Role of Critical Care Nurses in End-of-Life Care

E – International Scientific Research Journal, VOLUME – V, ISSUE – 3, 2013, ISSN 2094 - 1749
Role of Critical Care Nurses in End-of-Life

Care
Dr. Bella P. Magnaye RN, Debbie Marie D. Bais, Julie Anne May M. Banaag, Jovelyn A. Barrion,
Rawan Karla S. Catapang, Ma. Lerelyn C. Datinguinoo
Lyceum of the Philippines University

Capitol Site, Batangas City
INTRODUCTION
One of the most difficult realities that nurse face is that despite their best efforts, some
of their patients die. Although nurses cannot change this fact, they can have a significant and
lasting effect in which the patients live until they die the manner in which death occurs and the
enduring memories of that death for the families. Indeed, providing care to the patients who
are close to death and being present at the time of their death can be considered as one of the
most rewarding experiences a nurse can have. Critically ill patients together with their families
are understandably fearful of the unknown and may prompt new issues or previous concerns to
resurface and both of them have needs that should be addressed in every dimension with the
use of effective nursing care.
The Institute of Medicine (2004) defined optimum end-of-life (EOL) care as an
experience that is free from avoidable distress and suffering for patients and their families, in
accord with the patients' and families' wishes, and reasonably consistent with clinical, cultural,
and ethical standards. Standards for a good death include symptom management, patient- and
family-focused care, and spiritual well-being for both patients and families. The World Health
Organization has defined quality EOL care as the "active total care of patients whose disease is
not responsive to curative treatment." This definition includes meeting the psychological,
social, and spiritual needs for both patients and families, as well as the definitions of quality
care provided by the National Consensus Project and National Quality Forum summary.
The American Association of Critical-Care Nurses (AACN) has established nursing
standards that provide a framework for critical care nurses. Nursing practice varies depending
on the setting in which the nurse is employed and the patients cared for in that setting. The
standards set forth by AACN in terms of Quality Nursing Care, Communication, Education,
Collegiality, Ethics and Collaboration describe the practice of the nurse who cares for an acutely
or critically ill patient in the health care environment. These standards are authoritative
statements that describe the level of care and performance by which the quality of nursing care
can be judged. They serve as descriptions of the expected roles and responsibilities.
Moreover, on the Mission-Vision Statement of the Critical Care Nurses Association of
the Philippines (CCNAPI), the national organization of nurses interested in the field of critical
care nursing, it stated that the association strives for a culture of quality and safety in all
endeavors; believes in building competencies, career advancement and proactive evidenced
193
informed nursing practice and lastly, is committed in fostering the people’s health,
welfare and rehabilitation through community involvement and development. Its mission as
cited also seeks to become the epitome of utmost standards in critical care nursing through
demonstrating dedication in upgrading critical care nursing practice by responding with great
compassion to the needs of their clientele.
Critical care nurses work in a wide variety of settings, filling many roles including
bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse
specialists, and nurse practitioners. With the onset of managed care and the resulting migration
of patients to alternative settings, critical care nurses are caring for patients who are more ill
than ever before. Managed care has also fuelled a growing demand for advanced practice
nurses in the acute care setting. They provide direct patient care, including assessing,
diagnosing, planning, and prescribing pharmacological and non-pharmacological treatment of
health problems.
Having an inadequate exposure to the critical care unit, the researchers decided to
come up with this study. It served as a great opportunity to give each and everyone the chance
to have an idea about the real scenarios inside the ICU. The researchers viewed this as a means
of learning and understanding how critical care nurses rendered their duties and how they
complied with their roles among the dying patients.
The researchers firmly believe that the findings of this study would be a great help and
value to the respondents. This study will make them well-oriented to the significant role of
nurses in caring for a critically-ill client and providing peaceful and dignified death. To the
student nurses and College of Nursing, the study will help them enhance their knowledge and
increase their awareness on how to apply, respect and consider the different factors affecting
the effectiveness of the care being rendered to patients at near death thus improving the
quality of nursing care being delivered.
Objectives of the Study
The general purpose of this study was to ascertain the care rendered by the critical care
nurses here in Batangas in providing compassionate care in a dying patient. Specifically, the
purposes of this study were: a) to identify the profile of the respondents in terms of age,
gender, educational attainment, and length of service; b) to determine the extent of nursing
care rendered to a dying patient in terms of: quality of care, communication, education,
collegiality and collaboration, ethico-moral and legal responsibility; c) to discover if there is a
significant relationship between the profile variables and the extent of nursing care rendered to
a dying patient; d) lastly, to propose measures to enhance the nursing care rendered by the
respondents on the dying patient.
Theoretical Framework
The American Association of Critical Care Nurses (AACN) Synergy Model for Patient Care
describes nursing practice based on the eight patient characteristics which span the health-
illness continuum. The patient characteristics are resiliency, vulnerability, stability, complexity,
resource availability, participation in care, participation in decision making, and predictability.
194
The synergy model also describes eight nurse competencies. These competencies
consist of clinical judgment, advocacy and moral agency, caring practices, collaboration,
systems thinking, response to diversity, facilitation of learning, and clinical inquiry. According to
the synergy model, "nursing care reflects an integration of knowledge, skills, experience, and
attitudes needed to meet the needs of patients and families. Thus, continuums are derived
from patient needs".
The core concept of the model is that the needs or characteristics of patients and
families influence and drive the characteristics or competencies of nurses. Synergy results when
the needs and characteristics of a patient, clinical unit, or system are matched with a nurse's
competencies (AACN, 2006).The underlying tenets of the synergy model are: (a)patients'
characteristics are of concern to nurses; (b) nurses' competencies are important to patients; (c)
patients' characteristics drive nurses' competencies; and (d) when patients' characteristics and
nurses' competencies match and synergize, outcomes for the patient are optimal (Hardin &
Kaplow, 2005).
The assumptions guiding the AACN Synergy Model for Patient Care are: Patients are
biological, psychological, social, and spiritual entities who present at a particular developmental
stage, thus the whole patient (body, mind, and spirit) must be considered ; the patient, family,
and community all contribute to providing a context for the nurse-patient relationship ;
patients can be described by a number of characteristics which are connected and contribute to
each other and thus, cannot be looked at in isolation ; similarly, nurses can be described on a
number of dimensions. The interrelated dimensions paint a profile of the nurse; the goal of
nursing is to restore a patient to an optimal level of wellness as defined by the patient. Death
can be an acceptable outcome, in which the goal of nursing care is to move a patient toward a
peaceful death (AACN, 2006).
Since the study of the researchers focuses on the role of ICU Nurses in rendering end-
of-life care among dying clients, the AACN Synergy Model perfectly explains how the nurse’s
competencies in different aspects like Quality of Care, Communication, Education,
Collaboration and Collegiality and Legal and Ethico-Moral Responsibility directly affect the
client and his family during the most critical stage of his life. It illustrates how nurses play the
vital role in providing not only physical support to terminally ill clients but also spiritually and
emotionally. Derived from the health-illness continuum the Synergy model further emphasizes
that nurses and clients work together to help client achieve wellness or assist client towards a
peaceful death.
METHOD
This presents the research design, subject or respondents of the study, data gathering
instruments, data gathering procedure and statistical treatment of data.
Design
This research was conducted utilizing a descriptive correlational method in establishing

the relationship between the profile of the respondents and their role in providing end-of-life
care among dying patient in different hospitals in Batangas Province.
195
As one of the types of Descriptive Studies, the purpose of descriptive correlational

