Table 2 Nursing practices for end-of-life care: categories and sub-categories
Time period | Category (category no.) | Sub-category (sub-category no.) | Representative code |
|---|---|---|---|
Onset of Chronic Heart Failure | Provide thorough acute care by a multidisciplinary team to alleviate dyspnea (1) | Ensure that the doctor directly assesses the patient for intervention (1a) | GCNS3 |
Provide multidisciplinary responses to emergency patients (1b) | |||
Respond to sudden critical changes in patients, using acute treatment and sedation (1c) | |||
Provide acute treatment for palliation of dyspnea (1d) | GCNS1 | ||
Assess psychiatric symptoms and use a suitable environment to perform treatment (2) | Incorporate the patient’s lifestyle and favorite items into the treatment environment to encourage treatment (2a) | GCNS1 | |
Assess psychiatric symptoms including delirium (2b) | GCNS2 | ||
Explain the progression of heart failure with the doctor (3) | Ask the doctor to explain the patient’s medical condition, including the risk of sudden death (3a) | CNCHF2 | |
Explain the process of heart failure carefully several times to ensure the patient’s understanding (3b) | CNCHF2 | ||
Build a trusting relationship with the patient and family and implement ACP early during the patient’s recovery (4) | Implement ACP early, considering the patient’s background (4a) | GCNS3 | |
Build a trusting relationship with the patient and family, and use the outpatient clinic to discuss ACP after confirming the patient is stable (4b) | |||
Communicate the desire to align with the patient’s feelings before introducing ACP (4c) | |||
Confirm the patient’s wishes for future life and treatment and share information among professionals once the patient has stabilized (4d) | |||
Provide an opportunity to consider ACP using tools for its implementation (4e) | |||
Involve multiple professions to help patients to achieve their desired life (5) | Provide life-supporting interventions in parallel with acute care by multidisciplinary staff (5a) | GCNS2 | |
Adopt system innovations to ensure that multidisciplinary conferences are held as required (5b) | |||
Discuss with staff when there is a gap between the future intentions of the patient and their family, and liaise between them to address such gaps (5c) | |||
Coordinate discharge by multidisciplinary staff to realize the post-discharge life that the patient desires (5d) | GCNS3 | ||
Decompensation | Perform ACP always in collaboration with multiple professionals (6) | Recognize when to confirm the patient’s wishes regarding treatment and the future to establish a collaboration with the nurses (6a) | GCNS2 |
Reconfirm ACP at readmission, ensuring the patient who has already confirmed ACP is not burdened (6b) | |||
Work with multiple professionals to communicate prospects, confirm where the patient would like to spend the end of their life, and ensure that the patient’s and family’s wishes are met (6c) | |||
Engage in dialogue to elicit the patient’s wishes (6d) | |||
Provide lifestyle guidance according to patients’ feelings so that they can continue living at home after discharge from the hospital (7) | Inform the patients of the criteria for outpatient hospital admittance to determine if a patient prefers to be treated at recurrence (7a) | GCNS3 | |
Provide lifestyle and rehabilitation guidance gradually by mitigating the patient’s suffering and pain (7b) | |||
Provide necessary information to patients who wish to remain at home and work with them to determine the cause of rehospitalization (7c) | CNCHF4 | ||
Advanced Chronic Heart Failure | Provide palliative and acute care in parallel with multiple professions (8) | Discuss the need for palliative care with doctors (8a) | CNCHF1 |
Inform the family about palliative care using narcotics and initiate palliative care through collaboration with a palliative physician and team (8b) | |||
Use a combination of palliative and acute care for symptom palliation (8c) | CNCHF2 | ||
Explain to patients, family, and staff the need for concurrent palliative and acute care (8d) | |||
Achieve end-of-life care at home through multidisciplinary cooperation (9) | Explain the current situation to the patient and family and confirm the patient’s wishes for end-of-life care at home (9a) | GCNS1 | |
Realize end-of-life care at home by alleviating symptoms through multidisciplinary cooperation (9b) | CNCHF1 | ||
Provide basic nursing care to the patient and family until the moment of death (10) | Provide basic care and support to ensure that the patient can live as he/she wishes until the moment of death (10a) | GCNS2 | |
Provide nursing care for the family, for example, by conveying the importance of taking care of the family’s health (10b) | GCNS1 | ||
Any Period | Provide concurrent acute and palliative care as well as psychological support to alleviate physical and mental symptoms (11) | Provide acute treatment and palliative care for symptom relief (11a) | CNCHF2 |
Respond to the patient’s pain and fears by listening, bathing the feet, walking, and improving the environment (11b) | |||
Consult with psychiatry-related professionals and teams and provide mental and spiritual support (11c) | |||
Share the patient’s prognosis and future wishes with multiple professionals (12) | Involve patients who have heart failure and need NPPV from the time of hospitalization, or who are recognized by a physician that the patient needed further consultation with GCNSs/CNCHFs (12a) | GCNS5 | |
Understand the patient’s future and intentions through conferences with various professional (12b) | |||
Share the patient’s wishes among nurses and collaborate with the physician to realize them (12c) | |||
Share with other nurses and practice the future outlook and policies of nursing care (12d) | |||
Connect patients with multi-professionals to make home care possible by focusing on the patient’s life wishes after discharge from the hospital (12e) | |||
Provide patients and families with lifestyle guidance to maintain life after discharge by a multidisciplinary team including the outpatient department (12f) | |||
Engage in ACP from early stages through several conversations with patients and their families (13) | Perform ACP as early as possible before the condition transitions to advanced heart failure (13a) | GCNS4 | |
Capture the topic of conversation with the patient including what the patient says and the atmosphere before linking it to ACP (13b) | |||
Approach the patient in a timeous manner until the patient adequately understands their medical condition (13c) | |||
Confirm the thoughts and wishes of patients with their families and work collectively to realize them (13d) | CNCHF2 |