A Qualitative Study

A qualitative study
Donna
Goodridgea, Wendy Dugglebya, John Gjevreb, Donna Renniea.
College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada S7T 5E5 Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Saskatchewan Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
The
purpose of this descriptive study was to examine intensive care unit (ICU) clinicians perspectives on the challenges of providing quality EOL care for individuals with COPD who die within the critical care environment.
Critical care nurses have raised important concerns about the quality of care for individuals dying in the technologyrich, fast-paced setting of the ICU. Emotional and organizational supports for staff are wellrecognized as a key component of ensuring the delivery of quality care for those who are dying. Critical care clinicians care deeply about facilitating highquality dying (Seymour, 2001). Nurses reported that quality EOL care in the ICU was complicated by disagreements among family members or among clinicians, uncertainty about prognosis and communication problems between physicians and between physicians and family members (Kirchhoff et al., 2000).
Design:
Ethical approval was given by the researchers affiliated university
Behavioral Research Ethics Board and the local Health Region. A qualitative focus group design with three groups of staff was used to describe the experiences of critical care nurses and respiratory therapists (RTs) in providing EOL care to patients with COPD dying in the ICU. Each focus group met once and a follow-up interview was conducted with one volunteer from each group to validate the themes emerging from the focus group. The interview consists of 1) Opening / Introductory Question, 2) Transition Questions, 3) Key Question & 4) Ending Question.
Setting:
The three ICUs were comparable in size, ranging from 10 to 12 beds, although the number of admissions ranged from 350 to 800 per year and overall mortality rates varied from 9.5% to 21.2%. Of the 1600 admissions to these ICU units in 2005, approximately 240 patients were admitted with a diagnosis of COPD and invasive mechanical ventilation was required by about 100 patients. The nurses and respiratory therapists on these units have significant experience caring for patients with advanced COPD.
Participants:
1. 2. 3.
4.
Nurses Respiratory therapists Physiotherapists Physicians
Data analysis
Transcripts were checked for accuracy against the recordings. All transcripts were read by the research team members individually and then collectively. Qualitative data were stored and managed using N6 software. The analysis of focus group data focused on the individual and group levels. The data (transcripts and field notes) for each focus group were analyzed separately. The analysis focused on challenges that participants perceived as unique to, or especially pervasive in, caring for people with COPD in the ICU.
Seventeen ICU clinicians participated in the focus groups, a total which included 15 registered nurses and two respiratory therapists. While 21 staff members had originally committed to participate, four were unable to attend due to last minute personal conflicts in scheduling (including being called into work an over-time shift). All participants were employed at least half time in one of the three ICUs. The mean age of the participants was 42.3 years, with a range from 27 to 57 years. Participants had a mean overall nursing experience of 19.6 years with a range of 536 years, with a mean ICU experience of 12.3 years (range 121 years). Five participants were male.
Focus
group sizes were four, six and seven participants.

focus groups lasted from 55 to 75 min and were tape-recorded and transcribed.
The
In this exploratory study, focus groups of nurses and respiratory therapists working in three critical care settings described some of the challenges to providing EOL care to people with advanced COPD who were dying in the ICU. The three themes of managing difficult symptoms, questioning the appropriateness of life-sustaining care and conflicting care priorities were noted to be significant challenges. Dyspnea and anxiety were clearly the symptoms participants associated most often with patients dying with COPD in the ICU. Ethical considerations were central to the discussion of end-of-life care for people dying with COPD in the ICU. This study also revealed a number of areas that warrant further research.
The findings may reflect the particular culture and idiosyncrasies of each ICU setting, although they lay the foundation for future research in this area. This study is limited by the relatively small number of participants as well as including ICUs from a single city. However, credibility in a qualitative study is determined more by the richness of data than by sample size. The discussion relied on participants recollections of caring for individuals dying with COPD in the ICU setting.
Providing expert critical care for the high acuity patient with a diagnosis of COPD at the end of life is both complex and challenging. The purpose of this descriptive study was to examine intensive care unit (ICU) clinicians perspectives on the obstacles to providing quality care for individuals with COPD who die within the critical care environment. Transcripts of three focus groups of ICU clinicians were analyzed using thematic analysis. The three themes of managing difficult symptoms, questioning the appropriateness of life-sustaining care and conflicting care priorities were noted to be significant challenges in providing high quality end of life care to this population.
The
need to prioritize care to the most unstable ICU patients meant that patients with COPD did not always receive the attention clinicians felt they should ideally have. Organizational support must be made available for critical care clinicians to effectively deal with these issues.

A Qualitative Study

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A Qualitative Study

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A qualitative study

Goodridgea, Wendy Dugglebya, John Gjevreb, Donna Renniea.

Nurses Respiratory therapists Physiotherapists Physicians

group sizes were four, six and seven participants.

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