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Nursing patients with chronic critical illness and their families: a qualitative study
Author(s) -
Leung Doris,
Blastorah Margaret,
Nusdorfer Linda,
Jeffs Angie,
Jung Judy,
Howell Doris,
Fillion Lise,
Rose Louise
Publication year - 2017
Publication title -
nursing in critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.689
H-Index - 43
eISSN - 1478-5153
pISSN - 1362-1017
DOI - 10.1111/nicc.12154
Subject(s) - nursing , qualitative research , medicine , palliative care , relevance (law) , intensive care unit , end of life care , theme (computing) , psychology , intensive care medicine , social science , sociology , political science , computer science , law , operating system
Background chronic critical illness ( CCI ) is a complex syndrome with a high risk of dying in hospital. Intensive care unit nurses are well‐positioned to lead conversations integrating palliative and end‐of‐life care, yet have reported limited involvement. Aim To generate further understanding of nurses' experiences of patients with CCI and their families. Design and methods This qualitative study followed Thorne's interpretive description methods. In 2012, 16 intensive care unit nurses from one academic hospital participated in interviews. Results Our primary theme was that of internal tension generated through participants' knowledge of patients' anticipated and protracted dying, while wanting to shield families from suffering. This internal tension resulted from responsibilities to preserve hope for patients and families, while at the same time wanting to provide them prognostic information. Participants experienced challenges of: (i) preserving family trust, (ii) determining when and how to engage families in discussions and (iii) providing possibilities of a ‘good’ death. A secondary theme described constraints to acting on their insights because of interprofessional team dynamics or limited communication, within the team and with the family. Conclusion and relevance to clinical practice Internal tension, as experienced by participants reflects the challenges of transition from acute to palliation and end‐of‐life care, made more complex in CCI , because of its poorly defined terminal stage. Nurses' ability to manage the complex process of supporting hope while gradually providing information to build family understanding of CCI highlights their central role in facilitating what and how prognostic information is given, while managing the emotional implications and family response. To better support nurses do this, we advocate for formal structures enabling nurses to participate in decision‐making regarding timing of transitions using palliation and end‐of‐life care.