University of Southampton | UK
Yanxia Lin is doing her PhD study of exploring and understanding the practice of transferring dying patient’s home from critical care units. She had worked as a nurse in a hospital of China for seven years, of which two years were in intensive care unit. The experiences of caring for dying patients and witnessing their families making the challenging decisions of taking the patients home motivated her to conduct the research. A literature review derived from this study is currently under revision for an international nursing journal. Yanxia carried out several studies in clinical context of China and had published eight papers before her PhD study. Beyond research, she also has experience of teaching in the School of Medicine at Xiamen University, and training hospital nurses in regard with clinical nursing as well as conducting research.
Statement of the Problem: Evidence suggests many people prefer to die at home rather than in hospitals. However, an integrative literature review showed it is rare to transfer patients home to die from critical care units in the West but anecdotal evidence suggests it is more common in mainland China. Yet no published research was found about families’ experiences of this event and the practice of transfer in mainland China. Methodology & Theoretical Orientation: A qualitative study was carried out which comprised a 12-month retrospective audit and narrative interviews with family members of patients who were transferred home to die. In China, a general intensive care unit in a southeast tertiary hospital was selected to conduct the audit and recruit family members. First the audit reviewed number and characteristics of patients who were transferred home to die between 1st September 2015 and 31st August 2016. Second, narratives of families’ transfer experiences were collected through narrative interviews. Findings: The audit identified that of 187 dying patients, nearly half (49%) of them were transferred home to die. Thirteen participants contributed to in-depth narratives about ten patient transfers. Their relationship to the patient were son (n=6), daughter (n=2), grandson (n=2), spouse (n=1), cousin (n=1) and daughter-in-law (n=1). Narrative analysis has revealed four themes (See Figure 1) of family, custom, unsupported decision-making and unmet information needs. The decision of transferring home, as a customary requirement was made mainly by families with little support and information from healthcare staff. Conclusion & Significance: It is usual practice to transfer dying patients home from critical care in China. However, the decision-making was not always an easy and smooth event for families. Policies to raise awareness of healthcare professionals to support families’ decision-making around transfer and guidance for this clinical practice should be established in China.