ABSTRACT
BACKGROUND: Deaths in the intensive care unit (ICU) represent an experience of suffering for patients, their families, and professionals. End-of-life (EOL) care has been added to the responsibilities of the ICU team, but the evidence supporting EOL care is scarce, and there are many barriers to implementing the clinical recommendations that do exist. OBJECTIVES: To explore the experiences and perspectives of the various members of an ICU care team in Chile regarding the EOL care of their patients. METHODS: A qualitative study was performed in the ICU of a high-complexity academic urban hospital. The study used purposive sampling with focus groups as a data collection method. A narrative analysis based on grounded theory was done. RESULTS: Four discipline-specific focus groups were conducted; participants included 8 nurses, 6 nursing assistants, 8 junior physicians, and 6 senior physicians. The main themes that emerged in the analysis were emotional impact and barriers to carrying out EOL care. The main barriers identified were cultural difficulties related to decision-making, lack of interprofessional clinical practice, and lack of effective communication. Communication difficulties within the team were described along with lack of self-efficacy for family-centered communication. CONCLUSION: These qualitative findings expose gaps in care that must be filled to achieve high-quality EOL care in the ICU. Significant emotional impact, barriers related to EOL decision-making, limited interprofessional clinical practice, and communication difficulties were the main findings cross-referenced.
Subject(s)
Terminal Care , Chile , Communication , Death , Humans , Intensive Care Units , Qualitative Research , Terminal Care/psychologyABSTRACT
Background: The recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. Aim: To study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. Material and Methods: A scale, consisting of 54 items grouped in nine dimensions to measure physicians subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). Results: The internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. Conclusions: These results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.
Subject(s)
Female , Humans , Male , Job Satisfaction , Practice Patterns, Physicians'/trends , Physicians/psychology , Surveys and Questionnaires/standards , Chile , Quality of LifeABSTRACT
BACKGROUND: the recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. AIM: to study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. MATERIAL AND METHODS: a scale, consisting of 54 items grouped in nine dimensions to measure physicians subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). RESULTS: the internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. CONCLUSIONS: these results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.