research is primarily to observe, describe and document aspects of a situation as it naturally
occurs and sometimes to serve as a starting point for hypothesis generation or theory
development. Its aim as described by Polit and Beck (2008) is to describe relationships among
variables rather than to infer cause and effect relationships.
Participants
The respondents of the study were composed of 50 ICU nurses from the different
hospitals in Batangas Province. Convenience sampling was used by the reasearchers. The
chosen respondents for the study are nurses working in the Intensive Care Unit. The different
government and non-government hospitals where the respondents assigned in the ICU
included Batangas Regional Hospital, Jesus of Nazareth, Our Lady of Caysasay Medical Center,
Metro Lemery Medical Center, and Bauan Doctors General Hospital.
Instrument
A survey method of data collection through questionnaires was used. According to Polit
and Beck (2008), the advantage of this method is that it is less expensive, permits anonymity,
and may result in more honest responses. Another advantage is that the researcher does not
have to be present thus, eliminating bias due to phrasing questions differently for different
respondents.
In this study, the researchers used the Critical Care Nursing Standards in formulating the
questionnaire. To effectively obtain the necessary data needed by the researchers, they made
some modifications and devised a 30-item questionnaire formulated based from the standards
established by the American Association of Critical-Care Nurses (AACN), as well as the
respondents’ demographic profile, which the researchers seek to determine the significant
relationship to the role of Critical Care Nurses in End-of-Life Care.
The questionnaire was composed of 2 parts. The first part contained questions
regarding the profile of the respondents, the ICU nurses. It included the gender, age,
educational attainment and length of service as ICU nurse. The second part contained the
American Association of Critical-Care Nurses (AACN) standards to determine the extent of
nursing care rendered to a dying patient in terms of: quality of care, communication, education,
collegiality and collaboration, ethico-moral and legal responsibility. They utilized a 4-point Likert
Scale Survey to ascertain the Intensive Care Unit nurses’ perception on providing
compassionate death based on their practice in the clinical setting. It was validated by three
expert clinical instructors, adviser and panellists and asked for approval for the distribution of
the questionnaire.
Procedure
After browsing some books and other materials from the library, the researchers chose
a topic and consulted the approval of the adviser. After the approval, the researchers made a
thorough review of related literature and drafted the questionnaire which was validated by the
196
three expert clinical instructors, adviser and panellists. After the validation, the researchers
submit letters to the authorities and seek for their approval for distribution of the
questionnaire. The researchers distributed the questionnaire personally, attached with a letter
to the respondents which were collected after a week.
Analysis
After the retrieval of the questionnaires, data were tallied, tabulated, analyzed, and
interpreted by the researcher to see the results of the study. Frequency Distribution was used
to determine the profile of the respondents in terms of gender, age, educational attainment,
and length of service as Critical Care Nurse. Weighted Mean was used to identify the role of
critical care nurses in end-of-life care among dying patient in terms of the extent of nursing care
rendered to dying patient. ANOVA was used to test the relationship between the profile of the
respondents and the scale of the role of critical care nurses in end-of-life care.
RESULTS AND DISCUSSION
This section presents the data generated from the questionnaire which were then interpreted
and analyzed.
Table 1 presents the frequency distribution of the respondents’ profile variable in terms of
gender, age, educational attainment and length of service as ICU nurse.
197
As to gender, majority of the respondents are female with a frequency of 31 or 62.0%;

19 or 38.0% are male. Women dominate the nursing profession basically because women in
nature are caring. Nursing is also considered as a suitable job for women because it is an
extension of their familial roles. Aside from that, most of the students taking this course are
females. There is also a stereotype belief that this profession belongs only to women rather
than men. Roles like nurturing, dependency, caring, and submission are opposite from the ones
attributed to men in society.
According to Casao (2003) female nurses are more sensitive to the needs of their
patients because they are considered the surrogate mothers which are more inherent in female
nurses to provide the so-called TLC or Tender Loving Care to patients. The fact remains that
there are sex characteristics as to how females and males act, react, and perform in situations
affecting every aspect of life. When it comes to human relationship, intuitively women tend to
pick up subtle tones of voice and facial expressions, whereas men tend to be less sensitive to
these communication cues. In navigation, women tend to have difficulty finding their way,
while men seem to have a better sense of direction. The above results may be explained by
Begany (2000) where he cited that because nursing have historically been viewed as women’s
works, men in nursing have been categorized as feminine and have subsequently been labelled
homosexual, thus some men in nursing may already experience a form of gender discrimination
with regards to the based role assumptions,.
In terms of age, majority of them were 21-25 years of age which obtained the highest
percentage of 74.0. This is because they are the demographic profile of the freshly graduates
and newly registered nurses. Nurses belonging to the age group of 21-25 are more physically fit
to work in the critical care unit because they have the strength and vigour in rendering the care
needed by the patients. Since most of the critically ill patients are debilitated and incapable, it is
required that nurses are well- built to be able to perform necessary activities to improve the
mobility of the patient and prevent complications. As explained by the Institute of Medicine
(2004), as individual’s age, most will experience a progressive decline in aerobic power,
reaction speed, and acuity of senses. Aging decreases the speed of circadian adaptation to night
work, increasing the risk of sleep disorders and therefore impaired job performance and other
negative health effects.
In terms of educational attainment, most of the respondents are registered nurses only
with a frequency distribution of 41 or 82.0%; and 8 or 16.0% have completed their master’s
degree. The age of the respondents influence their educational attainment. Since most of them
are fresh graduates who belong to the age group of 21-25 they are expected to acquire only the
degree of being a registered nurse. Only few of them will pursue immediately their Masteral
degree, although some of them may decide to uplift their professional degree they cannot
easily accomplish or complete it because it takes time and at the same time they also have their
duties which they have to attend and requires high cost as mentioned by American Association
of Colleges of Nursing (2009) where they cited several financial barriers preventing nurses from
pursuing the advanced levels of education required to be a nurse educator
In terms of length of experience, most ICU Nurses have 3 years and below experiences
as revealed by the frequency of 34 out of (68.0%). Similar to the result of educational
attainment, the age of the respondents influence the length of service of the critical care
nurses. Most of the respondents are fresh graduates thereby it is also anticipated that they are
198
serving as ICU nurses for a period of less than three years. It could also be assumed that there
are nurses who only acquire experience for 2 years or less as preparation for bigger
opportunities abroad because as Cueto (2007) stated, as more and more developed countries
open their doors to migrant health workers, most of the new graduates made a beeline for jobs
overseas. The graduate’s fortunate enough to make the cut lost no time in applying for jobs
abroad, most of them skipping the minimum one-year experience required by hospitals abroad.
199
Table 2.1 presents the weighted mean distribution of the respondents’ role for the dying
patient in terms of providing quality care. It can be gleaned from this table that respondents
generally perceive Quality of Care as Great Extent with a composite mean value of 3.79. This
result only brings out the reason why Filipino nurses are perceived to be the best caregivers
worldwide, being able to be competitive enough in their field because they perform their duties
with heart and treat their patients as members of their own family(Silvestre, 2006).ICU is one of
the most delicate areas in the hospital, that’s why it is a necessity for critical care nurses to
render a safe and effective nursing care to a great extent for it is not only an obligation, but
rather a commitment. This area is a matter of life and death situations, wherein the survival of
the critically ill patients lies on the hands of nurses and other members of the healthcare team.
ICU nurses assess and monitor vital signs accurately and notify the physician to a great
extent, with the highest weighted mean of 3.96. They are aware that vital sign monitoring is a
fundamental component of nursing care. Monitoring basic vital signs allows us to identify
problems early and take measures to prevent them from becoming serious. It serves as the
basis of the physician in determining whether there is a development or deterioration in the
patient’s condition. It also determines which treatment protocols to follow, provide critical
information needed to make life-saving decisions, and confirm feedback on treatments
performed. This critical role of nurses in an ICU setting is also based on what Bare (2010) stated
that as death approaches and organ systems begin to fail, observable, expected changes in the
body take place, that is why nurses should report and consult with the physician about the
deviations in their client’s vital signs. Monitoring of vital signs should not be an automatic or
routine procedure; it should be a thoughtful, scientific assessment. It should be evaluated with
reference to the client’s present and prior health status and are compared to client’s usual and
accepted normal standards (Kozier, 2008).
Ensuring client’s safety by raising side rails and not leaving the client unattended has
been perceived by ICU nurses as to a great extent (x= 3.92). Ensuring patient safety has ranked
second since it is a necessity for all health professionals especially to those belonging in the
critical care unit. Patients in the ICU are afflicted with terminal illness that could predispose
them to situations that could cause injury to them such as fall. Lack of a safe environment can
200
cause additional harm or burden to the patients’ condition, which may then cause further
deterioration regarding their status. According to McAdam (2006), patient safety has been
described as an ethical imperative, and one that is implied in health care professionals’ actions
and interpersonal processes. Due to the hectic, complex environment in the critical care unit,
patients are particularly vulnerable due to their compromised physiologic status, multiple
technologic and pharmacologic interventions, and multiple care providers who frequently work
at a fast pace
Assessing pain frequently and administering analgesics only or as prescribed; positioning
client to semi-Fowler’s position to improve his/her breathing and; instructing relatives about
infection control such as hand washing, and avoidance of relatives/visitors with infectious
diseases were all classified by ICU nurses as to a great extent (x= 3.80). Since the essence of
end-of-life care is for patients to be free from avoidable distress and suffering, assessment of
pain and administration of analgesics when needed is perceived to be one of the most
important responsibilities of ICU nurses. Doing so may not totally alleviate the disease, yet may
relieve the patient’s suffering thereby increasing patient’s comfort and enable clients to
maintain some quality in their life and their daily activities, including eating, moving and
sleeping(Kozier, 2008).
On the other hand, proper positioning during dyspnea aids in the maximal use of
respiratory muscles thereby improving client’s respiration. Patients with breathing problems
were traditionally placed in semi-fowlers position because this is believed to relieve the
patient’s difficulty of breathing as well as prevent unnecessary secondary complications on the
patient’s respiratory status (Bare, 2010).
It is given that relative of the dying patients still want to let them feel loved and taken
care of. It is also known that their presence is needed especially in pediatric ICUs for feeding
purposes and strict aseptic technique should be observed. Before entering the critical care unit
it is a must that they perform handwashing, donning cap and mask, and wearing of foot cover.
Giving instructions among the relatives regarding infection control measures in the ICU is
necessary to protect the patient from infections or microorganisms that could contribute to the
aggravation of their condition. If relatives would be thought as to how they should avoid
infectious diseases, then nurses could assure that their patients are protected enough.
Interventions used in reducing infection includes the use of an antiseptic detergent or an
alcohol based sanitizer, wearing protective clothing such as gowns and gloves and teaching
nurses and families how they can help reduce the spread of infection(Willeke, 2006).
Ensuring adequate dietary intake without addressing any stress for the patient during
meal time ranked 6th having a weighted mean of 3.76, verbally interpreted as great extent since
adequate nutrition is crucial to the treatment of ICU patients. Accurately assessing nutritional
requirements and monitoring the adequacy of nutritional intake in critically ill patients can help
ensure that discomforts and complications associated with underfeeding or overfeeding are
avoided. As Cline (2006) stated, patients, families, and caregivers struggle to continue providing
food and fluids in the face of declining ability and interest. All caregivers should be reminded to
encourage but never to force intake of any kind
Regular positioning of the critically ill patients gained a great extent (x=3.70) which
ranked 7th among the variables under quality of care. It is necessary to prevent complications
201
such as atelectasis, constipation, and urolithiasis. Furthermore, it is important in maintaining

