WORKSHOP No. 1 1.

Research Problem: My research problem is to gain a perception on the delivery of care by Nurses assigned on the Intensive Care Unit towards the dying patient even though series of aggressive interventions had been given. 2. The condition which gave rise to my research question are: In recent studies done by Lissi Hansen, RN, PhD, Teresa T. Goodell, et.,al in

2009, they stated that nurses who work in Intensive Care Units (ICUs) have traditionally received little education and training in care of dying patients. Furthermore, they also cited that Critical care nurses lack knowledge about palliative care in general and in providing support to and communicating with patients and patients families. End-of-life issues are poorly addressed, both in nursing schools and healthcare institutions. No study on the ways that nurses establish care on the dying patients had been made in our province 3. The ideal situation would have been: Being assigned in the Intensive Care Unit, Nurses are expected to have full knowledge on concept about death and proper care for the dying. They were supposedly be more equipped on establishing care for the patient and their family. 4. The possible reason for discrepancy between No. 2 and No.3 In most hospitals, end-of-life training is not usually mandatory for Nurse assigned Critical care nurses are acknowledged experts in physical care for critically ill in the Intensive Care Unit. patients. These nurses are certified in various courses such as Advanced Cardiac Life Support and follow algorithms, protocols, and procedures to stabilize patients conditions

and treat the patients. However, few algorithms, protocols, and procedures are available to guide the care of patients and patients families at the end of life. 5. The following interventions have been done to address the problem, and the outcomes were: In the American Journal for Critical Care, citing a relative study on Nurses care for the dying an intervention was done in a certain hospital to aid nurses to establish care for the patient and their family. They have developed a bereavement program for patients families, a palliative medicine and comfort care team, use of preprinted orders for the withdrawal of life-sustaining treatment, hiring of a mental health clinical nurse specialist, and staff education in end-of-life care. 6. The following facts/findings have been reported in related studies about the problem. In the Nursing Education in Critical Care Discussion by Lissi Hansen, RN, PhD, Teresa T. Goodell, RN, PhD, CNS, CCRN, ACNS-BC,Josi DeHaven, RN, MPH, CCRN, and MaryDenise Smith, RN, CNS, ACHPN(AMERICAN JOURNAL OF CRITICAL CARE, May 2009, Volume 18, No. 3) It was found out that nurses with more years of ICU experience scored higher in knowledge and ability. End of-life care skills traditionally have been taught to critical care nurses on the job, and providing specific skills training and education for new nurses may help in the challenging transition from novice to skilled critical care nurse when helping dying patients and the patients families. The result they have gained might also differ in some extent because some units ( in which they have done the study) have more patients compared with the others like in Nurses working in the 4 ICUs developed the bereavement program to support patients families, but the program was first implemented in the MICU(Medical Intensive Care Unit). The MICU was the unit with the highest number of deaths, which was particularly challenging to the nurses, who felt their support of families was inadequate at that time. As with any program, considerable ongoing support by nurses and administration is needed for a bereavement program to

succeed As suggested by Kirchhoff and Beckstrand,22 bereavement management and psychiatric liaisons are ways nurses can be assisted in their care of patients families during the families time of loss; both of these interventions were implemented at the medical center. Implementation of the palliative medicine and comfort care team may also have added to the improvement in patient and family support scores. NURSES' ATTITUDES TOWARD CARING FOR DYING PATIENT IN MANSOURA UNIVERSITY HOSPITALS Wafaa Gameel Mohamed Ali1, Nahed Saied Ayoub2 1Lecturer of Adult Care Nursing, 2Lecturer of Gerontological Nursing, Faculty of Nursing, Mansoura University (EGYPT) The results of this study showed that the majority of Nurses reported that they are likely to provide care and emotional support for the people who are dying and their families, but about half of them were unlikely to talk with them about death and had a tendency not to accept patient's authoritative decision makers.They found that, most Nurses are likely to view death as a natural part of life and also as a gateway to the afterlife. Also, their study reported that they are likely to provide care and emotional support for the people who are dying and their families, but they were unlikely to talk with them or even educate them about death. In addition, they had a tendency not to accept patients and their families as the authoritative decision makers, and their participants tend to refuse involvement of families in patient care. Nurses are the closer health profession to the patient and his family and several factors can affect on nurses'attitudes towards care of dying patients. The results of the present study shows that there is no relation between the age of the nurses, this is very contradicting with the result study of comprehensive cancer center in New York, NY., Dunn, Otten, Stephens. (2005) (11), who reported that nurses with more years of nursing practices exhibits a positive attitude toward caring for dying patients, this is contradict with the results of the present study which demonstrated that there was no relation between Years of nurses' experience and nurses attitudes toward caring for dying patients. The findings of several studies mentioned that greater exposure and experience in working with dying patients were associated with more positive attitudes toward death and care of dying patients. In the

present study more than half of the nurses agree that there is benefit to the dying to verbalize his /her feelings, while regarding the responsibility of the nurse to talk with the dying person about death their responses range from uncertain, agree and strongly agree that it is not the nurse responsibility.