description of specific tasks, necessary skills or the extent of involvement in decision-making.
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