Modèle d’accompagnement des patients et des membres de leur famille lors de la transition vers des soins de fin de vie à l’unité des soins intensifs
Despite all efforts on intensive care units (ICU) to keep alive patients admitted, several statistics report a significant number of deaths each year on these units. In some cases, it happens that the death is not sudden and treatments for life support must become end-of- life care. Practices and expertise of stakeholders are not the same on a palliative care unit than on an intensive care unit, as the needs of patients and family members are different. Thus, when it comes time to consider and provide end-of-life care on ICU, it is necessary to make some adjustments in care practices and consider certain elements in order to properly accompany the patient and family members to this new reality. Therefore, the objective of this work is to provide a guidance model of patient and family members during the transition towards end-of-life on ICU. A literature review realized using Whittmore and Knafl (2005) integrative method allowed identifying different theories, approaches and models proposed by researchers and authors. The framework chosen for this work is the theory of transition Meleis.  After reviews of the literature, 67 articles were selected, which revealed the main factors that influence the transition quality between the support treatments and end-of-life care. The author have mentioned the needs of the patient and his family in these transitional situations, problems of the health care team, the ethical issues that may arise and decisions when it comes to end of life care. Throughout the presentation of these different aspects, possible solutions are proposed to overcome the difficulties exposed. The importance of communication emerged as the main element to consider in this process.  In addition, several articles have proposed the shared decision making model and family gatherings as tools to ensure proper communication of information between everyone involved in the situation. The accompany model proposed for the transition comes from a reflection on all of the information found in the literature and focuses particularly on the important aspect of communication.  The ultimate goal is to provide a useful reference tool by proposing nursing interventions to better support patients and their families confronted to a transition from support treatment to end-of-life care.
communication End of life care ethics intensive care unit nurse shared decision-making model transition