None listed
Conditions
Brief summary
The moment of death, a compelling image and dominant concept throughout history has become increasingly marginalised. Although the majority of deaths occur in hospital it has been suggested that dying in hospital is largely a negative experience. As doctors working in Palliative Medicine we care for people who ultimately will die yet rarely are we present at the moment of their death. Much published work on the moment of death has been written by anthropologists and sociologists but not by those involved directly in the care of the dying (Glaser & Strauss, 1968; Kastenbaum & Normand, 1990; Kellehear, 1984; Seale, 1995). Palliative Care programmes continue to demonstrate that enlightened and dedicated care can markedly reduce the suffering of patients with advanced cancer and their families yet Kastenbaum (1999) questions why the vast experience acquired has not yet been translated into a vision of the moment of death. The moment of death has become increasingly marginalised. There is a suggestion that institutionalized death cannot be a good death (Gomes & Higginson, 2008) and hospitalization of death is criticised (Seymour, 2001). Death at home is identified as the ideal location (Gomes & Higginson, 2006; Hunt, Bonett & Roder, 1993; Middlewood, Gardner & Gardner, 2001; Tang, 2003). Yet in many countries the majority of patients die in hospital and will continue to do so (Gott, Seymour, Bellamy, Clark & Ahmedzai, 2004). This is the fifth qualitative research study on the experience of the moment of death (Donnelly et al, 2006; Donnelly & Donnelly, 2009, Donnelly & Battley, 2010). This study focuses on what actually happens at the time of death in the ICU of a tertiary referral hospital of 427 beds, as described by the witnessing family, matched by the observations of nurses and doctors.
Interventions
Grounded theory approach to a qualitative enquiry into the experience of relatives, nurses and doctors present at the moment of death of a patient in Intensive Care Unit. Relatives to be interviewed as individuials or in group 2 weeks following the patient's death. Nurse and doctor to be interviewed separately and individually within 48 hours of the patient's death. . With the primary consultant’s permission, the researcher, a medical doctor not involved in the patient’s care and not working in
Grounded theory approach to a qualitative enquiry into the experience of relatives, nurses and doctors present at the moment of death of a patient in Intensive Care Unit. Relatives to be interviewed as individuials or in group 2 weeks following the patient's death. Nurse and doctor to be interviewed separately and individually within 48 hours of the patient's death. . With the primary consultant’s permission, the researcher, a medical doctor not involved in the patient’s care and not working in ICU, will meet the family to explain the study during the patient’s admission and following the patient’s death will telephone to obtain consent to visit at home where the interview will take place or in the hospital if the interviewee prefers. Meeting the family prior to the patient’s death will facilitate the early post-bereavement research interview. The nurse and doctor most involved in the patient’s care at the time of their death will be approached to request an interview as soon as possible after the death. The nurse and doctor caring for the patient at the time of his/her death cannot be identified in advance as we do not know exactly when the patient will die and staff change daily and during the day. As a result chance of behaviour change due to the study is much less than if they could be identified and approached before the patient dies. An information sheet will be given/posted to the potential interviewee. Written informed consent will be obtained from the interviewee(s) prior to the interview. Participants will be informed that the interview can be terminated at any point and that confidentiality will be maintained. All interviewees will be offered bereavement support from ICU bereavement team or Hospital pastoral Care team. Mindful of the sensitivity of the topic, emphasis will be placed on minimizing potential distress to interviewees, at all times being tactful and considerate. The interview will take approximately 30-60 minutes opening with the invitation to the interviewee to describe their experience of the patient's dying and death.
Sponsors
Wellington Regional Hospital
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Families of patients who are dying in ICU. Families live within Wellington, Hutt, Kapiti areas Families present at the moment of death Nurse present at the time of patient's death Doctor present at the time of patient's death
Exclusion criteria
Families of child dying in ICU Families whose first language is other than English
Outcome results
None listed