How Do Critical Care Nurses Define a “Good Death” in the Intensive Care Unit?

Abstract

The purpose of this qualitative study was to explore and describe the characteristics of a good death as defined by 15 critical care nurses working in the intensive care unit (ICU) at a hospital in a mid-sized urban city. The target population was registered nurses employed in the intensive care unit where the study was conducted. Given the fact that the sample population was a very specific group, a purposive, convenience sample was utilized to explore the personal thoughts and feelings of the nurses who volunteered for this project. A nondirective, in-depth interview technique was the method of data collection. Interviews lasted up to 60 minutes, and data was collected by tape recorder, then immediately transcribed verbatim; basic demographic data was collected at the beginning of each interview and this information was used to describe the sample. In describing a good death in the ICU, most participants identified multiple themes. Eight main themes emerged from the nurses' responses to the research question, and of those, 3 were mentioned most often. The 3 most frequently mentioned themes were patient does not die alone, patient does not suffer (pain management/symptom management), and acceptance of death by the patient and/or loved ones. Much of what nurses described as elements of a good death in the ICU supports other published results. The themes that were identified in this research study provide an initial framework that is important for further research in the area of critical care nursing.

Undergraduate Critical Care Nursing Students’ Knowledge And Attitudes Toward Caring Of Dying Patients

“…Kock (2011) (41) revealed that most of the study nurses agreed that families need emotional support. (44,45) On the other hand nearly half of the UCCNSs had a negative attitude as they disagreed that educating families of dying patients about death and dying is nursing responsibility. This result may be attributed to students' feelings of anxiety and being uncomfortable to talk about death.…”

Biomedical approaches to care and their influence on point of care nurses: a scoping review

“…More important, a biomedical approach to care and technology cannot replace nurse presence and empowered caring because patient's individuality, subjectivity and dignity [19] is of utmost importance in wholistic care. Nurses are advocates, a voice when their patients cannot speak for themselves, they challenge the status quo when everything seems hopeless, [40,45] even when physicians want to pursue aggressive medical treatment in futile situations. [45] A biomedical model and technology in high acuity areas has the potential to overshadow humanistic caring, making nurses question what is dignified care in high acuity areas.…”

“…Nurses are advocates, a voice when their patients cannot speak for themselves, they challenge the status quo when everything seems hopeless, [40,45] even when physicians want to pursue aggressive medical treatment in futile situations. [45] A biomedical model and technology in high acuity areas has the potential to overshadow humanistic caring, making nurses question what is dignified care in high acuity areas. To ensure wholistic care nurses establish communities of practice, collaborative learning environments, and pedagogic strategies that include mindfulness, reflection, and refinement of emotional and spiritual [46] experiences that have the potential to enhance wholistic care.…”

“…Engaging and reflecting in the data is a long but necessary process. [44] The following nine categories emerged in order of dominant codes: nurse presence (123), knowledge (82), experience (61), environment (57), invaluable use of 'self' (48), technology (45), power relationships (44), sociopolitical factors (41), and time (39). After categorizing data each code was re-evaluated to ensure suitability in each category; this resulted in no changes to codes within the categories.…”

“…For instance, nurses must remember that they care for the patient in the bed and not the equipment and acknowledge that the equipment does not take precedent over a life. [19] Despite advanced knowledge, skills, and education nurses have acquired, it is necessary to be mindful that technology is a necessary tool to assist in monitoring a patient, [17,19,36,45] and should supplement nursing care not overpower it. The integration of theoretical knowledge, simple gestures carried out with a compassionate heart, [17] hands that touch a person who is suffering, [36] a soft voice that reassures a patient ultimately communicates that nurses are listening while conveying trust, respect and that they care.…”