Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

Reni Sulung Utami; Ahmat Pujianto; Dody Setyawan; Elsa Naviati; Nana Rochana

doi:10.14710/nmjn.v10i3.31302

DOI: https://doi.org/10.14710/nmjn.v10i3.31302

Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

*Reni Sulung Utami - Universitas Diponegoro, Indonesia

Ahmat Pujianto - Universitas Borneo Tarakan, Indonesia

Dody Setyawan - Universitas Diponegoro, Indonesia

Elsa Naviati - Universitas Diponegoro, Indonesia

Nana Rochana - Universitas Diponegoro, Indonesia

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:

Abstract

Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out.

Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC.

Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes.

Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions.

Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.

Fulltext View|Download

Keywords: Critical care nurse; end of life care; experience; intensive care unit

Funding: Faculty of Medicine, Diponegoro University

Article Metrics:

Article Info

Section: Articles

Language : EN

In Vol 10, No 3 (2020): (December 2020)

Recent articles

Quality of Nursing Care in Saudi Arabia: Are Empathy, Advocacy, and Caring Important Attributes for Nurses? The Effect of “SELF-HELP Packages” on Post Stroke Depression among Ischemic Stroke Survivors Preparedness among Family Caregivers of Patients with Non-Communicable Diseases in Indonesia Editorial Front Matter Editorial Back Matter More recent articles

Most cited articles

Emergency Training, Education And Perceived Clinical Skills For Tsunami Care Among Nurses In Banda Aceh, Indonesia Transformational and Transactional Leadership Styles of Nurse Managers and Job Satisfaction among Filipino Nurses: A Pilot Study Dyspnea Experience and Dyspnea Management in Patients with Chronic Obstructive Pulmonary Disease in Bangladesh PSYCHIATRIC CLINICAL PLACEMENT UPON NURSING STUDENTS PERCEIVED KNOWLEDGE IN CARING FOR MENTALLY ILL Music and Music Intervention for Therapeutic Purposes in Patients with Ventilator Support; Gamelan Music Perspective More cited articles

