Acute care nurses regularly care for patients during transition from curative to comfort-focused care. The purpose of this qualitative descriptive analysis was to explore the personal impact on nurses of caring for dying patients and their strategies for self-support and development of competence.
As individuals and their families make end-of-life decisions, nurses find themselves embedded in a process that can be morally distressing. Professional nurses may lack education and experience in the specialized knowledge and skills needed to provide quality palliative and end-of-life care to patients and their families.
Data collected in a study of acute care nurses’ views of caring for patients and families during transition to comfort care were analyzed using the constant comparative coding techniques of grounded theory to develop and characterize categories. The data were derived from twenty-six semi-structured, audio-recorded, and transcribed interviews.
Nurses experienced moral distress in situations of continuing treatment when a cure was very unlikely. Treatment appeared to be a source of patient suffering with little or no benefit. In managing symptoms for patients at the end of life, nurses struggled to foster an often tenuous balance of patient comfort and calm, with as much alertness as possible. In addition, they were challenged to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care.
Nurses navigated these challenges through support from nurse colleagues, managers, and also called upon interdisciplinary guidance. Nurses reflected on their fears as new nurses caring for end-of-life patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them. They identified mentoring and experience as important to development of expertise. They also recommended enhanced educational preparation. Many reflected on the unique satisfaction possible when caring well for dying patients.
Strong nurse-to-nurse support as well as inter-professional collaboration reduced moral distress arising around comfort-focused care. Mentoring and education are needed to support successful assimilation to comfort-care nursing for novice nurses.
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