1. Singh Joy, Subhashni D.


According to this study:


* Additional training and improved communication would ease nurses' issues with caring for terminally ill patients.



Article Content

This qualitative study examined the experiences of 18 RNs providing terminal care on four ICUs. Through interviews and focus groups, Espinosa and colleagues identified three themes surrounding the nurses' experiences: barriers to optimal care, internal conflict, and coping.


Barriers to optimal care were categorized into six areas: nurses' lack of involvement in the choice and timing of patient care; clashes between physicians who focus on a specific symptom or organ and nurses who use a holistic approach; patients treated by several physician specialists, each of whom focuses on a separate symptom or organ, which can result in different prognoses; the delivery of care that provides no apparent benefit; family members' unrealistic expectations; and the need for more education for nurses who care for terminally ill patients.


Nurses also identified five major areas of internal conflict: feeling relief when the care they provide is switched from curative to palliative; wanting dying patients to be comfortable and families to have good final memories of their loved ones; feeling abandoned while carrying out physicians' orders to stop care and powerless because they're unable to save the patient; conflicted about administering medication to keep patients comfortable that may also cause them harm; and disturbed by younger terminal patients who remind them of their own mortality.


Five coping strategies were highlighted: building trust with family members, crying, humor, talking to others about terminal care, and avoiding caring for terminally ill patients. Some nurses also talked about having a "crusty" attitude as a coping mechanism.


Nurses also suggested that improved education, increased staff support, and better communication would be helpful.


Espinosa L, et al. Crit Care Nurs Q 2010; 33(3):273-81.