ObstaclesInterestingly, four of the

Obstacles
Interestingly, four of the top eight obstacles regarding
patients’ families also had the component of emotion, as
in dealing with anxious, overly optimistic, distraught, or
angry family members. The other four top 10 items surrounding
family issues regarded the family not accepting
the poor prognosis, family and friends who continually
call the nurse, family not understanding consequences
of aggressive treatment, and the family not wanting the
patient to be overly sedated. The data surrounding family
issues at EOL are validated by other studies. Popejoy,
Brandt, Beck, and Antal (2009) identified that helping the
patient through the dying process also involved helping
the family, and that the family became the patient.
Waldrop (2007) found that caregiver grief during EOL
care included the components of heightened responsiveness,
anxiety, depression, anger, and fear. Similarly, the
obstacles of family not understanding life-saving treatment,
frequent telephone calls from family, and dealing
with distraught and angry family members were found
among critical care and emergency room nurses (Beckstrand
& Kirchhoff, 2005; Beckstrand et al., 2008).
Inadequate time to provide high-quality EOL care
was identified in the third (being called away to help
with another nurse) and fifth (family and friends
continually call the nurse) most commonly rated obstacles.
However, among critical care and emergency
nurses, lack of time was the most highly rated obstacles
(Beckstrand et al., 2006; Beckstrand & Kirchhoff, 2005;
Beckstrand et al., 2008). The issue of limited time for
offering compassionate and comprehensive EOL care
among oncology nurses also was identified by Pavlish
and Ceronsky (2007).
Other highly rated obstacle items were the nurse being
called away from the patient (7th), and two issues
regarding physicians, doctors being overly optimistic
about survival (10th), and doctors insisting on aggressive
care (11th). Critical care nurses (Beckstrand &
Kirchhoff, 2005) also identified physicians being overly
optimistic about survival as an important obstacle but
ranked “differing opinions among physicians” and
“physicians being evasive” as even higher obstacles.
Of note, although previous research identified lack
of communication as a major obstacle (Beckstrand