Abu Hasheesh, M. O., Abozeid, S. A. S., El-Said, S. G., & Alhujaili, A. D. (2013). Nurses’ characteristics and their attitudes toward death and caring for dying patients in a public hospital in Jordan. Health Science Journal, 7(4), 384–394
Aslakson, R. A., Wyskiel, R., Thornton, I., Copley, C., Shaffer, D., Zyra, M., …, & Pronovost, P. J. (2012). Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: A qualitative exploration. Journal of Palliative Medicine, 15(8), 910–915. doi: 10.1089/jpm.2011.0481
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., …, & Balboni, T. A. (2013). Why is spiritual care infrequent at the end of life? spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology, 31(4), 461–467. doi: 10.1200/JCO.2012.44.6443
Blackwood, B., Albarran, J. W., & Latour, J. M. (2011). Research priorities of adult intensive care nurses in 20 European countries: A Delphi study. Journal of Advanced Nursing, 67(3), 550–562. doi: 10.1111/j.1365-2648.2010.05512.x
Brooks, L.A, Manias, E., & Nicholson, P. (2017). Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Australian Critical Care, 30, 161-166. doi: 10.1016/j.aucc.2016.08.001
Carlson, E. B., Spain, D. A., Muhtadie, L., McDade-Montez, L., & Macia, K. S. (2015). Care and caring in the intensive care unit: Family members’ distress and perceptions about staff skills, communication, and emotional support. Journal of Critical Care, 30(3), 557–561. doi: 10.1016/j.jcrc.2015.01.012
Cavaye, J., & Watts, J. H. (2010). End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives. Journal of Research in Nursing, 17(4), 317–326. doi: 10.1177/1744987110379531
Chen, J., Lin, Y., Yan, J., Wu, Y., & Hu, R. (2018). The effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness: A systematic review. Palliative Medicine, 32(7), 1167–1179. doi: 10.1177/0269216318772267
Coombs, M., Addington-Hall, J., & Long-Sutehall, T. (2012). Challenges in transition from intervention to end of life care in intensive care: A qualitative study. International Journal of Nursing Studies, 49(5), 519–527. doi: 10.1016/j.ijnurstu.2011.10.019
Crump, S. K., Schaffer, M. A., & Schulte, E. (2010). Critical care nurses’ perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimensions of Critical Care Nursing, 29(6), 297–306. doi: 10.1097/DCC.0b013e3181f0c43c
DeCato, T. W., Engelberg, R. A., Downey, L., Nielsen, E. L., Treece, P. D., Back, A. L., …, & Curtis, J. R. (2013). Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical Care Medicine, 41(6), 1405–1411. doi: 10.1097/CCM.0b013e318287f289
Espinosa, L., Young, A., Symes, L., Haile, B., & Walsh, T. (2010). ICU nurses’ experiences in providing terminal care. Critical Care Nurse, 33(3), 273–281
Fitriyani, N., Juniarto, A. Z., & Utami, R. S. (2018). Life quality of end of life patient’s family in intensive care units. Indonesian Journal of Nursing and Midwifery, 6(1), 16–24. Retrieved from http://ejournal.almaata.ac.id/index.php/JNKI
Flannery, L., Peters, K., & Ramjan, L. M. (2020). The differing perspectives of doctors and nurses in end-of-life decisions in the intensive care unit : A qualitative study. Australian Critical Care, 33(4), 311–316. doi: 10.1016/j.aucc.2019.08.004
Griffiths, I. (2019). What are the challenges for nurses when providing end-of-life care in intensive care units? British Journal of Nursing, 28(16), 1047–1052
Hinderer, K. A. (2012). Reactions to patient death: The lived experience of critical care nurses. Dimensions of Critical Care Nursing, 31(4), 252–259. doi: 10.1097/DCC.0b013e318256e0f1
Jin, J. (2013). Clinicians examine advances and challenges in improving quality of end-of-life care in the ICU. JAMA, 310(23), 2493–2495. doi: 10.1001/jama.2013.283830
Kim, S., Savage, T. A., Song, M. K., Vincent, C., Park, C. G., Ferrans, C. E., & Cavanaugh, K. (2019). Nurses’ roles and challenges in providing end-of-life care in neonatal intensive care units in South Korea. Applied Nursing Research, 50, 151204. doi: 10.1016/j.apnr.2019.151204
King, A., & Thomas, P. (2013). Phenomenological study of ICU nurses’experiences caring for dying patients. Western Journal of Nursing Research, 35(10), 1292–1308
Kisorio, L. C., & Langley, G. C. (2016). Intensive care nurses’ experiences of end-of-life care. Intensive and Critical Care Nursing, 33, 30–38. doi: 10.1016/j.iccn.2015.11.002
Levin, T. T., Moreno, B., Silvester, W., & Kissane, D. W. (2010). End-of-life communication in the intensive care unit. General Hospital Psychiatry, 32(4), 433–442. doi: 10.1016/j.genhosppsych.2010.04.007