the skin integrity of patients in the ICU and preventing the formation of pressure ulcers. It also
promotes patient’s mobility thereby improving circulation. This same rationale was mentioned
by and Goldhill et. Al., (2007) where in many hospitalized clients in ICU cannot reposition
themselves in their beds therefore, they are regularly turned by their nurses, primarily to
prevent pressure ulcer formation and it has long been recognized that immobility is associated
with complications involving many organ systems including the lungs, the cardiovascular
system, skin, muscles and bone (American Society for Pain Management Nursing, 2010). The
use of positioning therapy has been advocated for the prevention and treatment of many of
these complications. It is also routine practice, unless contraindicated, to place patients in a
head up position Positioning therapy is also used to improve oxygenation in patients with
severe respiratory failure (Goldhill et. al., 2007).
Providing the client with means to call for assistance ranked lower compared to other
items under quality of care since call bell/light are not always readily available at the critical
care unit, and nurses usually stay close to the client so that they can easily attend to their
needs. Thought it is interpreted as great extent (x=3.62), it is not considered a necessity
because nurses themselves are aware of the client’s needs for they are very focused about the
assessment of their condition.
Tzeng (2010) proposed that an effective way to decrease call light frequency is to
remove the reason for call lights in the first place. Hourly nursing rounds to ascertain and meet
patients' needs are an evidence-based strategy that reduces dependence on call lights.
Rounding not only fulfils the more mundane requests that are usually made via call lights but
also demonstrates the nurse's availability to the patient and her readiness to anticipate the
patient's needs. Rounding is about building relationships and trust as much as it is about
meeting physical needs.Patients like to know someone is watching over them.
The use of non pharmacologic measures to alleviate pain is one of the least aspects
under quality of care, having a weighted mean of 3.58 verbally interpreted as great extent.
Since patients in the critical care unit need immediate means of relieving their pain, most of the
times, they are managed through medications. Their pain may be so severe that guided
imagery, music therapy, or deep breathing exercises cannot relieve. Most of the patients are
unconscious or lethargic that’s why non pharmacologic measures may not be so useful and
applicable.
In a descriptive, exploratory study, 54 pediatric ICU nurses responded to a questionnaire
that elicited self-report of their use of five nonpharmacologic techniques: distraction, focusing
on breathing, focusing on relaxing, imagery, and changing perceptions of painful stimuli.
Content analysis indicated that (a) nurses' lack of time and heavy workload impede their use of
nonpharmacologic techniques; (b) nurses' most frequent use of nonpharmacologic techniques
is with children undergoing painful procedures; and (c) nurses perceive parents as helpful in
implementing nonpharmacologic techniques with children (Pederson and Harbaugh, 2010).
The environment in the critical care setting is highly controlled, and strict aseptic
technique should be observed. Patients in this area are considered vulnerable since their
immune system is compromised. Nurses may not guarantee the total elimination of infection
however their occurrence can be minimal through strict aseptic technique.
202
Eventhough infection control was perceived by the ICU nurses to have a great extent
(x=3.58), it is quite bothering that nurses give least attention with this measure. Infection
control is considered to be a means of promoting safety for the client and preventing
unnecessary secondary complications like the development of nosocomial infection. The
researchers strongly believe that infection control measures among ICU nurses should be one
of their top priorities that they must consider at all times because according to Bihari (2005),the
highest rates of nosocomial infections are observed in intensive care units (ICUs), because of
their underlying diseases or conditions associated with impaired immunity , several violations
of their immune system or risks of aseptic mistakes in patient management during invasive
monitoring, exposure to multiple invasive devices and procedures; increased patient contact
with health-care personnel; a longer ICU stay which prolongs the risk of exposure; and space
limitations that increase the risk of contaminating equipment(Zaki,2010).
203
Table 2.2 presents the weighted mean distribution of the respondents’ role for dying
patient in terms of communication with a composite mean value of 3.72 verbally interpreted as
great extent. From the start, nurses are trained how to communicate effectively to various
groups of people, that’s why it is anticipated to be practiced at all times. The use of therapeutic
communication enables nurses to establish rapport with their patient thereby providing them
the opportunity to deliver the most efficient and effective care their patients needed.
Communication among healthcare providers, patients, and their families regarding end-
of-life (EOL) care is an important determinant in providing quality care in the setting of choice
for patients with terminal illnesses. Communication used therapeutically enables us to build
rapport with our patient thereby providing us the opportunity to deliver the most efficient and
effective care our patients needed. Communication in a critically ill patient is very tough
process. We must be ready to accept how the client grieves, or how the client went through the
process of it (Campbell, 2009).
Communication with the patient and family is a standard of professional nursing

