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Nursing Perceptions and Satisfaction With Terminal Extubation in the Medical Intensive Care Unit: Phase I of a Quality Improvement Project FREE TO VIEW

Margaret Hayes; Karen Oakjones-Burgess; Shilta Subhas; William Checkley, PhD; Roy Brower
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Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD

Chest. 2014;146(4_MeetingAbstracts):726A. doi:10.1378/chest.1993706
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SESSION TITLE: Hot Topics in Pulmonary & Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: Half of all deaths in the hospital occur in the ICU. Half of these deaths occur after withdrawal of mechanical ventilation, with the expectation of death within a short time. This is an emotional experience for patients, families, and ICU staff, especially the nurses who are at the bedside. Withdrawing mechanical ventilation in a compassionate way requires careful consideration of several aspects of care, such as the use of generous sedation and analgesia and discontinuation of medications that do not contribute to the goals of care. We evaluated terminal extubations and end-of-life care by assessing nurses’ perceptions.

METHODS: Nurses employed in the Johns Hopkins Medical Intensive Care Unit were given a 15 question survey to assess comfort level and satisfaction with terminal extubation.

RESULTS: 39/72 nurses completed the survey (a 54.2% response rate). 40.6% of nurses had formal training in end-of-life care, 45.9% had no formal training, and 13.5% were unsure. 60.0% “agreed” that they were comfortable with terminal extubation, 28.2% “somewhat agreed” and 2.6% “disagreed”. When asked to rate the quality of patients’ death and dying on a scale from 0 (terrible) to 10 (almost perfect), the median rating was 7 (range 0-9). The median rating for the families’ experiences with death and dying was 7 (1-10). The median rating of the providers’ care during terminal extubation was 7 (1-9).

CONCLUSIONS: The majority of the nurses surveyed were comfortable with terminal extubations. However, the ranges for the satisfaction ratings for the quality of patients’ death, family experiences and provider care were very variable, with many unfavorable responses.

CLINICAL IMPLICATIONS: Based on nursing perceptions, there is room for improvement in the overall quality of death and dying of our patients. We have developed and implemented a terminal extubation checklist in our ICU and will assess its efficacy by repeating the survey to assess nurse perceptions and satisfaction.

DISCLOSURE: The following authors have nothing to disclose: Margaret Hayes, Karen Oakjones-Burgess, Shilta Subhas, William Checkley, Roy Brower

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