Nurses at Rural Facilities Explain Barriers to End-of-Life Care

By Jonathan Springston, Editor, Relias Media

A survey of nurses who work at rural medical facilities across the United States revealed some of the challenges they face when treating critically ill patients at the end of life.

There are more than 1,300 critical access hospitals (CAHs), defined as rural and hard-to-reach medical facilities at least 35 miles from another hospital that operate with 25 or fewer acute patient beds, operate a 24-hour emergency department, and the average length of stay for acute care patients is shorter than 96 hours. Researchers gathered data based on a 79-item questionnaire completed by 188 nurses working at a nationally representative sample of 39 CAHs.

The investigators learned seven of the top 10 issues facing nurses treating critically ill patients concerned patients’ families. Often, family members disagree with each other about whether to stop life support. Also, family members misunderstand the meaning of “lifesaving measures.” Survey respondents also indicated educating family about how to act around a dying patient, helping them accept when a loved one is dying, and providing a dignified bedside environment are all helpful and important when providing end-of-life care.

Since CAHs are accustomed to operating generally without much staff, special equipment, or other resources, survey respondents did not mark these as obstacles to providing proper end-of-life care. However, respondents did indicate the presence of certified nursing assistants is helpful.

“Recommendations include additional research to identify effective education for families regarding life-support measures and advance care directives,” the authors offered. “A chart posted in hospital waiting rooms with definitions of common terms used in critical care interventions may enhance family understanding and decision-making in EOL [end-of-life] care. An informational handout explaining common obstacles and helpful behaviors could be developed and made accessible for nurses who assist distraught family members during EOL care.”

In the upcoming November issue of ED Management, author Dorothy Brooks will report on the concept of rural emergency hospitals (REHs). Beginning in 2023, some rural hospitals will be able to convert to an REH, a new model that was created to preserve healthcare services in sparsely populated areas with financially ailing hospitals operating at low volumes. Not all the rules and regulations governing REHs have been unveiled. However, under proposed provisions, an REH will function much like an emergency department, although it must create a transfer agreement with a hospital for patients who require admission. Brooks will write about how many hospitals are expected to convert to REH and where these hospitals are, how these new entities will operate, and what this new model will mean to emergency medicine.

For more on this and related subjects, be sure to read the latest issues of Critical Care Alert and Medical Ethics Advisor.