practice (Brener, 2007). When a patient is dying, compassionate communication becomes a
clinical skill as important as assessment, drug administration, and physical intervention. The
fact is that nurses are in the best position to help dying patients communicate about their
wishes, help families understand the course of the patient’s transition, ease conflicts and
difficulties that are sure to arise, and facilitate interactions with physicians and other members
of the palliative care team (Campbell, 2009).
The use of simple and lay terms instead of complex medical language when talking to
the relatives of the patient on matters regarding his/her condition gained the highest weighted
mean of 3.92, verbally interpreted as great extent. Since it is a must for nurses to make the
family members of the dying patient understand the progress of the patient’s condition and the
treatment being rendered to them, the use of medical terminologies will not be helpful on the
part of the client’s significant others because not all of them are knowledgeable of the medical
language.
End-of-life decisions commonly include what treatments to elect, which to decline and
when. When talking with the patient about the treatments, nurses must help him and his family
understands the topic being discussed. When communicating with the patient or family
members, it is essential to reduce the language to the eloquence of simplicity. Be matter-of-fact
and empathetic. Give accurate information. Listen actively and, if appropriate, use gentle touch
to show your care and concern (Ufema, 2001).
When communicating with a patient and family members, nurses must always take care
to convert medical language into lay language, not only to increase the patient’s and family
understands but also to better invite them into the conversation. Also, they should keep in
mind that many families have varying educational levels, reading abilities, and language
preferences. To communicate effectively with patients and their families, make sure nurses are
communicating with cultural sensitivity, building rapports, using empathy, participating as
needed in important end- of-life decisions, and continuously assessing thyself and their
effectiveness (Adams et al, 2005).
Discussing about patient’s plan of care, providing accurate information and telling the
family what to expect during conferences were considered by ICU nurses as to a great extent
204
(x= 3.72). End-of-life care is not just focused on alleviating the suffering on part of the patient
but also to the family members. Discussing the patient’s plan of care will help establish a
trusting relationship between nurses and relatives. Telling the family members what to expect
will not just provide them information regarding the development of the patient’s condition but
will also prepare them about the possible complications that may arise.
Scott (2010) proposed that nurses should always keep the family informed of every
action that are being taken, but avoid allowing different specialists to deliver conflicting
information and recommend taking advantage of any opportunity to clarify information and to
allow people time to express concerns or feelings. All questions needs to be addressed until
family members feel assured they are making the right decisions under the circumstances.
Apart from assessment and management of pain, in which the nurse's key role has been
clearly recognized, no palliative care process is more important in the ICU than the family
meeting to establish goals of care. It is in this process that families are helped to understand
the patient's condition and prognosis, can share their knowledge of the patient's values and
preferences along with their own concerns and questions, and receive emotional and practical
support. Thus, the family meeting is the backbone of informed, patient-focused, decision
making about appropriate care goals and the corresponding treatment plan. Nurses can
contribute to these meetings in many important ways. The ICU bedside nurse has the latest
information about the patient's condition. Usually, this nurse is also the clinician with the best
knowledge of and strongest relationship with the family. The nurse at the bedside often has
extensive discussions with family members before the family conference, including discussions
of the patient's values and treatment preferences(Cortez et. al., 2011).
ICU nurses consider exploring patient’s wishes and encouraging realistic goals as great
extent (x=3.70) in the aspect of communication, however it is not perceived as a top priority.
Being aware of the various wishes of the critically ill patients will enable us to relate this to their
family thereby giving patient’s a sense of satisfaction whenever these wishes are met. Setting
realistic goals will provide direction that will guide nurses in rendering the care needed by their
patients. It will also prevent unnecessary expectations because the goals being set are realistic
and attainable. The nurse may be in a position to understand and interpret patient wishes
based on his or her intense contact with the patient. The nurse may also be able to reiterate
messages about prognosis and answer patient and family questions based on his or her
involvement in the discussions (Miller, 2001).
Talking and addressing with the patient’s family their spiritual/ religious and cultural
needs were interpreted as to great extent (x=3.66). Critical care nurses perceive this aspect as
important, yet there are certain issues that they prioritize to attend and communicate rather
than the religious, spiritual, and cultural needs. Nurses assume that their patients belong to the
same religion and culture as they are since majority of the patients they are handling are
Roman Catholics and belonging to the same ethnic affiliation.
Campbell (2009) mentioned that when communicating about end-of-life issues, many
cultural variables come into play, including respect, causing harm, provoking anxiety or
depression, and self-fulfilling prophecy. One common pitfall to avoid in becoming culturally
competent is unintentionally stereotyping a patient into a particular culture or ethnic group on
the basis of characteristics such as outward appearance, race, country of origin, or stated
205
religious preference. Stereotyping is defined as an oversimplified conception, opinion, or belief

about some aspect of an individual or group of people (Flowers, 2004).
Moreover, Smith (2006) stated that it is not expected that every nurse is or should be a
spiritual nurse. Specialized education in spirituality can help ensure that nurses are aware that
spiritual care is within the purview of nursing and can prepare all nurses to deliver an
appropriate level of spiritual care to patients.
ICU nurses encourage the sharing of feelings of both the client and his/her family about
death and provide emotional support by listening attentively to what they have to say with a
weighed mean of 3.58 verbally interpreted as great extent. Discussion of feeling is a form of
providing empathy towards the patient and his family. It is interpreted to be great extent since
ICU nurses still find time to communicate, discuss, and listen to the concerns of the patient’s
significant others, but it is not accomplished at all times. Critical care unit is known to be an
area wherein every second counts and every situation creates pressure among health care
providers, so instead of providing comfort to the relatives, nurses tend to focus more on
performing their duties and giving appropriate interventions to their patients. In a study,
American Journal of Critical Care (2005)cited that the most prominent cluster of needs that
family members felt were least satisfactorily cared for just after admission were related to
medical information: the clarity of explanations given, family representatives' knowledge of
equipment being used, and the representatives' understanding of the patients' treatment.
These findings are generally consistent with those of the many previous studies conducted with
families of critical care patients.
Although receipt of clear information about patients has been identified as a primary
need of patients' families, the specific aspects of the hospital staff's communication process
most important to the family members was addressed in only one study, Jurkovich et. al. (2000)
found that along with the clarity of the communication, the most important feature in the
process of receiving bad news was the attitude of the news giver. This feature was even more
important than the news giver's knowledge or ability to answer questions (American Journal of
Critical Care, 2005).
206
Education is one of the vital components in rendering quality care to every patient.
Through it, nurses obtained various knowledge and skills that are necessary in the survival of
every patient. It continuously strengthens nurses’ confidence when they are guided with the
things they have learned. Table 2.3 presents the weighted mean distribution of the
respondents’ role for dying patient in terms of Education which illustrates that ICU nurses value
education of high importance with a composite mean value of 3.67 verbally interpreted as
great extent.
Among the 5 items under Education, taking advantage of educational programs and
mentoring opportunities that will provide them the knowledge and skills needed to implement
critical care standards got the highest weighted mean of 3.88, verbally interpreted as to a great
extent. It goes to show that ICU nurses continually search for the enhancement of their
knowledge and skills even if they have already obtained their baccalaureate degrees. This is
explicitly cited by AACN (2008) where nurses must seek learning opportunities that reflect
evidence-based practice in order to maintain clinical skills and competencies needed to care for
207
acutely and critically ill patients and families and participates in ongoing learning activities
related to professional practice and maintains professional records that provide evidence of
competency and lifelong learning.
ICU nurses constantly view applying the theories and concepts learned in providing end-
of-life care in the clinical setting to a great extent having a weighted mean of 3.74. This means
that they utilize the different nursing theories and concepts learned in their nursing education
as basis in identifying what appropriate action need to be applied to client care by reviewing,
reflecting, critically analyzing , questioning specially in times of doubt or uncertainty about their
actions.
Because nurses and nursing practice are often subordinate to powerful institutional
forces and traditions, the introduction of any framework that encourages nurses to reflect on,
question and think about what they do provides an invaluable service. Evidence- based practice
involves the recognition of which knowledge is appropriate for application to health care.
Practice theories, those that describe the relationships, among variables as applied to specific
clinical situations are important contributors to effective evidence-based practice (Campbell,
2005).
Education is a dynamic process. Nurses constantly attend trainings and seminar that
may enhance and develop their knowledge, skills and competency in terms of critical care
nursing to a great extent (x= 3.68). This means they are aware that as part of their personal
and professional growth as nurses, learning is continuous and attending conferences and
seminars will constantly brush up their knowledge and skills to keep up with the rapid
advancement of technology. AACN (2008) cited that nurses should participate in ongoing
learning activities to acquire and refine the knowledge and skills needed to care for acutely and
critically ill patients and their families.
ICU nurses keep themselves updated/abreast with the current trends regarding end-of-
life care practices to a great extent (x= 3.62). This proves that as health care practitioners,
nurses value constant updating about the scientific and technological change and changes
within the nursing profession to improve the quality of care being rendered to their clients. This
is the same with what Bare (2010) mentioned in her book, nurses must continually be aware of
studies that are directly related to their own area of clinical practice and critically analyze those
studies to determine the applicability of their implications for specific patient populations.
On the other hand, Critical Care Nurses perceive actively involving themselves in on-
going research studies on critical care nursing and applying the significant findings of which in
nursing practice into a moderate extent only, with a weighted mean of x= 3.43. This means that
only a few ICU nurses actively participate in research studies which may be brought by lack of
time in conducting and implementing research, lack of interest in reading current research
findings, lack of understanding about the importance of research to name a few as cited by
Voda (2003) in a study where he identified these constraints to impinge upon the successful
initiation conduct and application of research to the clinical setting.
208
It can be gleaned from Table 2.4 that ICU nurses perceive Collaboration and Collegiality
as an essential component in the delivery of the best end-of-life care to terminally ill patients
with a composite mean value of 3.87 verbally interpreted as to great extent.Collaboration
among healthcare team is vital to facilitate better patient outcome. The health care team works
as a group utilizing individual skills and talents to reach the highest patient care standard.
Collegial relationship between nurses and other health workers are vital to achieving the goal of
clinically integrated care.A more collegial unified relationship between nurses, physicians, and
hospital administrators leads to improved patient care and increases the power of nurses and
physicians to protect the best interest of patients
An advanced practice nurse to pull together interdisciplinary teams early in the
admission to develop a consistent plan of care focusing on the family spokesperson,
identification of decision makers (family), identification of primary physician spokesperson (may
not be the primary doctor), and identification of a primary nurse (caregiver or advanced
practice nurse). This team would identify the patient’s predicted quality of life and
prognosis(American Journal of Critical Care, 2006).
209
ICU nurses establish a good-working relationship with the members of the health care
team in planning and delivering quality care to a great extent having the highest weighted
mean of 3.94.Collaboration and collegiality involves all members of the health care team and
establishing rapport with co-workers aids in rendering efficient and quality nursing care.
Individuals must be willing to work together, have the same objectives and goals, and provide a
plan of care which is individualized to the patient’s needs. A health care team which works well
together, has mutual respect for everyone’s contributions and communicates effectively can
make all the difference in the patient’s outcome.
The health of people depends on what happens in organizations and what they do.
Cultivating good team work and nurses’ cohesion will establish harmony working condition,
enhance quality of patient care and increase patient satisfaction (Heap, 2001).
The patient is the most important part of the team, and through a collaborative team
based approach, patients can receive the highest quality of care. The medical team of doctors,
nurses and other medical professionals that engage and respect each other will create a
positive working environment and perform at an elevated level which can produce quality
patient care with exceptional patient outcomes. And like any team, the medical team needs to
work together respectfully and thoughtfully. The medical team needs to listen attentively to
each other and communicate and problem solve together. Each member of the team supports
and respects one another. The synergy of collaboration will greatly benefit the patient (Ficara,
2010).
Consultation and collaboration with co-health workers whenever in doubt especially on
certain matters concerning the health status of patient gained the second rank having a great
extent (x= 3.92) in the respondents’ nursing practice.
One way to ensure client safety is through collaboration and consultation. Nurses should not
perform any procedure whenever they are in doubt. They must learn how to consult with other
members of the health team to prevent errors that may harm the patient. Nurses at all times
must keep in their minds that they are handling lives of dying patients, it is a must that every
assessment, deterioration, or changes should be relayed accurately to other members of the
health care team. It is the same with what Lenz (2010) mentioned that protecting the rights of
subjects is a basic consideration in planning and undertaking any measurement activity. Since
many ethical issues related to nursing measurement remain open to considerable controversy,
the nurse who is unsure of the ethical and risk-related consequences of a given activity is well-
advised to consult others before proceeding.
Honoring and humbly accepting their colleagues’ criticisms as a means of developing

