How do hospital nurses experience end-of-life care provision? A creative phenomenological approach
Current evidence suggests that hospital nurses' end-of-life care is complex due to the conflicting tasks of treatment-focused care and palliation. This is a topic that needs further exploration.
To understand hospital nurses' experiences of end-of-life care.
Interpretive phenomenology was used to explore 10 hospital nurses' experiences.
Nurses' individual experience of death informed their attitudes to death. The dominant theme was death-as-calm, accompanied by human connection, and death-as-process. The nurses' actions indicated their end-of-life care included love, defined as a desire to create calm, grounded by the virtue of natural goodness, responsibility and dedication, with a willingness to focus on the individual and their family, making the most of whatever time they have left. To continue providing end-of-life care the nurses successfully protected their authentic self by using a ‘professional identity’ and employing ‘defence of self’. The nurses found the unpredictable nature of hospital end-of-life care difficult but used a collaborative power to manage situations.
This study suggests hospital nurses successfully navigate an approach to hospital end-of-life nursing care, represented as a ‘harbour’, which facilitates transitioning from ‘stormy’ treatment to calm end-of-life care and death.
In England, figures from 2017 show that 81% of people aged 75 years and older had at least one hospital admission in their last year of life (Public Health England (PHE), 2020). In other countries, between 52% (in France) and 76% (in Austria, Slovenia and Israel) of the population aged 66-80 had at least one hospital admission in the last year of life (Overbeek et al, 2017). As the populations of the UK and other European countries age, the use of health services is predicted to increase among those aged 65-80 (Rechel et al, 2009). In England, the figure for hospital admissions in the last year of life had been dropping before the pandemic, but there were still 227 272 deaths in hospitals in England in 2017 (PHE, 2019), indicating that palliative and end-of-life care continues to be important in the hospital setting.
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