Paper
Friday, July 23, 2004
Insight Into Nurses’ Experience of Withdrawal/Withholding of Treatment in the Intensive Care Unit
Elizabeth J. Halcomb, RN, BN, Nursing Research Unit, School of Nursing, Family & Community Health, Nursing Research Unit, School of Nursing, Family & Community Health, University of Western Sydney, Parramatta, New South Wales, Australia
| Learning Objective #1: Demonstrate an increased awareness and understanding of the experience of nurses involved in withdrawing or withholding treatment within the intensive care unit |
| Learning Objective #2: Identify and discuss key concepts related to withdrawal and withholding treatment that can assist in improving nurses' future clinical practice |
Background: The success of technology has produced moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, those in the ICU are rarely able to exercise this right. Aim: This study aimed to explore the lived experience of Intensive Care nurses caring for clients having treatment withdrawn or withheld. Methods: Van Manens’(1) hermeneutic phenomenological framework formed the conceptual framework as it provided an in-depth insight into the human experience. A convenience sample of 10 Registered ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. Results: The five major themes that emerged were; comfort & care, tension & conflict, do no harm, nurse-family relationships and invisibility of grief & suffering. This experience represents a significant personal and professional struggle. Whilst nurses sought to provide comfort and care to the dying client, they were faced with tension and conflict with medical colleagues and within themselves to provide care that does no harm. The close relationships that developed between the nurse and the family were both a source of comfort and stress. Despite the widespread emotional and psychological costs incurred by nurses few services were seen to be available to assist in coping with what was considered to be often invisible grief and suffering. Conclusion: Improvements in communication between health professionals, debriefing and education about the process of treatment withdrawal would be beneficial and has the potential to improve patient care and reduce the current burden. Given the rising prevalence of chronic disease it is likely that nurses will be increasingly confronted by dilemmas in end-of-life care. It is important that the nursing research agenda includes issues such as advanced directives, and palliative care options for chronic disease.
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