and enhancing their performance in the ICU was perceived to a great extent, having a weighted
mean of 3.88. Learning how to accept people’s criticisms will improve the quality of care being
rendered by nurses, especially when it comes from those people who had a lot of experiences
and expertise on the field of critical care nursing. Since patients in the ICU are at delicate
conditions, it is imperative for them to accept those mistakes that they have made and to be
open with the new learning. This aids to the development of nurses’ personally and
professionally as well as the assurance of patient’s safety. Venzon (2005) even cited that
constructive criticism is always welcome but not fault-finding. Fault-finders, gossipers and those
210
who are fond of intrigues will surely resent it too if they become the target of their own
practices.
Establishing bonds of trust and cooperation requires helping one another achieve a
common goal. Nurses establish good working relationships with other health care workers by
involving themselves in the personal and professional development of their colleagues by
imparting knowledge to them and had interpreted it as to a great extent (x= 3.88). Sharing
knowledge with colleagues allows for sharing others ideas and experience. It is crucial to the
development of skills and competencies. Through sharing of learnings, nurses and other
members of the health care team were given the opportunity to learn from each other. This
knowledge helps them to develop personally and professionally. This also facilitates evaluation
of one’s perception regarding the performance of their colleagues, therefore correcting
misconceptions (Venzon, 2005).
Respondents join and actively participate in different organizations involving advanced
nursing practices to a great extent (x= 3.74). Learning and developing are life-long processes. It
provides a means of staying current in their field. Organizations provide trainings, seminars, and
programs that will enhance their competencies. It also offers opportunities to lead and relate to
others. Through membership from different organizations, nurses receive valuable information
concerning a variety of topics.However, nurses viewed joining organizations as a less important
thing to accomplish. Nurses do not regard this matter as one of their top priorities because
most of them believe that joining organizations may be time consuming and they do not
recognize the benefits it offers. Compared with foreign countries, different nursing associations
are not known to Filipino nurses, they are not well aware that there are existing organizations
that can contribute to their professional development. Ellis and Hartley (2004) cited reasons for
the low level of membership in nursing organizations; these are the high cost of membership
and the lack of time participating in the activities. Others also have the dual responsibilities of
job and home and feel that they have no time left for involvement in professional organization.
Some just do not see how the benefits available through membership in the association are
personally valuable and explain that they are not just interested with the issues and concerns of
the organization.
211
Ethical dilemmas are encountered daily in the practice of critical care. The critical nature
of the situation and the speed that is required to make decisions, often prevent practitioners
from gaining insight into the desires, values, and feeling of patients. Table 2.5 presents the
weighted mean distribution of the respondents’ role for dying patient in terms of Ethico-Moral
and Legal Responsibility with a composite mean value of 3.84 verbally interpreted as to great
extent.
Among the 5 items under Ethico-Moral and Legal responsibility, Being aware that they
are responsible and accountable for individual nursing practice as well as in preserving the
client’s integrity and safety got the highest weighted mean of 3.98, verbally interpreted as to a
great extent. This shows that as ICU nurses and acting as client advocates, part of their duties is
to promote and protect the health, safety and rights of their clients. They know that they are
held responsible and accountable for their actions, consistent with the nurses’ obligation to
provide optimum patient care (Brenner, 2007).
212
Verbally interpreted as to a great extent with a weighted mean of weighted mean of

