ICU Nurses' Experiences in Providing Terminal Care

Abstract

At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

Passing Away: An Exploratory Study into Physiotherapy Students' Experiences of Patient Death whilst on Clinical Placement

“…Focus groups have previously been used to explore a wide range of issues relating to end-of-life care from a number of perspectives (Costello & Trinder-Brook 2000, Hudson 2003, Halpern et al 2009, Espinosa et al 2010, Kelly & Nisker 2010 and were therefore considered an appropriate method to employ. Group interviews were selected as peer support was considered important when discussing end-of -life care experiences, and the interaction between members is thought to generate and refine data which individual interviews may not (Kitzinger 2005, Plummer-D'Amato 2008a.…”

“…The use of black humour by experienced staff was discussed in many of the focus groups and can be used as a way of coping (Hopkinson et al 2005, Halpern et al 2009, Espinosa et al 2010, Williams 2013. One participant found the use of black humour helpful as it allowed staff to discuss the death on some level whilst reducing the seriousness of the event.…”

“…(Redinbaugh et al 2003, Stedeford 1994. Being able to 'turn-off' or establish professional distance is considered a coping strategy (Hopkinson et al 2005, Shorter & Stayt 2009, Espinosa et al 2010, Kelly & Nisker 2010, Peterson et al 2010, Melvin 2012, Williams 2013). However, whilst these coping strategies may protect the healthcare professional from the cumulative effects of providing care for the dying, they do not promote quality, patient-centred compassionate care and may be deemed 'callous' and 'indifferent', as reported in the Francis Report (2013, p13).…”

“…In turn, this may lead to inadequacies in meeting the psychosocial needs of dying patients (Matzo et al 2003, Rich 2005, Willard & Luker 2006. Whilst elements of palliative care are permeating acute hospitals, death remains 'taboo' and is often feared (Rich 2005), consequently the transition from providing life-sustaining treatments to implementing a 'good death' is often poor, which is potentially distressing for patients, relatives and staff (Yang & McIlfatrick 2001, Matzo et al 2003, Willard & Luker 2006, Espinosa et al 2010.…”

“…Emotional distress may have long-term detrimental effects both personally and professionally such as post-traumatic stress disorder, burnout, reduced clinical effectiveness (Matzo et al 2003, Clouder 2005, Rich 2005, Halpern et al 2009, Shorter & Stayt 2009) and professional compassion fatigue (Wilson & Kirshbaum 2011, Melvin 2012). Such distress may also limit emotional engagement and thereby contribute to lack of support and compassion for the dying patient and/or their family (Matzo et al 2003, Espinosa et al 2010, Melvin 2012). …”