Abstract
Background: For intubated patients, where recovery from a disease process is not possible, palliative extubation is a procedure that may be offered in the intensive care unit (ICU). There is currently limited literature or evidenced-based protocols surrounding palliative extubation within the intensive care setting, which can be challenging and stressful for nurses. Additionally, the nurses' experiences of palliative extubation are poorly understood.
Objective: This integrative literature review aims to review the current literature surrounding the experiences of ICU nurses involved with palliative extubation. It is hoped that by understanding the nurses' experiences, supporting evidence can be used to improve the care delivered to patients and families and identify areas where nurses may need support, protocols or education surrounding this procedure.
Methods: An integrative literature review was chosen to capture the nurses' experience of palliative extubation, allowing for qualitative and quantitative research to be included. A qualitative descriptive design was utilised for this review with an aim to explore contemporary research on this topic. The databases CINANL, Embase and Google Scholar were searched using predetermined search terms. Ten articles were found that met the inclusion criteria and were included for analysis. Articles were screened using the Joanna Briggs Institute (JBI) critical appraisal tool. Thematic analysis was used to synthesise results and develop themes and sub-themes from the data.
Results: The ten articles that met the inclusion criteria were all qualitative. None of the articles were focused entirely on the nurses' experience of palliative extubation. Instead, the articles either explored how clinicians felt about palliative extubation, with extractible nursing experiences, or how nurses experienced the withdrawal of care and referenced palliative extubation within the article specifically. The extracted data was synthesised into three main themes: Making the end of life as good as possible, the nurses' emotions regarding their involvement in palliative extubation, and education, with associated sub-themes; symptom relief, de-medicalisation, patient and family focused care, positive emotions, negative emotions, learning on the job and teaching families.
Conclusion: There are wide and varied beliefs and practices surrounding palliative extubation. Nurses experience many emotions and personal challenges when performing palliative extubation, both positive and negative. A lack of formal education was acknowledged, with a tendency for on-the-job learning. There is a clear need for nurses, in particular, less experienced nurses, to be provided with additional support during this highly emotive and stressful procedure. In addition, there is a clear need for further research which focusses solely on the nurses' experience.