Welcome

to
Journal
Club
 ICU Team
Amanat Buya
Azkiya Ulki
Eko Arsetyanto
Innas Khanifah
Pramastuti Budi
How important End-Of-Life Care for patient and
Family in ICU?

?
 What obstacles are currently taking place in EoL
care in ICU?

 A lack of knowledge on the dying process

 physicians didn’t involve and leaving withwout explanation
 COMMUNICATION
 a lack of preparation in dealing with EOLC
 EOLC a major source of stress
 A lack of collaboration
 An adequate experience in EOL
 Cultural differences and disagreements between ICU
physicians and nurse
 What is the role of nurse in EOL care ?

 Nurse play role in helping both patient and family who have positive and
meaningful experience at difficult in this role
 Nurses commented that EOLC should be provided for all dying patient to
respect patient’s dignity and to facilitate peaceful death, as well as enhancing
the acceptance of the patient family for their patient’s condition

 What is solution to improve EOL care in ICU ?

 The nurse suggested strategies improve theirs ability to conduct difficult

conversation
 Unnecessary intensive care and painful interventions should be avoided
 Organizing a meeting eith the family for education and to discuss the ICU team ‘s
expectation about the patient’s situation
 Clear communication between health professional and families about a patient’s
situation
 Telling the truth allowing family members to be present
 Share decision-making and providing family centered care inICU
 What are the barriers of communication about
EOL care for the patient and the family in ICU?
 Participant in our study was resistant as to wether to talk to family about the
patient’s poor prognosis
 Nurse still struggle dealing with difficult conversation and most would prefer to
refer the family to the doctor for any explanation
 Physician participants also described their ability to conduct difficult conversation
 language barriers affected EoLC conversations about patient wishes. One nurse
noted that even the Arabic translators were considered a primary barrier to
perform EoLC.
 The findings demonstrated that having a designated family member might be less
effective because other family members continue to ask for updates and there
can be a lack of consensus between family members.
 Communication with families in EoL crisis situations is difficult because they may
not grasp the reality of the situation.
How to enhance communications nurse in do
eol care?
How nurses are able to convince doctors that
nurses can implementation EOL care?
 According to the point of view in icu , what is
obstacles that arises from doctor when EOL
care?
 physicians did not involve or inform family regarding the decision about the
patient’s resuscitation status, leaving them without explanation or preparation for
do not resuscitate (DNR) orders.
 A nurse commented that physicians might have ignored palliative care needs, and
considered more aggressive interventions or futile care instead.
 sometimes physicians appeared to delay the patient death by passing the patient
to another physician’s shift.
 physicians often did not inform the patients’ families regarding the patient’s
situation because of their beliefs, particularly when a patient had a poor
prognosis.
 Nurses know the patients best but physicians often do not involve nurses in
decision-making regarding the care
 The nurses highlighted some issues related to physicians’ roles in EoLC during the
study. This concern has also been noted in other research about EoLC in ICUs. The
issues referred to physicians who differ in opinions from each other, do not
communicate a poor prognosis