An assessment of social diffusion in the Respecting Choices advance care planning program.

This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients' medical records. Using data from a survey of more than 5,000 White Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney.

Effect of a disease-specific advance care planning intervention on end-of-life care.

Objectives: To compare patient preferences for end-of-life care with care received at the end of life.

Design: A randomized controlled trial was conducted with individuals with congestive heart failure or end-stage renal disease and their surrogates who were randomized to receive patient-centered advance care planning (PC-ACP) or usual care.

Setting: Two centers in Wisconsin with associated clinics and dialysis units.

Effect of a disease-specific planning intervention on surrogate understanding of patient goals for future medical treatment.

Objectives: To determine whether a disease-specific planning process can improve surrogate understanding of goals of patients with life-limiting illnesses for future medical treatments.

Design: A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007.

Setting: Six outpatient clinics of large community or university health systems in three Wisconsin cities.

Challenges Facing Families at the End of Life in Three Settings.

This study examined the challenges faced by family members at the end of life in different care settings and how those challenges compare across settings. A total of 30 participants, who had a family member die in inpatient hospice, a skilled nursing facility or a community support program were interviewed. Semi-structured interviews were recorded and transcribed.

Current practices for withdrawal of life support in intensive care units.

Background: Nurses are present at the bedside of patients undergoing withdrawal of life support more often than any other member of the health care team, yet most publications on this topic are directed at physicians.

Objectives: To describe the training, guidance, and support related to withdrawal of life support received by nurses in intensive care units in the United States, how the nurses participated, and how the withdrawal of life support occurred.

Methods: A questionnaire about withdrawal of life support was sent to 1000 randomly selected members of the American Association of Critical-Care Nurses, with 2 follow-up mailings.

Materials to prepare hospice families for dying in the home.

Many changes occur in the final hours of life. Family members of those dying at home need to be prepared for these changes, both to understand what is happening and to provide care. The objectives of this study were to describe (1) the written materials used by hospices to prepare families for dying in the home setting and (2) the content of such materials.

Preparing families of intensive care patients for withdrawal of life support: a pilot study.

Background: Most deaths in intensive care occur after withdrawal of life support. Although preparation of patients' families is recommended, the specific information required has not been theoretically developed or tested.

Objective: To assess the feasibility of testing 4 tailored messages to prepare families of patients having a planned withdrawal of life support, to assess barriers to conducting such a study, and to obtain preliminary data on measurable effects that could be used to compare such preparation with usual care.

Family support at end of life.

Much of the literature for end of life in the intensive care unit focuses on patients and their treatment. Families are usually present and should be a focus, as well as a resource, in end-of-life plans. Using categories from a recently published Society of Critical Care Medicine guideline on family support during an intensive care unit stay and 7 end-of-life domains, literature retrieved since 2000 was summarized.

Recruiting participants in end-of-life research.

A great deal of time, attention, and funding has been dedicated to research concerned with improving care at the end of life. However, sizes of samples for such research are reduced by recruitment problems unique to end-of-life studies, which limits their power and generalizability. In this article, experiences are shared and suggestions are offered to increase recruitment using 4 recent studies on end-of-life topics as examples.

Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy.

Objective: Although noninvasive positive pressure ventilation (NPPV) is a widely accepted treatment for some patients with acute respiratory failure, the use of NPPV in patients who have decided to forego endotracheal intubation is controversial. Therefore, the Society of Critical Care Medicine charged this Task Force with developing an approach for considering use of NPPV for patients who choose to forego endotracheal intubation.

Data Sources And Methods: The Task Force met in person once, by conference call twice, and wrote this document during six subsequent months.

State of the science of translational research: from demonstration projects to intervention testing.

An overview of the effort of nursing in translation research begins with studies in research utilization. Delineation of issues in the uptake of evidence using guidelines and systematic reviews is discussed next. The federal initiatives in translation research are described with a focus on the Translating Research Into Practice (TRIP) studies.

Providing a "good death": critical care nurses' suggestions for improving end-of-life care.

Background: Providing appropriate end-of-life care has become a primary concern of nurses and the public. The highly technological critical care environment may not facilitate such care.

Objective: To collect suggestions from critical care nurses for improving end-of-life care in intensive care units.

American Association of Critical-Care Nurses' national survey of facilities and units providing critical care.

Background: Little information is available nationally about critical care units and nurses. What is known about nurses in hospitals is generally not broken down among all the specialties.

Objectives: To describe issues of workforce, compensation, and care specific to critical care units and nurses who work in them.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

Objective: Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit.

A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery.

Background: Although many healthcare providers and researchers consider it necessary to assist patients with end-stage chronic illnesses to plan for the end of life, they tend to avoid discussing end-of-life issues with patients before major surgery. Consequently, surgical patients and their families generally have insufficient knowledge to make plans in case of life-threatening complications.

Objective: The objective of this study was to evaluate short-term effects of Patient-Centered Advance Care Planning (PC-ACP).

Providing end-of-life care to patients: critical care nurses' perceived obstacles and supportive behaviors.

Background: Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and/or supportive behaviors that help in delivery of end-of-life care is limited.

Objective: To measure critical care nurses' perceptions of the intensity and frequency of occurrence of (1) obstacles to providing end-of-life care and (2) supportive behaviors that help in providing end-of-life care in the intensive care unit.

Documentation on withdrawal of life support in adult patients in the intensive care unit.

Background: Patients' charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research.

Caring for the family of the critically ill patient.

Family's needs and considerations are an essential component of intensive care unit (ICU) care. Family satisfaction is related to clinician communication and decision making. Indeed, timely, honest communication is vital to the psychosocial health and satisfaction of the family.

Patient-centered advance care planning in special patient populations: a pilot study.

The purpose of this study was to assess the feasibility of a patient-centered advance care planning (PC-ACP) approach to patients with chronic illnesses and their surrogates with respect to promotion of shared decision-making outcomes-congruence between patient and surrogate, patient's decisional conflict, and knowledge of advance care planning. An experimental design was used. The settings were the heart failure, renal dialysis, and cardiovascular surgery clinics at Gundersen Lutheran Medical Center in La Crosse, WI.

Analysis of end-of-life content in critical care nursing textbooks.

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted.

ICU nurses' preparation of families for death of patients following withdrawal of ventilator support.

Intensive care unit nurses were asked how they prepared families for the death of their patient following withdrawal of mechanical ventilation. Forty-three descriptors were identified, of which 67.5% (n = 29) were "physical sensations and symptoms.

Patient-centered interventions.

Patient-centered care is valued in nursing. However, until recently, nurse-researchers have focused on testing the effects of standardized rather than patient-centered interventions (PCIs). The latter are those interventions that are altered to address selected patient characteristics (e.

Promoting a peaceful death in the ICU.

Care for the dying ICU patient and family should be inclusive of respect for their goals, preferences. and choices. Care should be comprehensive, inclusive of all the patient domains (physical, psychosocial and, spiritual), and inclusive of all the specialties and disciplines that can be helpful at this complex time.

The vortex: families' experiences with death in the intensive care unit.

Background: Lack of communication from healthcare providers contributes to the anxiety and distress reported by patients' families after a patient's death in the intensive care unit.

Objective: To obtain a detailed picture of the experiences offamily members during the hospitalization and death of a loved one in the intensive care unit.

Methods: A qualitative study with 4 focus groups was used.