Background / Aims: In critical care end-of-life care is a process that occurs in stages, which can vary in duration. It is the domain of nurses, while involvement in decision-making is less defined and based more on the individual nurse and the choices they make. The aim of this study was to examine the influence critical care nurses’ have on end-of-life decision-making and care in New Zealand, using the grounded theory methodology of Corbin and Strauss.
Methods: This study was undertaken using the qualitative research methodology of grounded theory, underpinned by symbolic interactionism. Nine critical care nurses working in a large tertiary hospital were interviewed and asked about their role in the process of decision-making. Interviews were audio recorded and transcribed verbatim, then manually coded, categorised and conceptualised.
Results: The research found that critical care nurses are vital to the joint processes of end-of-life decision-making and end-of-life care. In terms of their role, balancing the needs of both the patient and their family featured strongly, along with recognition that a patient was dying, transitioning from cure to comfort, utilising strategies to stay engaged and facilitating a good death. Ultimately, an explanatory theory of Experienced Understanding was reached.
Conclusions: It is proposed the outcomes of this research have the potential to inform current practice regarding end-of-life decision-making and care in critical care, including how nurses’ skills and experience can be utilised to facilitate both these processes. A significant reason for this potential is the nurse’s constant and consistent bedside presence. Consequently the nurse is the immediate health professional available to the patient and their family and acts as a conduit between these parties and the multidisciplinary team.
Counties Manukau Health