Education and training for moral and ethical decision-making at the end of life in critical care

Consales, Guglielmo; Zamidei, Lucia; Michelagnoli, Giuliano

doi:10.1016/j.tacc.2014.10.005

Cited by 1 publication

(1 citation statement)

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“…This scoping review has revealed relatively little published research exists to specifically guide education policy or supportive practice in this area. Other disciplines including medicine and nursing, have a diverse and building evidence base outlining optimal clinician preparation and support for resuscitation decision-making, communication with bereaved relatives and coping with patient death (63,(64)(65)(66)(67)(68). While this research offers some useful insights, resuscitation decisions in the community setting have unique contextual features, and the needs of ambulance personnel may differ.…”

Section: Implications and Recommendationsmentioning

confidence: 99%

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

Anderson

Slark

Gott

2019

Australasian Journal of Paramedicine

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IntroductionResearch shows that ambulance personnel can find it challenging to withhold or terminate resuscitation and manage patient death in the field. This scoping review provides a synthesis of published research that has addressed three main questions. Each relates to ambulance personnel enacting decisions to withhold or terminate resuscitation and manage patient death: How are they prepare; what supports and coping strategies are utilised; and what preparation and support needs have been identified?MethodsUsing Arksey and O’Malley’s five-stage scoping review framework this review identifies what is known and what further research is needed in this area.ResultsSixteen methodologically heterogenous papers were located. Half of the studies were conducted in the United States, with the remainder in Canada, Singapore, Spain, Sweden and the United Kingdom. Ambulance personnel receive little formal training and feel unprepared to manage situations where resuscitation is unsuccessful or unwarranted, particularly communicating with family, breaking bad news and managing death scenes. These aspects of termination of resuscitation are so challenging that distancing and avoidance are sometimes used as coping strategies, even when medical futility has been established. In addition to formal counselling for personal loss and stressors, ambulance personnel value downtime and informal peer debriefing, following difficult resuscitation decisions and patient deaths.ConclusionAmbulance personnel feel inadequately prepared to withhold or terminate resuscitation and manage patient death in the field. They want more opportunities to learn about death notification, communication with bereaved families and safe, sensitive management of death scenes. More research is needed to determine how best to prepare and support ambulance personnel for the challenges of resuscitation decision-making and patient death.

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