Factors associated with nurse assessment of the quality of dying and death in the intensive care unit

Objective: To determine the feasibility of using nurse ratings of quality of dying and death to assess quality of end-of-life care in the intensive care unit and to determine factors associated with nurse assessment of the quality of dying and death for patients dying in the intensive care unit. Design: Prospective cohort study. Setting. Hospital intensive care unit. Patients: 178 patients who died in an intensive care unit during a 10-month period at one hospital. Interventions: Nurses completed a 14-item questionnaire measuring the quality of dying and death in the intensive care unit (QODD); standardized chart reviews were also completed. Measurements and Main Results: Five variables were found to be associated with QODD scores. Higher (better) scores were significantly associated with having someone present at the time of death (p < .001), having life support withdrawn (p = .006), having an acute diagnosis such as intracranial hemorrhage or trauma (p = .007), not having cardiopulmonary resuscitation in the last 8 hrs of life (p < .001), and being cared for by the neurosurgery or neurology services (p = .002). Patient age, chronic disease, and Glasgow Coma Scale scores were not associated with the 14-item QODD. Using multivariate analyses, we identified three variables as independent predictors of the QODD score: a) not having cardiopulmonary resuscitation performed in the last 8 hrs of life; b) having someone present at the moment of death; and c) being cared for by neurosurgery or neurology services. Conclusions: Intensive care unit nurse assessment of quality of dying and death is a feasible method for obtaining quality ratings. Based on nurse assessments, this study provides evidence of some potential targets for interventions to improve the quality of dying for some patients: having someone present at the moment of death and not having cardiopulmonary resuscitation in the last 8 hrs of life. If nurse-assessed quality of dying is to be a useful tool for measuring and improving quality of end-of-life care, it is important to understand the factors associated with nurse ratings.