Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders

Abstract

Purpose:The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. Methods: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. Results: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. Conclusion: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.

Ethical Conflicts Experienced by Nurses in Geriatric Hospitals in South Korea: “If You Can’t Stand the Heat, Get Out of the Kitchen”

“…In other words, the source of moral distress is extrinsic factors (e.g., organizational constraints), while on the contrary, due to intrinsic factors (e.g., seeing oneself desensitized to death), nurses can feel distressed when they do not perform ethically right actions despite their awareness. This response to patient death was found in other research among nurses in end-of-life care settings [47,48], as well as a study on exploring reflections among medical students on dying patients [49]. According to the previous findings, when faced with patient's death, the more medical students employed "denial" or "ignorance" as self-defense instead of sharing grief with their patients' families, the more desensitized they became to patients' deaths.…”

Nurse's, physician's and family member's experiences of withholding or withdrawing life‐sustaining treatment process in an intensive care unit

“…Before the enforcement of the Act, do‐not‐attempt‐resuscitate (DNAR) decisions, which have been called do‐not‐resuscitate (DNR) in South Korea, were expanded to mean withholding life‐sustaining treatment. Some qualitative studies have been conducted to explore experiences of WWLT in South Korea; however, they predate the enforcement of the Hospice, Palliative Care and Life‐sustaining Treatment Decision‐making Act ( 2018 ) (Kim & Kang, 2011; Kim, Kang, et al, 2012; Kim, Son, et al, 2012; Koh et al, 2017; Lee et al, 2017; Lee & Kim, 2016). Therefore, his research, which explores the experiences of nurses, physicians and family members regarding WWLT in South Korea following the enforcement of the Hospice, Palliative Care and Life‐sustaining Treatment Decision‐making Act (2018), is timely and appropriate.…”

Caregivers' psychological suffering and posttraumatic growth after patient death

“…The suffering undergone by caregivers owing to patients' death is a subjective experience that is influenced by culture, religion, and values, sometimes resulting in positive attitudes toward pain and death 8 . People who experience traumatic events often exhibit negative outcomes, such as PTSD; however, they also enjoy positive changes.…”

“…7 The suffering undergone by caregivers owing to patients' death is a subjective experience that is influenced by culture, religion, and values, sometimes resulting in positive attitudes toward pain and death. 8 People who experience traumatic events often exhibit negative outcomes, such as PTSD; however, they also enjoy positive changes. Traumatic events can lead an individual to explore the meaning and purpose of life and experience positive changes, such as personal growth, changes in worldview, and stronger personal relationships.…”

“…11 Individuals who face traumatic events tend to experience better PTG. Although most studies of PTG in caregivers who experienced patient death have focused on parents and spouses of patients, 12 some research works have been performed on nurses 8 and social workers. 13 Meller et al 14 described the grieving process for nurses experiencing patient death as managing personal grief in death and dying.…”