Leavitt, Rebekah
Nursing Perceptions of End of Life Care Obstacles in Critical Access Hospitals
Faculty Mentor: Renea Beckstrand, PhD, RN, CCRN, CNE
College of Nursing
Introduction
Death is an unavoidable occurrence. Nurses are on the front lines when it comes to caring for dying patients. When providing end of life (EOL) care for critically ill patients, nurses frequently come across obstacles (Beckstrand, Giles, Luthy, Callister & Heaston, 2012). The purpose of this study is to identify the largest and the most frequent obstacles when providing EOL care to rural critical care patients. Our intent is to use the data to improve EOL care for rural patients and their families.
One quarter of community hospitals in the United States are critical access hospitals (CAH) and 19 percent of the total population live in rural areas (Seright, & Winters, 2015). A CAH is a hospital that is located in a rural area, is at least 35 miles from the nearest hospital, and is state certified as a necessary provider of care to area residents (Beckstrand et al., 2012). Over half of people living in rural areas have at least one major chronic illness but often lack the proper resources to care (Seright, & Winters, 2015). CAH nurses are the first line health care providers for these patients and often provide EOL care for critically ill patients. Nurses in rural hospitals provide care for a wide variety of patients, often working on several different floors within the same shift. Because of the diversity seen in CAH, a unique health care environment develops.
Methodology and Results
After obtaining IRB approval, a list of 1334 critical access hospitals throughout the United States was created and each one was contacted via phone. The following information was obtained in order to establish eligibility for our study. Whether the hospital had a critical care unit, how many critical care beds they had, the name and contact information of the nurse manager or director of nursing, whether the manager was willing to participate in the study, and how many nurses worked on the critical care unit. After calling all of the hospitals on our list, some of which required multiple contacts, we found that many of the hospitals did not have any critical care beds. The hospitals that did have critical care units were usually willing to participate in our study with the exception of a few.
The next step in our ongoing research is to send out a 30 question voluntary survey for each of the nurses that work in a critical care unit at a CAH. Included with the surveys will be a stamped, addressed return envelope. The survey packets will be sent to the unit managers who have agreed to distribute the packets to their critical care nurses. After the surveys are returned to us, the data will be entered into an statistical analysis data base. The data will then be cleaned and missing data analysis performed. Final analysis will then be performed.
Conclusion
We are still in the process of completing our research but are excited to see what the results yield. EOL care is sometimes overlooked because so much emphasis is placed on curative measures but it is still a big part of nursing care, especially on critical care units. The purpose of this research is to help make the EOL process smoother and free of obstacles. We wish to identify the common obstacles to EOL care in rural hospitals so that they can be addressed. Our goal is to make EOL care better for nurses, patients and patient families in rural settings.
References
Beckstrand, R. L., Giles, V. C., Luthy, K. E., Callister, L. C., & Heaston, S. (2012). The last frontier: Rural emergency Nurses’ perceptions of end-of-life care obstacles. Journal of Emergency Nursing, 38(5), e15–e25. http://doi.org/10.1016/j.jen.2012.01.003
Seright, T. J., & Winters, C. A. (2015). Critical care in critical access hospitals. Critical Care Nurse, 35(5), 62–67. http://doi.org/10.4037/ccn2015115