The intensive care unit (ICU) embodies an environment of advanced technology and care, collaborative decision making and life-threatening emergencies. Critically ill patients are central to this unique milieu and culture, cared for by knowledgeable and skilful nurses who manage each patient’s intensive care journey. Highly developed decision making skills become essential as life and death are often finely balanced. In the United Kingdom, once the decision to withdraw life-sustaining treatment has been made by the medical team, further decision making relevant to the actual withdrawal of treatment is conducted by nurses. The aim of this study was to explore critical care nurses’ experiences following the decision to withdraw treatment from patients in a UK intensive care cultural setting. An ethnographic lens of enquiry was the chosen methodology, and methods employed included 144 hours of observation and eight semi-structured interviews (using two vignettes) developed from the ICU experience. The research was conducted in a large 20 bed ICU in the North West of England. The participants were qualified nurses who met the main inclusion criteria of the study in that they had all experienced caring for a patient following the decision to withdraw treatment. Data analysis was undertaken using Ricoeur’s analytical framework. Three central themes emerged from the data analysis, namely: the decision to withdraw treatment; nurses’ actions following the withdrawal of treatment decision; and shared experiences in the journey towards death. The findings suggested that nurses’ created a private space for the dying patient and discovered a parallel journey towards death experienced by the patient, the nurse and the family. The nurse’s adaptation from a curative focus of care to palliative care also emerged, where the desire was to offer positive and meaningful experiences for the family during this emotive phase of ‘end-of-life care’. Recommendations for clinical practice include the recognition of the value and benefits of formal and informal support for nurses during the patient’s withdrawal of treatment and subsequent dying trajectory. Recognition of the importance of the intensive care environment as a whole for dying patients, their families and their care cannot be undervalued. In addition, given the palliative nature of care required of critical care nurses, a recommended of the inclusion of a palliative care specialist nurse in the multi-disciplinary team could enhance the patients’ quality of end-of-life care.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:674952 |
| Date | January 2015 |
| Creators | Templeman, J. S. |
| Publisher | University of Salford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://usir.salford.ac.uk/36188/ |
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