Mathew, J. E., Azariah, J., George, S. E., & Grewal, S. S. (2015). Do they hear what we speak? Assessing the effectiveness of communication to families of critically ill neurosurgical patients. Journal of Anaesthesiology, Clinical Pharmacology, 31(1), 49–53. doi: 10.4103/0970-9185.150540
Morgado, P., & Cerqueira, J. J. (2018). Editorial: The impact of stress on cognition and motivation. Frontiers in Behavioral Neuroscience, 12, 326. doi: 10.3389/fnbeh.2018.00326
Muni, S., Engelberg, R. A., Treece, P. D., Dotolo, D., & Randall, J. (2011). The influence of race / ethnicity and socioeconomic status on end-of-life care in the intensive care unit. CHEST Journal, 139(5), 1025–1033. doi: 10.1378/chest.10-3011
Ozga, D., Woźniak, K., & Gurowiec, P. J. (2020). Difficulties perceived by ICU nurses providing end-of-life care: A Qualitative Study. Global Advances in Health and Medicine, 9, 1–8. doi: 10.1177/2164956120916176
Pereira, S. M., Fradique, E., & Hernandez-Marrero, P. (2018). End-of-life decision making in palliative care and recommendations of the Council of Europe: Qualitative secondary analysis of interviews and observation field notes. Journal of Palliative Medicine, 21(5), 604–615. doi: 10.1089/jpm.2017.0403
Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., & Hood, K. (2013). How death anxiety impacts nurses’ caring for patients at the endof life: A review of literature. The Open Nursing Journal, 7, 14–21
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (Tenth). Philadelphia: Wolters Kluwer Health
Ranse, K., Yates, P., & Coyer, F. (2016a). End-of-life care practices of critical care nurses: A national cross-sectional survey. Australian Critical Care, 29(2), 83–89. doi: 10.1016/j.aucc.2015.07.001
Ranse, K., Yates, P., & Coyer, F. (2016b). Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision. Intensive & Critical Care Nursing: The Official Journal of the British Association of Critical Care Nurses. doi: 10.1016/j.iccn.2015.11.003
Rochmawati, E., Wiechula, R., & Cameron, K. (2018). Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study. Nursing and Health Sciences, 20(2), 231–237. doi: 10.1111/nhs.12407
Ryan, L., & Seymour, J. (2013). Death and dying in intensive care: Emotional labour of nurses. End of Life Journal, 3(2), 1–9
Safitri, A., Trisyani, Y., & Iskandar, A. A. (2017). An exploration of nurse experience in caring for end of life care client and family in critical care setting in Indonesian context. Journal of Advances in Health and Medical Sciences, 3(2), 53-62. doi: 10.20474/jahms-3.2.2
Sandi, C. (2013). Stress and cognition. Wiley Interdisciplinary Reviews. Cognitive Science, 4(3), 245–261. doi: 10.1002/wcs.1222
Sinclair, S., Beamer, K., Hack, T. F., Mcclement, S., Bouchal, S. R., Chochinov, H. M., & Hagen, N. A. (2017). Sympathy, empathy, and compassion: A grounded theory study of palliative care patients ’ understandings, experiences, and preferences. Palliative Medicine, 31(5), 437–447. doi: 10.1177/0269216316663499
Vincent, J.-L., Marshall, J. C., Ñamendys-Silva, S. A., François, B., Martin-Loeches, I., Lipman, J., …, & Sakr, Y. (2014). Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine, 2(5), 380–386. doi: 10.1016/S2213-2600(14)70061-X
Wessner, P. B. (2018). Last chance to care : An autoethnography of end-of-life care in Indonesia. The Qualitative Report, 23(9), 2238–2250
Willemse, S., Smeets, W., Van Leeuwen, E., Nielen-Rosier, T., Janssen, L., & Foudraine, N. (2020). Spiritual care in the intensive care unit: An integrative literature research. doi: 10.1016/j.jcrc.2020.01.026
Williams, B. R., Lewis, D. R., Burgio, K. L., & Goode, P. S. (2012). Next-of-Kin’s perceptions of how hospital nursing staff support family presence before, during, and after the death of a loved one. Journal of Hospice & Palliative Nursing, 14(8), 541–550. doi: 10.1097/NJH.0b013e31825d2af1
Witt Sherman, D., & Free, D. C. (2015). Culture and spirituality as domains of quality palliative care. In M. Matzo & W. S. Deborah (Eds.), Palliative Care Nursing (4th ed., pp. 91–2015). New York: Springer Publishing Company. doi: 10.1891/9780826196361.0005
Zhang, B., Nilsson, M. E., & Prigerson, H. G. (2013). Factors important to patients’ quality-of-life at the end-of-life. Arch Intern Med, 172(15), 1133–1142. doi: 10.1001/archinternmed.2012.2364.Factors
Zomorodi, M., & Lynn, M. R. (2010). Critical care nurses’ values and behaviors with end-of-life care: perceptions and challenges. Journal of Hospice & Palliative Nursing, 12(2), 89–96. doi: 10.1097/NJH.0b013e3181cf7cf6

