Uncovering the Lived Experience of Hospital Nurses Providing End-of-Life Care

TITLE: Uncovering the Lived Experience of Hospital Nurses Providing End-of-Life Care BACKGROUND: In end-of-life care there is one chance to get it right. Policy and drivers that aim to achieve this are founded on sound palliative care principles. How these principles effect the care in a treatment orientated hospital environment is not clearly understood. Current evidence suggests hospital nurses end-of-life care is complex due to the conflicting tasks of treatment focused care against palliation which needs further exploration. AIM: To understand hospital nurses’ experiences of end-of-life care. METHOD Interpretive phenomenology was used to explore 10 hospital nurses’ experiences. Visual images created by the nurses as metaphors of their experiences were explored in an elicitation interview. Transcriptions were analysed using Ricoeur’s approach to hermeneutic analysis. FINDINGS AND IMPLICATIONS The hospital nurses lived experience is represented as The Harbour. In The Harbour it will be calm, informed by the nurses’ ideas of a good death, transitioning from the storm of treatment to the calm of dying, human contact and practical care. This may differ to the palliative principles that inform current practice, indicating an emergent field of knowledge. Protection is needed in The Harbour to maintain the calm. The nurses protect their authentic-self to maintain end-of-life care, but this creates emotional dissonance and vulnerability, with potential physical and psychological consequences. Nurse managers recognition of the emotional burden and vulnerability of their nurses providing end-of-life care is needed. The nurses’ actions suggest their end-of-life practice may be principled by love; a desire to create calm, grounded by the virtue of natural goodness and a willingness to focus on the individual and their family, making the most of whatever time they have left. In The Harbour, nurses work collaboratively to enable the calm. Recognition of this form of collaborative power may help with nurses’ management of end-of-life care. Appropriate knowledge is needed in The Harbour to manage the transition to calm, but the unpredictable nature of end-of-life care required them to operate outside their objective knowledge base, suggesting end-of-life education should combine objective, technical rational education with more principled, less task based, professional artistry. Not all the nurses reported being changed existentially by their end-of-life care experience. Those that did reported living for the moment, being more appreciative of life with the suggestion of not being self-absorbed with unimportant activities. CONCLUSION Hospital nurses are motivated by love to provide end-of-life care that is guided by their attitude to death, principally to transition the storm of treatment to calm.