As medical advances have extended life for people with serious illnesses, more demand has been placed on nurses in critical care and end-of-life (EOL) care environments.
A recent study published in the Journal of Hospice & Palliative Nursing asked nurses across the United States and the nation’s territories about their experiences providing care for patients at EOL. The qualitative study analyzed the responses from 216 critical care nurses and synthesized the data to come up with 5 distinct themes encompassing the participants’ responses, including: “We Can’t Fix Everyone,” “Task-Oriented Nursing,” “A Profession of Broken Individuals,” “Unaware and Unprepared,” and “A Hand to Hold.”
We Can’t Fix Everyone
Many participants expressed frustration about the dissonance between their training as health care providers and the harsh reality that they could not heal all their patients. “The nurses perceived their inability to heal and restore the patient to health as a limitation in delivering therapeutic nursing care,” The study reported.
Nurses cited a shared sense of having too many patients and insufficient resources. They sometimes reported a feeling that hospital administration viewed patients as “numbers.” As demands increased, the respondents felt that the quality of their care decreased. This was described as not having enough time to perform adequate basic care practices or have meaningful conversations with families about the transition from critical care to EOL care.
A Profession of Broken Individuals
Another theme that emerged was the feeling of inadequacy due to the patients/caregivers viewing them as “just the nurse” or the “prevailing culture in critical care of avoiding the discussion of death.” Some felt that critical care physicians should bear the onus of introducing the concept of EOL care earlier and that patients/caregivers weren’t given enough time to fully understand their situation.
Unaware and Unprepared
Many nurses felt their education did not adequately prepare them for EOL care. One commented that they “actually feel as though we are very limited in resources and training regarding these discussions and how to handle them.” Many of the respondents echoed this sentiment, calling for more training surrounding EOL care.
A Hand to Hold
A large portion of respondents felt that patient advocacy and effective communication were important parts of their job. They acknowledged that the ICU can be a disorienting and alarming environment for patients and caregivers and that the nurses should be present to support the patients/caregivers during the EOL process. One insightfully commented that due to their own experience with the death of a loved one, they now try to be more present during EOL as opposed to giving the families privacy and space. They reported feeling “abandoned” by the nursing staff during their loved one’s passing.
These themes and responses largely illustrate the hardship of caring for patients at EOL and the lack of support nurses are given while doing so. Corresponding author, Toby Bressler, PhD, RN, OCN, FAAN, commented, “It’s important to amplify the message that the complex feelings associated with these experiences are valid and real and [nurses in this situation] are not alone.”
“Unaware and unprepared”: experiences of critical care nurses providing end-of-life care; a qualitative study.