A Study On The Quality Of Dying And Death Of Patients At The End Of Life In ICU

BackgroundAccording to the quality of death Index of 80 countries reported by the Economist Intelligence Unit in 2015,the quality of death of residents in mainland China ranked 71st.Recently,palliative care and hospice care that bases on humanistic care and aims at a good death have gradually attracted people's attention,people have realized that the meaning of life is not only the extension of the length of life but also the improvement of the quality of life and the maintenance of the quality of death are also issues worthy of attention.Hospice care is a care model that is created and developed to meet the needs of dying patients and their families.To improve the quality of death is one of the important targets of end-of-life care because it reflects the level of hospice care to a certain degree.It is necessary to introduce the concept and measurement tools of quality of death to promote the development of hospice care.The quality of death is the final quality of life of an individual.Traditional ICU is emphasized to "saving lives",which leads some dying patients to receive the ineffective treatment,reduces the quality of death and increases the consumption of medical resources.As a frontier position of saving lives and healing the wounded,ICU should not only pay attention to the success rate of rescue the development rate of new technology and new business,but also to the quality of death for ineffective patients.At present,there is still a lack of research in this field in China,such as pay more attention to the quality of death for ICU ineffective patients,the specific,reliable and valid evaluation tools for the quality of death,and the in-depth discussion on the quality of death in ICU ineffective patients.ObjectiveA comprehensive investigation was conducted on the quality of death of patients at the end of life in intensive care units,including the status of receiving life support 24 hours before death,the status of receiving hospice care services,and the quantitative evaluation of the quality of death of patients cared for by ICU nurses.ICU nurses'cognition and practical experience of the quality of death of patients at the end of life,the promoting and hindering factors in the working environment,and their suggestions.Methods1.On the basis of literature research,a self-designed medical record questionnaire was designed,and the medical record retrospective analysis method was used to analyze the medical records of 131patients who died n the comprehensive ICU of a single tertiary medical center in Wuhan from January to June 2018.2.The ICU quality of death scale developed by the Curtis team of the University of Washington was cross-culturally adjusted,and the scale was used to investigate the quality of death of 231 patients at the end of life in 7 intensive care units in Hubei province.3.The method of the personal in-depth interview was used to interview 12 nurses in the Department of Intensive Care Medicine of a third-grade-hospital in Wuhan to understand their experience in taking care of patients at the end of life and suggestions to improve the quality of death of patients.Result1.ICU patients still will be actively treated even if they have entered the end of life,the utilization rate of comfortable drugs is low,the development of hospice care services is still in the early stage,and the quality of death is low.Before the death 24 hours,the endotracheal intubation rate was 76.34%,the mechanical ventilation rate was 74.81%,and the cardiopulmonary resuscitation rate is 29.01%.87.02%of patients used vasoactive drugs,and 76.32%of patients used combination drugs.However,the utilization rate of hospice care services before deathbed was low.56.49%of patients used analgesics,of which only 16.03%were combined and 39.69%were single.2.The Chinese version of QODD-3.2A has good reliability and validity.The Cronbach's a of the total scale is 0.891,the split-half reliability is 0.801,the content validity index of the scale level is 0.94,and the cumulative variance contribution rate is 67.47%.It can be utilized as a tool to evaluate the quality of death of domestic ICU patients at the end of life.The quality of death of ICU patients at the end of life is not much better,with a total average score of 39.59±13.76.Among which,the scores of spiritual care and deathbed decision-making are 1.61±2.39 and 2.99±2.39 relatively low.3.ICU nurses to believe that the quality of death of patients at the end of life is not high,including inadequate comfortable care of end of life patients;failure to meet the spiritual needs of patients' and family members;lack of preparation of staff and patients family for the face of death;family members have ethical and moral dilemmas;medical staff are lack of professional support.It is suggested to promote the model of palliative care and hospice care in medical institutions,carry out professional training in hospice care,and pay attention to and meet the needs and wishes of individuals and families.ConclusionIn this study,the quality of death of ICU patients at the end of life was investigated systematically through retrospective analysis of medical records,questionnaires,and personal in-depth interviews.The results showed that the quality of death of patients at the end of ICU was low,the development of ICU hospice care service was still in the primary stage,and ICU nurses lacked hospice care knowledge,ability to accept and manage death and psychological support.In the future,it is necessary to further explore the care mode of ICU patients at the end of life,train nurses and improve the evaluation index of care quality to improve the death quality of ICU patients at the end of life.