“Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

Abstract

Background: Although the culture in burns/critical care units is gradually evolving to support the delivery of palliative/end of life care, how clinicians experience the end of life phase in the burn unit remains minimally explored with a general lack of guidelines to support them. Aim: To explore the end of life care experiences of burn care staff and ascertain how their experiences can facilitate the development of clinical guidelines. Design: Interpretive-descriptive qualitative approach with a sequential two phased multiple data collection strategies was employed (face to face semi-structured in-depth interviews and follow-up consultative meeting). Thematic analysis was used to analyze the data. Setting/participants: The study was undertaken in a large teaching hospital in Ghana. Twenty burn care staff who had a minimum of 6 months working experience completed the interviews and 22 practitioners participated in the consultative meeting. Results: Experiences of burn care staff are complex with four themes emerging: (1) evaluating injury severity and prognostication, (2) nature of existing system of care, (3) perceived patient needs, and (4) considerations for palliative care in burns. Guidelines in this regard should focus on facilitating communication between the patient and family and staff, holistic symptom management at the end of life, and post-bereavement support for family members and burn care practitioners. Conclusions: The end of life period in the burn unit is poorly defined coupled with prognostic uncertainty. Collaborative model of practice and further training are required to support the integration of palliative care in the burn unit.

“Resuscitate and Push”: End-of-Life Care Experiences of Healthcare Staff in the Emergency Department – A Hermeneutic Phenomenological Study

“…Studies in the intensive care unit have highlighted similar concerns noting that family members are often in a state of uncertainty which was worsened by poor communication. 12,27 Thus, ED staff will require training in communication skills which should focus on initiating goals of care discussion with families (and patients where applicable), providing regular updates to families, interprofessional communication, and breaking death news. 46 Where possible, collaboration with palliative care specialists may help to support ED staff in ensuring a family-centred approach to care.…”

“…1,[8][9][10] Palliative/ EOL care does not seek to only relieve physical symptoms, but also, to respond to the psychosocial and spiritual needs of patients and their families to attain a dignified death and offer bereavement/ post-bereavement support to families 11 and healthcare staff. 12 The ED is a highly specialized clinical unit requiring swift clinical decision with focus on acute care, resuscitation, and trauma care. 13 Care in the ED is underpinned by the philosophy of actively treating the patient, usually with limited attention to health-related suffering.…”

“…1,8-10 Palliative/ EOL care does not seek to only relieve physical symptoms, but also, to respond to the psychosocial and spiritual needs of patients and their families to attain a dignified death and offer bereavement/ post-bereavement support to families 11 and healthcare staff. 12…”

“…25 This may imply a need for PC/ EOL care to be fully integrated into health systems, including traditionally non-palliative care settings such as the ED in both developed and developing settings. 12,26,27 Moving towards this direction requires an in-depth exploration of how ED staff experience and navigate through care at the EOL to underpin the development of context-specific services. 4,28 Thus, this study sought to uncover the EOL care experiences as lived by ED staff.…”

Exploring the Background, Context, and Stressors of Caregiving to Elderly Burned Patients: A Qualitative Inquiry

“…As mentioned in previous studies from the same setting, innovative healthcare financing strategies are urgently needed to support burn patients and their families. 36,37 The study findings bring to the fore the experiences of informal caregivers of elderly persons admitted with burn injuries albeit some limitations are noteworthy. Firstly, the study was conducted in a Ghanaian setting and the findings may be unique to that setting.…”