3.90, ICU nurses always follow the principles of Confidentiality and Privacy by ensuring client’s
privacy by pulling curtains around the bed, closing the door and making sure that he/she is
adequately covered when doing certain procedures. This attests that nurses protect the rights
of their clients and ensure that their client’s dignity is preserved in their actual practice.
According to Brener (2007), Confidentiality and Privacy are two vital elements of fidelity or
faithfulness that is based on traditional health care professional ethics. Regardless of the
amount of autonomy that patients have in the critical care areas, they still depend on the nurse
for a multitude of types of physical care and emotional support.
ICU nurses answered taking affirmative action responsive to the client’s condition and
documenting what was done to protect the client to a great extent with a weighted mean of
3.84. It clearly indicates that in their everyday encounter with critically-ill clients, ICU nurses
always keep in mind that as healthcare practitioners, they are legally responsible for their
obligations and actions. Documentation is important and not just for legal purposes but is
necessary and it is a way of giving high-quality care (Berman, 2008).
The cornerstone of the nurse-patient relationship is trust, especially in keeping the
philosophy of family-centred care. Veracity, or truth-telling, is an important ethical principle
that underlies this relationship. ICU nurses always tell the truth when talking with the family
regarding the client’s condition to a great extent (x= 3.82). However, according to Daniels
(2004), though truth-telling is essential in establishing a nurse-patient relationship, it is often is
difficult to achieve. It may not be hard to tell the truth, but it can be very hard to decide how
much truth to tell.
Among the 5 items, facilitating informed decision-making for patients making choices
about end-of-life care had the least weighted mean of 3.64, but verbally interpreted as to a
great extent. This means that although it is part of the responsibility of the nurses as advocates
to be involved in making decisions about patient care, not all ICU nurses perceived themselves
as being held accountable in facilitating decision-making with regards to client’s plan of care. In
a study conducted by Brenner (2007), only 8% of physicians recognize nurses as part of the
decision-making team. Other research reports that a majority of nurses feel relatively
powerless to change things they dislike in their work environment. This autonomy-
accountability gap interferes with nurses’ ability to optimize their essential contribution and
fulfil their obligations to the public as licensed professionals.
213
Table 2.6 presents the composite means of all the variables in respondent’s role to a
dying patient. Collaboration and collegiality got the highest rank with the composite mean of
3.87, verbally interpreted as great extent.ICU nurses have given the above results because
basically, nurses do not only perform independent interventions but as well as dependent and
interdependent functions, that is why it becomes an imperative in the critical care unit for ICU
nurses and other health care teams to communicate assessment, findings, or changes about the
health status of the patient to facilitate better outcomes. As Heap (2001) pointed out, the
health of people depends on what happens in organizations and what they do. Furthermore,
cultivating good team work and nurses’ cohesion will establish harmony working condition,
enhance quality of patient care and increase patient satisfaction.
Education got the lowest rank with a composite mean of 3.67, verbally interpreted as
great extent. Among the variables about the respondent’s role to a dying patient, the
researchers agree that this is the least priority since the educational aspect of the nurses’ role
will enhance the nurses’ personal andprofessional development rather than the patient’s
progress. Quality of care, Communication, Collaboration and collegiality, and Ethico-Moral and
Legal Responsibility are more client-centered and has a direct impact on patient outcome
compared to Education. Though education may somehow aid in the enhancement of the
patient’s prognosis, it is viewed to have an indirect effect, because as nurses gain additional
knowledge, they become more competent in rendering the needs of their patients in terms of
Quality of care, Communication, Collaboration and collegiality, and Ethico-Moral and Legal
responsibility. As Boyle (2001) mentioned, although nurses take pride in the expert care they
provide, they often feel frustrated with the lack of knowledge, support, and training they have
for care at the end-of-life. The above results also agree to what Research suggests that there
are persistent deficiencies in end-of-life nursing care practice and the education to support that
care (Schlairet 2009).
214
Table 3 presents the relationship between the respondents’ profile variables and their
role among dying patients based on the table, the computed p-value of age in relation to
education and length of service to quality of care, was less than 0.05 level of significance; thus
the hypothesis of significant relationship between the profile variables (age and length of
service) and the extent of role rendered to dying patient (education and quality of care) is
accepted.
The age of respondents affect the educational aspect of their role as critical care nurses.
Since most of them belong to the age group of 21-25, they are more open to accept new trends
and attend different seminars. Nurses belonging to this age group are highly flexible compared
to those nurses who are older and resistant to changes. Younger nurses have more time to
attend seminars and trainings because they are not yet committed to a profound responsibility.
They also view themselves as novice and they still lack knowledge that’s why they are pushed
to strive and achieve higher learning.
Highly complex and technologically rich work settings could be a contributing factor for
the professional nurses seeking further education. Murray (2005) noted that learning to be an
information management specialist with increased problem solving skills has become a
necessity for RNs to survive and thrive in many positions.Additionally, aggressive marketing by
nursing programs, combined with pressures to obtain advanced degrees with the enticement of
increased salary as a result have also been found as a major factor in attracting younger RNs
back into the academic world (HRSA, 2002).
Furthermore the quality of care improves as the length of service increases. This means
that as one nurse serves as an ICU Nurse for a greater time, she develops her potentials to the
fullest, enabling her to provide a good quality of care to a dying patient. ICU nurses serving for
long period of time acquire different experiences that open avenues for them to learn and
develop professionally. They are able to identify which things must be prioritized regarding
patient care. And they become used to the routines being observed inside the critical care unit,
they can easily determine what interventions to render even without the physician’s order and
easily recognize inaccuracy of the patient’s treatment regimen.
215
ICU nurses view their work as once in a lifetime chance to prove to themselves they can
do something for the betterment of the profession. Advanced beginners demonstrated
marginally acceptable performance, because they had coped with enough real situations or had
mentors who previously identify correct clinical decisions while competent practitioners who
had worked 3 years and above could relate their immediate actions to a along range of goals or
plans. Proficient nurses perceive a situation as a whole and limited their number of reasonable
options and experts had an intuitive grasp of situations and zeroed in on accurate data and
were therefore able to provide care accurately and quickly; and they analyzed data without
delay when novel situations occurred and events and behaviours did not respond as expected
(Martin, 2005).
In adjunct with this, Dunton et. al. (2007) mentioned that a research compiled National
Database Nursing Quality Indicators which looked at the nursing environment and
characteristics in relation to patient outcomes. This research concluded that multiple factors,
including nurse staffing, percentage of RN staff, and RN years of experience, impact patient’s
safety and nurse-sensitive outcomes.
Gender and Educational attainment does not have a significant effect on any variables
under the respondent’s role among the dying patient. In terms of gender, the researchers
ascertained that the quality of care being rendered is not determined by the masculinity or
femininity of a nurse.Males can do what females can and vice versa. Even though males are
known to have a strong personality; they are still capable of being compassionate, empathic,
and submissive.
Moreover, education does not also directly affect the extent of nursing care rendered by
ICU nurses to their dying patient. The degree of educational attainment does not justify the
service that ICU nurses can offer. Though higher education can enhance the knowledge of
nurses, it does not follow that the caring attitude of the nurse will also be mouldedsince it is a
personal attribute. Sometimes those nurses who are just recognized as RNs can work as
competent as those having the Masteral degree.
Table 4
Proposed Measures to Enhance Nursing Care rendered on the Dying
Patient
General Objective: To enhance the nursing care rendered by ICU Nurses on dying patient in
terms of quality of care, communication, education, collaboration and collegiality and ethico-
moral and legal responsibility.
Specific Area of Program and Persons Expected
Objective Responsibi- Activities Responsibl Outcome
lity e
ICU Nurses will The ICU Nurses
be able to: will:
to develop Seminars regarding ICU Nurses actively
interest in 1.Research the current trends in participate in
conducting will be Research, latest on-going
research, be enhanced evidence-based research studies
216
knowledgeable through practices and the and apply

of the disseminatio comparative findings to
important role n and effectiveness of improve client
of Research in application of different treatments care.
Nursing and research and clinical practices.
integrate findings in
findings into nursing
practice. practice a.Seminars/
raise and Conferences about
maintain the the current nursing participate in
highest practices in critical 2.ICU formal and non-
standard and 2.The care setting. Nurses and formal
quality of personal and Hospital education and
nursing professional b. Staff training that Managers gain adequate
practice development will enhance knowledge,
through must be the skills of nurses in skills and
attending expanded applyingevidence- attitude and
trainings and through the based practices in ICU applies learned
seminars pursuing information for
continuing the improve-
education ment of care.
keep abreast Utilize available
with the latest 3.regular subscription resources such
trends in end- and habitual reading as internet,
of-life care of nursing journals, magazines, TV
magazines, books and and others to
others resources for acquire latest
3.The updates about critical 3.ICU updates on
personal and care nursing Nurses critical care
professional nursing and
develop- apply these into
ment will be practice.
developed
through
continuing
education.
Research will
be expanded
through
application of
findings and
trends from
studies in the
clinical
217
setting.
CONCLUSIONS
Based on the aforementioned findings, the researchers came up with the following
conclusions:
Nursing has been historically viewed as an extension of women’s familial roles, and
young nurses have a greater capability of caring for people who are critically ill since they are
more physically fit and in their productive stage in life.
ICU Nurses generally are competent in rendering end-of-life care to terminally ill clients.
Among the five standards established by the AACN in Critical Care nursing, Education had the
least priority since it is more focused on the nurses’ personal and professional development
and is believed to have an indirect effect to the patients’ prognosis.
Age and length of service are significant predictors of nurses’ role in critical care setting.
The quality of critical care rendered depends largely on these profile characteristics.
The proposed enhancement program in Table 4, if utilized, will improve the roles of ICU
nurses in providing end-of-life care to critically ill patients in terms of key themes of comfort,
attachment and worth.
RECOMMENDATIONS
Based on the findings and conclusions of this study the researchers highly recommend
the following:
1. The proposed measures may be utilized by the health care institutions to enhance the
nursing care rendered to dying patients.
2. The ICU Nurses and all members of the health care team shall provide the best quality
of care to their patients, family, and significant others. And continuously prepare patients on
what to expect, provide information to alleviate uncertainty and facilitate therapeutic
communication at all times.
3. Healthcare institutions should continuously improve their service and have adequate
resources to enhance the quality of care provided to their client. They should implement a strict
policy and carefully evaluate ICU Nurses in order to assure the safety of critically ill patients.
4. The College of Nursing shall provide student nurses the needed knowledge to
improve the skills required in the intensive care unit and carefully evaluate student’s
performance.
5. The student nurses should maintain and enhance the quality of care they are
providing. They should also be guided to be more compassionate and caring to their patients as
well as to the family members. Student nurses should also apply different nursing care
strategies to help them cope with their fears.
6. For future researchers, they may work on a similar topic but need to evaluate the ICU
Nurses’ performance in a broader perspective.
218
REFERENCES
American Association of Critical-Care Nurses (AACN). (2006). The AACN Synergy Model for
Patient Care. Retrieved November 15, 2006, from
http://www.certcorp.org/certcorp/certcorp.nsf/vwdoc/SynModel?opendocument
American Association of Critical-Care Nurses. (2008). AACN Scope and Standards for Acute and
Critical Care Nursing. 101 Columbia, Aliso Viejo, CA 92656.
American Association of Critical-Care Nurses. (2005). Americal Journal of Critical Care, from
http://www.medscape.com/viewarticle/503776_5
American Society for Pain Management Nursing. (2010). Pathways to Clinical and Translational
Research Fellowship. Published by Elsevier Inc. from http://www.sciencedirect.com/science
American Association of Colleges of Nursing. (2009).

