The cardiovascular intensive care unit nurse's experience with end-of-life care: a qualitative descriptive study.

摘要

PURPOSE: Nurses in the cardiovascular intensive care unit (CVICU) informally expressed moral angst when caring for patients who are approaching the end of life. The purpose of this study was to better understand CVICU nurses' perceptions about their roles and responsibilities in the decision-making process about change in intensity of care and end-of-life care for patients within the CVICU setting. PARTICIPANTS AND METHODS: Nineteen nurses from one CVICU consented to being interviewed individually regarding their experiences caring for patients approaching the end of life, and specifically regarding the initiation of a change in code status. Investigators used a qualitative descriptive approach to collect and analyse the data. Transcript data were analysed and as concepts emerged they were compared with those from earlier interviews to establish similarities and differences. Investigators reached consensus about the major themes. FINDINGS: Analysis revealed four major themes: (a) exhausting patient treatments; (b) promoting family presence; (c) acknowledging physician authority; and (d) walking a fine line. CONCLUSIONS: This research adds to the limited body of knowledge concerning CVICU nurses' experiences with end-of-life care. Results of this study provide a basis for putting in place support systems for CVICU nurses.