The lived experiences of critical care nurses while caring for patients that are not expected to survive

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Mary R. Kime (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Debra Wallace

Abstract: The purpose of this study was to report the stories of critical care nurses as they cared for patients receiving full-curative treatment, knowing that these patients would not survive and needed goals of care decision-making (GOC-DM). Phenomenological inquiry was used to guide the mindset for this research to gain insight into the nurses’ lived experience and to understand the meaning of such experiences. Phenomenology of Practice (Van Manen, 2014) was used to develop a phenomenological mindset. Munhall’s process of phenomenological inquiry was followed during the interviews and analysis of the data (Munhall, 2007). Phenomenology was applied to enter the nurses’ lifeworld with the proper mindset and to collect stories that were rich in experiential content to provide insight into the human experience. One experience was presented as a lived experience description and the others were sorted using thematic analysis. This organized the stories to enable exploration into the context and meaning of this phenomenon. The factors that influenced the nurses lived experiences developed into the following themes: (1) The nurses’ judgement and appraisal of the patient situation; (2) The nurse-family-patient relationship; (3) The nurse’s actions related to goals of care decision-making and (4) The emotions experienced by the nurse. The nurse’s willingness to be engaged, level of energy, expertise, and degree of flexibility were also important factors that affected their lived experience when caring for these patients. The nurses described their experiences as family members struggled with life and death decisions and emphasized that every situation was different due to variations in the human interactions as incorporated into the thematic elements. The nurses in this study described a critical care environment in which the physicians took a proactive approach to GOC DM. Nurses described that certain aspects of decision-making, such as prognosticating and telling bad news, was the doctors’ responsibility. The nurses saw their role to advocate for the patient, update and educate the family, and serve as a go-between with families and the health care team. Nurses were able to participate in decision-making when there was certainty in the patient’s prognosis, a connection and trust between themselves and family members, and feeling valued and able to contribute. It was important to facilitate relationships with family members to foster trust and connection. The nurses described situations in which they felt that they were torturing the patients. Nurses should learn to recognize such difficult situations early to reduce conflict, to preserve family trust, and decrease staff burnout. In addition, programs should be offered and led by nurses, bioethicists, and professional organizations to community groups about the need for and usefulness of advanced directives. The findings from this study have implications for nursing practice, education and research. Suggestions for practice are that healthcare providers be engaged and work together as a team and within their roles to facilitate GOC DM for patients. Nurse educators should include GOC DM case studies in simulated training exercises, present patient cases to encourage discussions of GOC DM in clinical seminars, and teach courses on the ethical principles that surround GOC DM. In addition, training and simulation exercises to improve communication, collaboration, emotional awareness, conflict resolution, self-care, and knowledge in palliative care and ethical practices are important, especially in prelicensure programs. Further research should include qualitative inquiry into the lived experiences of patients, family members, and other health care professionals in different settings and circumstances for GOC DM. Also, examination and evaluation of policies, procedures and guidelines for GOC DM should be conducted using systematic policy mechanisms and practice standards.

Additional Information

Language: English
Date: 2019
Critical care, End-of-life, Goals of care decision-making, Intensive care nurses
Intensive care nursing $x Decision making
Terminal care $x Decision making
Nurses $x Attitudes

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