http://www.aacn.nche.edu/government/pdf/FS_Heal.pdf
American Nurses Association. (2011).American Nurses Association Code of Ethics for Nurses.
www.nursingworld.org/.../EthicsStandards/CodeofEthicsforNurses.aspx
Armola, R. R. & Brandeburg, J. (2011). Integrating Palliative Care in the ICU: The
Nurse in a Leading Role: Journal of Hospice and Palliative Nursing, from
http://ccn.aacnjournals.org/content/30/5/55.full
Armstrong, D.M.,Cohen, J.R. and Koerner, B.L. (2005). Collaborative practice and patient
satisfaction: impact on selected outcomes. Eval Health Prof.; 8(3): 299–321.
Azoulay E., Barboteu M., Canoui P., Chevret S., Le Gall J.R., Leleu, G., Pochard, F., Schlemmer B.
(2000).Half the families of intensive care unit patients experience inadequate communication
with physicians. Crit Care Med.; 28:3044-3049.
Baggs, J.G., Johnson K., Phelps W., Richeson P., Ryan B.,(2002) The association between
interdisciplinary collaboration and patient outcomes in a medical intensive care unit. Heart
Lung; 32(1): 18–24.
Bare,B.G.,Cheever K.H., Hinkle J.L., Smelt- zer S.C.,(2010).Brunner &Suddarth’s Textbook of

Medical –Surgical Nursing (12th ed.).Philadelphia:Wolters Kluwer Health/ Lippincott William &
Wilkins.
Beck,C.T.,and Polit,D.F.,(2008).Nursing Research: Generating and Assessing Evidence for

Nursing Practice(8th ed.). Philadelphia:Wolters Kluwer Health/ Lippincott William & Wilkins.
219
Berman,A., Erb,G.,Kozier,B.,Snyder,S.(2008).Kozier&Erb’s Fundamentals of Nursing (8th

ed.).Singapore:Pearson Education South Asia Pte Ltd.
Bihari, P. M.,Bruining, J., Hemmer M., Nicolas-Chanoin M., Spencer R.C., Suter, H. A.,Vincent
J.L., White J., Wolff M.,(2005). The prevalence of nosocomial infection in intensive care units in
Europe: results of the EPIC study. J.A.M.A. 274: 639-644
Black, D.R., Hardy, G., Parry, G., Turpin, G.,(2008). Patient Education and Counseling . (Vol. 12,
Issue 1pp. 29-36). Published by Elsevier Science Ireland Ltd., from
http://www.sciencedirect.com/
Bolyard, E.A., Deitchmann, S.D., Pearson, M.L., Shapiro, C.N., Tablan, O.C., Williams, W.W. , et.
al. Guideline for infection control in health care personnel, 2008. Am J Infection
Control1998;26,289-354
Brener, T. O. (2007). End of Life: A Nurse’s Guide to Compassionate CareLippincott Williams and
Wilkins
Boyle, D. K., Forbes, S., and Miller ,P.A.(2001). End-of-life care in the intensive care unit: A
challenge for nurses. Am J Crit Care. Dimensions of Critical Care Nursing: Volume 22 - Issue 5 -
pp 216-222
Campbell, E. T. (2005). Child abuse recognition, reporting and prevention: A Culturally

Congruent Approach. Journal of Multicultural Nursing and Health, 11(2),35-40.
Campbell, M. L. (2009). Nurse to Nurse Palliative Care :Expert Interventions McGrawHill

Companies, Inc.
Chiplaskey, L.M.(2001) from http://www.rnjournal.com/journal_of_nursing/end-of-

life-care.htm
Cline, D. (2005). Hospice and Palliative Care: Nutrition Issues and Tools for Palliative Care.
Home Healthcare Nurse (Vol.24 Number 1,pp 54 – 57 Retrieved from January 2006, from
http://www.nursingcenter.com/library/Journal Article.asp? Article_ID=621948
Conrad, S.N. (2006). American Association of Critical-Care Nurses: Hand Hygiene Compliance
Among Healthcare Professionals. from http://www.capital.edu/18046/
Cortez, T.B Curtis, R.J., Nelson, J., et al. (2006). Palliative and Hospice Carefrom
http://www.nursingcenter.com/library/ Journal Article.asp? Article _ID = 112967
Cueto, F. (2007). Nurses going abroad: We train, they gain. The Manila Times,
http://snpinoy.blogspot.com/2007/10/nurses-going-abroad-we-train-they-gain.html
220
Daniels, R. (2005).Nursing Fundamentals: Caring and Clinical Decision Making.

Shenton Way, Singapore: Thomson Learning Asia.
Draper, E.A., Knaus, W.A., Wagner, D.P.,Zimmerman, J.E.,(2002). An evaluation of outcome

from intensive care in major medical centers. Ann Intern Med.; 104(3): 410–418.
Dunton, N., Gajewski, B., Moore, J., Taunton, R.L.,(2007). Nurse staffing and patient falls on
acute care hospital units. Nurse Outlook, 52, 53-9.
Durie, P.R. and Pencharz, P.B. (2011).Oxford Journals Medicine . British Medical Bulletin (Vol.
48. Issue 4, pp. 823-846) from http://bmb.oxfordjournals.org/content/48/4/823.abstract
Edmunds, M.W. and Scudder, L. (2009).What Is the Relationship Between Nursing Knowledge
and Nursing Performance? http://www.medscape.com/viewarticle/714090
Ellis, J. R. and Hartley, C. L. (2004). Nursing in today's world: trends, issues &management (8th
ed.). Lippincott Williams and Wilkins
Ferrel, B., Grant, M , Rhome, A., Virani, R.,et.al,(2000). End-of-Life Care: Nurses Speak Out.
Nursing 2000: The Journal ofExcellence, Vol. 30 No. 37. SpringhouseCorporation
Ficarra, B. (2010). Health in 30. http://healthin30.com/2010/11/when-doctors and-

nurses-work-together
Fitzpatrick, J.J., and Whall, A. L.(2005). Conceptual models of Nursing :Analysis and Application
(4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Flowers, D.L., (2004). Culturally Competent Nursing Care: A Challenge for the 21st Century.
Published by: InnoVision Group from 101 Columbia, Aliso Viejo, CA
92656.http://ccn.aacnjournals.org/cgi/external_ref?link
Gaines, S. and Kinghorn, S. O. (2007). Palliative Nursing: ImprovingEnd-of-Life Care (2nd Ed.).
Elsevier
Goldhill, D.R., Imhoff, M., McLean, B. et. al. (2007). American Journal of Critical Care. Rotational
Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis.
http://ajcc.aacnjournals.org/content/16/1/50.full.pdf
Hall, W.J., Maibach, E. W., Wagner, M. C., Williams, M.E.,and Williams, T.F.,et.al.(2007). How
does the team approach to outpatient geriatric evaluation compare with traditional care: a
report of a randomized controlled trial. J Am Geriatr Soc.; 35(12): 1071–1078.
Harbaugh,B.L. and Pederson, C., (2010) from

http://informahealthcare.com/doi/abs/10.3109/01460869509080962?journalCode=cpn
221
Hardin, S.R. & Kaplow, R. (2005). Synergy for clinical excellence: The AACN Synergy Model for
patient Care. Sudbury, MA: Jones and Bartlett Publishers
Harrison,J.C. (2010). The Academic Path to Becoming a Nurse.http://ezinearticles.com/?The-

Academic-Path-to-Becoming-a-Nurse &id=4516768
Health Resources and Services Administration (HRSA). (2002). U.S. department of Health and
Human Services. Retrieved February 5, 2009 from
http://hrsa.gov./culturalcompetence/curriculumguide
Heap, M.J., Klinck, J.R., Males, A. G.,Munglani, R.,(2001). Elderly patients' preferences
concerning life-support treatment. Anaesthesia 93;48(12):1027–33. Comment in:
Anaesthesia. (12):1025–6.PMID: 8285319.
Himmelberg, C.J., Kessler, J.M., Pleasants, R.A., Samsa, G.P., Spivey, J.M.,Weber, D.J.,(2001). Use
of antimicrobial drugs in adults before and after removal of a restriction policy. Am J Hosp
Pharm;48,1220-1227
Howard, P. (2010).Why Belong to a Professional Nursing Organization?

