How expert hospice nurses find meaning in their work.

摘要

Hospice nurses who provide care to individuals, who are facing death, make meaning of their experiences in a variety of ways. This hermeneutic phenomenology study based on the stories of five participants with extensive experience found five major themes: (a) the calling: being drawn to hospice, (b) early experiences with death, (c) making a difference, with two subthemes, relationships with patients and families, and pain and symptom management, (d) relationships with colleagues, and (e) leadership. For these participants, making meaning evolved from the purpose of their work which was to assure that patients have a good death, one that is peaceful, calm, and comfortable and facilitated by the ability of the hospice nurse to make a difference. Making meaning also emerged from activities that they engaged in to meet this purpose and included establishing caring relationships with patients and families, providing excellent pain and symptom management, and teaching families how to provide supportive care and manage pain and symptoms, encouraging activities that promoted life closure for patients and family members, advocating on behalf of patients and families to get those things deemed necessary to accomplish the intended purpose, and supporting patients and families as death approaches and families after death has occurred. Participants reported a sense of efficacy, or perception of control over situations, resulting from mastery in the areas of pain and symptom management, moving patients and families towards reconciliation and life closure, working the system to get what they needed to be able to make a difference, and pronouncing death in a manner that both honored the patient and supported family members. Finally, a sense of self worth came from an awareness of their own sense of a job "well done," as well as receiving acknowledgement and recognition from colleagues, hospice leadership, and the community at large.