The experience of the nurse caring for families of patients at the end of life in the intensive care unit

Abstract

The patient who enters at the intensive care unit (ICU) usually does because of health conditions that are sometimes irreversible and lead to death, and the care at the end of life becomes the main factor of this situation; therefore, the aim of this article was to understand the meaning of the experience of giving care to families at the end of life in an ICU. For this reason, a qualitative, hermeneutic phenomenological research was carried out. For the data collection, a semi‐structured interview was conducted to 18 participants, and the results were returned to each of the participants in order to validate each of the categories and interpretations. Among these results, two main categories were identified: emotional response of the nurse to the family and nursing care to the family of patients at the end of life. It was concluded that the nurses working at the ICU are facing aspects related to the end of life that generates emotional and psychological burden; additionally, they do not have specific training in this subject, especially in relation to the care of the families in this situation, for which they provide this care based on empiricism.

Difficulties Perceived by ICU Nurses Providing End-of-Life Care: A Qualitative Study

“…8 As far as care provided to patients' families at ICUs is concerned, nurses recognized the need for satisfying the basic needs such as company, intimacy, education, and psychological and social support for families while also claiming that this is not enough. 1,6,8,21 There is extensive literature on issues related to this subject, but even though family's needs are recognized, its importance is not explicitly emphasized, and family-centered care involves primarily informing relatives about the treatment, procedures, and prognosis. 1,6,8,21 Contrary to expectations, studies have shown that some families consider communication from nurses to be vague and evasive, as they pay most of their attention to patients.…”

“…1,6,8,21 There is extensive literature on issues related to this subject, but even though family’s needs are recognized, its importance is not explicitly emphasized, and family-centered care involves primarily informing relatives about the treatment, procedures, and prognosis. 1,6,8,21 Contrary to expectations, studies have shown that some families consider communication from nurses to be vague and evasive, as they pay most of their attention to patients. 22 This might be attributable to the lack of training, guidelines, and/or procedures related to EOLC patients, as well as to the emotional burden nurses have to cope with on a daily basis.…”

“…20,26 It was found that nurses providing care to end-of-life patients and their families are likely to experience emotional and psychological distress, and this finding was consistent with other studies. 1,25 Existing research emphasizes that positive communication and cooperation, as well as impeccable manners, are necessary to provide a safe and high-quality EOLC. Discussions with patients and their families can be helpful in preparing them for the transition from active treatment to EOLC.…”

“…4 This makes it necessary to apply mortality analysis to both patient treatment and end-of-life care (EOLC), representing a challenge for professionals tasked with ensuring a good death in critical care. 1,5 Both end-of-life patients and their families are in need of appropriate care and support. At ICU, it is the nursing personnel's responsibility to provide such care.…”

“…At ICU, it is the nursing personnel’s responsibility to provide such care. 1,6,7 International literature on EOLC in ICUs supports the use of “protocol bundles.” 8 Extensive research exists to suggest that the approach to end-of-life patients should change toward a greater focus on the patients and their families. 6 The provision of EOLC comprises a significant component of work for critical care nurses, and EOLC has been identified as a research priority area in an international Delphi study.…”