|eHow.comhttp://www.ehow.com/about_6702912_belong-professional-nursing-
organization_.html#ixzz1Ih02dizK
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st
Century. Washington, DC: National Academy Press.
Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of
nurses. Washington, DC: National Academic Press
Jurkovich, G. J., Panamen, L., Pierce, N., Rivara, F.P.,(2000). Giving bad news: The family
perspective. The Journal of Trauma: Injury, Infection, and Critical Care, 48(5), 865-873.
Kerfoot, K.M. (2004). Synergy from the vantage point of the chief nursing officer. Excellence in
Nursing Knowledge, 1(1), 11-15.
Knaus, W.A., Wagner, D.P. and Lynn, J. (2006). Short-term mortality predictions for critically ill
hospitalized adults: Science and ethics. Science, 254, 389-394.
Lenz, E.R., Strickland, O. L., and Waltz, C. F.(2010). Measurement in Nursing and Health
Research (4th ed.) Rosewood Drive, Danvers, MA: Springer Publishing Company.
Leonard, J. (2002). Nursing Staff in Hospitals and Nursing Homes: Is It Adequate? Washington,
DC: National Academy Press
222
Mackay, T., (2005). What Degree do You Need to be an ICU Nurse?..

http://www.ehow.com/way_5714789_degree-do-need-icu-nurse_.html
Martin, K.S (2005).The Omaha System, A Key to practice, documentation, and information
management.2nd Edition. St. Louis: Elsevier.
McAdam, J. l. and Puntillo, K. A. (2006). Critical Care Nursing Secrets. Mosby Elsevier.
Murray, P. (2005). Nursing informatics: Views from the international community. British Journal
of Healthcare Computing & Information Management, 20(1), 20-22.
National Consensus Project for Quality Palliative Care. (2004). Clinical Practice Guidelines for
Quality Palliative Care.
Newman, M. (2009). Professional Ethics Report. 22(3), from

http://www.aaas.org/spp/sfrl/per/newper
Norlando, L. (2008). To Comfort Always – A nurse’s Guide to end-of-Life-Care. Sigma Theta Tau
International.
Perry, A. and Potter, P.A. (2003). Basic Nursing Essentials for Practice: Professionalism,
confidentiality, Courtesy, trust, Availability, Empathy, and Sympathy:
http://www.medscape.com/viewarticle/442646.
Pofessional Regulation Commission. Handout issued by the Board of Nursing Chairman, Ms.
Corazon dela Pena, at the ANSAP Convention, March 16, 2002.
Reed, K.D., Cline, M., & Kerfoot, K.K. (2007). Implementation of the synergy model in critical
care. In R. Kaplow, & S.R. Hardin (Eds.), Critical care nursing. Synergy for optimal outcomes (pp.
1-12). Sudbury, MA: Jones & Bartlett Publishers.
Schlairet, M.C. (2009). Journal of Professional Nursing.Volume 25, Issue 3, Pages 170-177.
http://www.professionalnursing.org/article/S8755-7223(08)00164-6/abstract
Scot, S. A. (2010). Life Support Interventions at the End-of-Life:Unintended Consequences.

American Journal of Nursing.Volume 110. No.1
Silvestre E.M. (2006). Despite recent scandal, Filipino Nurses still seen as Heroes in White.
(2006, November 11). Philippine Headline News, from
http://www.newsflash.org/2004/02/tl/tl012847.htm
Smith, A.R. (2006). American Association of Critical-Care Nurses (AACN). Using

Synergy Model to provide Spiritual Nursing Care in Critical Care Settings. (Vol. 26, No. 4) from
http://ccn.aacnjournals.org
223
Thompson, S. and Tilden, V. P. (2005). Policy Issues in End-of-Life Care. Journal of

Professional Nursing.
Top of Form
Bottom of Form
Truog, R.D., et al. (2001): Recommendatons for End-of-Life Care in theIntensive Care Unit:The
Ethics Committee of the Society of the CriticalCare Medicine, Crit Care Med 29 (12):2332-2348
Tzeng, H.M. (2010).Perspectives of staff nurses of the reasons for and the nature of patient-
initiated call lights: an exploratory survey study in four USA
hospitals.http://www.biomedcentral.com/1472-6963/10/52
Ufema, J. (2001).Death and Dying: Bedside Vigils. Nursing 2001, 30 (7). 26
Lough, M. E. Stacy, K. M., and Urden L. D., (2008).Thelan’s CriticalCare Nursing Diagnosis and
Management, 5th Edition. Elsevier, Mosbyhttp://EzineArticles.com/594747
Venzon, L.M. and Venzon, R.M. (2005).Professional Nursing in the Philippines, (10th Edition).
Quezon City, Philippines: C & E Publishing Inc.
Willeke, E. (2006). American Association of Critical-Care Nurses: Nurse's Role in Reducing the
Spread of Infections Among Patients, from http://www.capital.edu/18046/
World Health Organization. (2006). WHO Definition of Palliative Care.

http://www.who.int/cancer/palliative/definition/en/
Yox, S. (2004). (2004): An interview with ANA president Barbara Blakeney. Medscape Nurses, 6
(1). Retrieved October 21, 2004, from www.medscape.com/viewarticle/474867 .
Zaki, E.M. (2007). Infection Control ProtocolinIntensive Care Unit.

http://www.seci.info/program.pdf.
________________, Intensive care acquired infection is an independent risk factor for hospital
forhospital mortality: a cohort study, HTTP://CCFORUM.OM/CONTENT.10/2/r66. Published:
April 20, 2006
________________, Infection control protocol in Intensive Care Unit.

http//www.aun.edu.eg/SECI/emanmosaad/Infection%20control%20in%20intensive%20care%2
0unit.pdf.
______________,(2005)http://www.myicucare.org/Critical_Care_Team/Pages/default.aspx MY
ICU CARE.ORG.
224

Role of Critical Care Nurses in End-of-Life Care

Uploaded by

Copyright:

Available Formats

Role of Critical Care Nurses in End-of-Life Care

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Role of Critical Care Nurses in End-of-Life Care

Uploaded by

Copyright:

Available Formats

E – International Scientific Research Journal, VOLUME – V, ISSUE – 3, 2013, ISSN 2094 - 1749

Role of Critical Care Nurses in End-of-Life

Lyceum of the Philippines University

Objectives of the Study

This research was conducted utilizing a descriptive correlational method in establishing

As one of the types of Descriptive Studies, the purpose of descriptive correlational

RESULTS AND DISCUSSION

As to gender, majority of the respondents are female with a frequency of 31 or 62.0%;

such as atelectasis, constipation, and urolithiasis. Furthermore, it is important in maintaining

Communication with the patient and family is a standard of professional nursing

religious preference. Stereotyping is defined as an oversimplified conception, opinion, or belief

Honoring and humbly accepting their colleagues’ criticisms as a means of developing

Verbally interpreted as to a great extent with a weighted mean of weighted mean of

knowledgeable through practices and the and apply

American Association of Colleges of Nursing. (2009).

Bare,B.G.,Cheever K.H., Hinkle J.L., Smelt- zer S.C.,(2010).Brunner &Suddarth’s Textbook of

Beck,C.T.,and Polit,D.F.,(2008).Nursing Research: Generating and Assessing Evidence for

Berman,A., Erb,G.,Kozier,B.,Snyder,S.(2008).Kozier&Erb’s Fundamentals of Nursing (8th

Campbell, E. T. (2005). Child abuse recognition, reporting and prevention: A Culturally

Campbell, M. L. (2009). Nurse to Nurse Palliative Care :Expert Interventions McGrawHill

Chiplaskey, L.M.(2001) from http://www.rnjournal.com/journal_of_nursing/end-of-

Daniels, R. (2005).Nursing Fundamentals: Caring and Clinical Decision Making.

Draper, E.A., Knaus, W.A., Wagner, D.P.,Zimmerman, J.E.,(2002). An evaluation of outcome

Ficarra, B. (2010). Health in 30. http://healthin30.com/2010/11/when-doctors and-

Harbaugh,B.L. and Pederson, C., (2010) from

Harrison,J.C. (2010). The Academic Path to Becoming a Nurse.http://ezinearticles.com/?The-

Howard, P. (2010).Why Belong to a Professional Nursing Organization?

Mackay, T., (2005). What Degree do You Need to be an ICU Nurse?..

Newman, M. (2009). Professional Ethics Report. 22(3), from

Scot, S. A. (2010). Life Support Interventions at the End-of-Life:Unintended Consequences.

Smith, A.R. (2006). American Association of Critical-Care Nurses (AACN). Using

Thompson, S. and Tilden, V. P. (2005). Policy Issues in End-of-Life Care. Journal of

Ufema, J. (2001).Death and Dying: Bedside Vigils. Nursing 2001, 30 (7). 26

World Health Organization. (2006). WHO Definition of Palliative Care.

Zaki, E.M. (2007). Infection Control ProtocolinIntensive Care Unit.

________________, Infection control protocol in Intensive Care Unit.

You might also like