Last update:

Motivations behind end-of-life care: a qualitative study of Iranian nurses’ experiences
Zahra Royani, Khadijeh Yazdi, Gholam Reza Mahmoodi Shen. BMC Palliative Care, 23 (1), 2024. doi: 10.1186/s12904-024-01582-5
The effect of end‐of‐life care awareness education on the knowledge, attitudes and behaviours of intensive care nurses: A randomized controlled trial
Fırat Demir, Cansu Polat Dunya, İlknur Özkan. Nursing in Critical Care, 2024. doi: 10.1111/nicc.13192
Nursing Students’ Perception of the Educational Environment in a Public University in Ahvaz, Iran: A Study Based on DREEM Questionnaire
Dariush Rokhafrooz, Zhila Alborzi, Sima Sadat Ghaemi Zade Shustari, Meysam Heydari. Nurse Media Journal of Nursing, 12 (1), 2022. doi: 10.14710/nmjn.v12i1.41727
Exploring nurses’ experiences of recommended patient care: a descriptive phenomenological study
Azam Faraji, Amir Jalali, Alireza Khatony, Rostam Jalali. BMC Nursing, 23 (1), 2024. doi: 10.1186/s12912-024-01736-z

Last update: 2024-11-21 04:09:21

No citation recorded.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Journal Author(s) Rights

In order for the Department of Nursing, Faculty of Medicine, Universitas Diponegoro to publish and disseminate research articles, we need non-exclusive publishing rights (transferred from the author(s) to the publisher). This is determined by a publishing agreement between the author(s) and the Department of Nursing, Faculty of Medicine, Universitas Diponegoro. This agreement involves the transfer or licensing of the copyright for publishing to the publisher, while authors still retain significant rights to use and share their own published articles. The Department of Nursing, Faculty of Medicine, Universitas Diponegoro supports the need for authors to share, disseminate, and maximize the impact of their research through these rights in any databases.

As the author(s), you have rights to a wide range of uses of your article, including use by your employing institution or company. These author rights can be exercised without the need to obtain specific permission. Authors publishing in the Nurse Media Journal of Nursing have extensive rights to use their works for teaching and scholarly purposes without needing to seek permission, including:

use for classroom teaching by the author or the author’s institution and presentation at a meeting or conference, including distributing copies to attendees;
use for internal training by the author’s company;
distribution to colleagues for their research use;
use in a subsequent compilation of the author’s works;
inclusion in a thesis or dissertation;
reuse of portions or extracts from the article in other works (with full acknowledgment of the final article);
preparation of derivative works (other than for commercial purposes) (with full acknowledgment of the final article);
voluntary posting on open websites operated by the author or the author’s institution for scholarly purposes;

following the open access license of the Creative Commons CC BY-SA License.

Authors, readers, and third parties can copy and redistribute the material in any medium or format, as well as remix, transform, and build upon the material for any purpose, even commercially, but they must give appropriate credit (including the name of the creator and attribution parties, detailed information about the authors, a copyright notice, an open access license notice, a disclaimer notice, and a link to the material), provide a link to the license, and indicate if changes were made. The publisher will indicate any modification of the material (if any) and retain an indication of previous modifications using a CrossMark Policy and information about Erratum-Corrigendum notifications.

Authors, readers, and third parties can read, print, and download, redistribute or republish the article (e.g., display it in a repository), translate the article, download it for text and data mining purposes, reuse portions or extracts from the article in other works, sell or reuse it for commercial purposes, remix, transform, or build upon the material. They must distribute their contributions under the same license as the original Creative Commons Attribution-ShareAlike (CC BY-SA).

Copyright Transfer Agreement for Publishing (Publishing Right)

The Authors submitting a manuscript do so on the understanding that if accepted for publication, non-exclusive right for publishing (publishing right) of the article shall be assigned/transferred to Publisher of the Nurse Media Journal of Nursing (Department of Nursing, Faculty of Medicine, Universitas Diponegoro).

Upon acceptance of an article, authors will be asked to complete a 'Copyright Transfer Agreement for Publishing (CTAP)'. An e-mail will be sent to the Corresponding Author confirming receipt of the manuscript together with a 'Copyright Transfer Agreement for Publishing' form by online version of this agreement.

Nurse Media Journal of Nursing and Department of Nursing, Faculty of Medicine, Universitas Diponegoro, the Editors and the Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the Nurse Media Journal of Nursing are sole and exclusive responsibility of their respective authors and advertisers.

Please note that even though we ask for a transfer of copyright for publishing (CTAP), our journal Author(s) retain (or are granted back) significant scholarly rights as mentioned before.

The Copyright Transfer Agreement for Publishing (CTAP) Form can be downloaded here: [Copyright Transfer Agreement for Publishing (CTAP) Form NMJN 2024]

The copyright form should be signed electronically and send to the Editorial Office in the form of original e-mail below:

Dr. Meira Erawati (Editor-in-Chief)
Editorial Office of Nurse Media Journal of Nursing
Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Jl. Prof. Soedarto, Tembalang, Semarang, Central Java, Indonesia 50275
Telp.: +62-24-76480919; Fax.: +62-24-76486849
E-mail: media_ners@live.undip.ac.id

(This policy statements has been updated at 24th January 2024)

Critical Care Nurses’ Experiences of End-of-Life Care: A Qualitative Study

Journal Author(s) Rights

Copyright Transfer Agreement for Publishing (Publishing Right)

OFFICE INFORMATION