Intensive care units poorly equipped to care for the dying

Most relatives are nevertheless happy with the care given, shows a thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

An intensive care unit (ICU) is designed primarily to save lives rather than provide end-of-life care. When a patient dies on an ICU, this often follows a sudden illness or trauma, and neither the patient nor relatives are prepared for death.

“The location and environment in which people die mean a lot not only for the person who is dying but also for those who are to look after them and those who must learn to live without them,” says nurse Isabell Fridh, who wrote the thesis.

Her thesis shows that Swedish ICUs are often unable to care for dying patients in separate rooms. The waiting rooms to which relatives are sent are often too few and too small. Most units do not have a care programme for end-of-life care, and many also have no procedures in place for supporting relatives after a death, which is standard practice at hospices. The results also show that almost half of the patients (in the study) died within 24 hours after admittance (to intensive care), and 40% of these did not have any relatives present at the time of death.

“This may seem to paint a bleak picture, but the truth is that most of the relatives I interviewed for my thesis thought that the care given was a positive experience despite their sense of loss,” says Fridh. “Many feel that their loved one benefited from all available medical resources and that everything that could be done to save their life was indeed done.”

Relatives rarely complain about the physical environment, but they do not like to be separated from the patient against their will, and greatly appreciate being able to spend that last bit of time with their loved one in a private room.

Isabell Fridh also interviewed ICU nurses, who do their utmost to care for dying patients even where the environment is not well suited to it. Nurses use the available medical technology to alleviate patients' suffering and try hard to provide privacy and give relatives a lasting sense that their loved one's death was peaceful and dignified.

For more information:
Isabell Fridh, PhD and nurse, +46 31-786 60 59, 070-172 27 28, isabell.fridh@fhs.gu.se
The thesis was successfully defended on October 2.
Title: Vårdmiljö, vård och omvårdnad vid livets slut inom intensivvård (End of life in intensive care units: health care environment and nursing)

Link to thesis: http://hdl.handle.net/2077/20463

The thesis is based on the following papers:
I. Fridh, I., Forsberg, A., & Bergbom, I. (2007). End-of-life care in intensive care units – family routines and environmental factors. Scandinavian Journal of Caring Sciences, 21, 25-31.
II. Fridh, I., Forsberg, A., & Bergbom, I. (2007). Family presence and environmental factors
at the time of a patient's death in an ICU. Acta Anaesthesiologica Scandinavia, 51, 395-401.
III. Fridh, I., Forsberg, A., & Bergbom, I. (2009). Close relatives' experiences of caring andof the physical environment when a loved one dies in an ICU. Intensive and Critical CareNursing, 25, 111 -119.
IV. Fridh, I., Forsberg, A., & Bergbom, I. (2009). Doing one's utmost: Nurses' descriptions of caring for dying patients in an intensive care environment. Intensive and Critical Care

Nursing, in press, doi:10.1016/j.iccn.2009.06.007

BY: Elin Lindström Claessen
elin.lindstrom@sahlgrenska.gu.se
+46 31-7863869