Medical treatment meant to cure diseases often inflicts burdensome hardships and pain for the dying patient. The medical model of cure is personified by critical care units where life-sustaining technology not only supports the acutely ill patient until curative therapy is successful, but may also prolong the dying patient’s suffering.  The critical care nurse is caught in a struggle to provide both cure and palliation.

 Purpose:

The purpose of this study was to explore experiences of ICU nurses caring for dying patients and to discover essences of the phenomenon through emergent themes.

 Methodology:

A phenomenological approach based on the philosophical works of Merleau-Ponty was used to interview 14 ICU nurses in five northern and southeastern states about their experiences caring for dying patients.  Verbatim interview transcripts were analyzed using a hermeneutical approach developed by Pollio and Thomas.

 Findings:

When patients died, nurses experienced loss and grief similar to their patients and patient families.  When death had, or was going to occur, care changed from “a paradigm of curing to a paradigm of caring.”  Marked as a transitional point in time, roles of nurses changed from curing with technology to caring with compassion.  An encompassing theme of promises to keep wove throughout the interviews as nurses described the implicit and explicit promises made to patients and families in their care, with the moral obligations those promises entailed.

 Discussion:

In this study, nurses described an active role of advocacy for patients and families in decision making.  Nurses described efforts to keep promises of compassionate care for a peaceful death with dignity, including initiating and/or participating in decisions to discontinue futile care.  As moral distress may be inherent in making care decisions in an emotionally sensitive context, nurses need supportive policies that promote a collaborative interdisciplinary approach.