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Reflecting on one's own death: The existential questions that nurses face during end-of-life care

Published online by Cambridge University Press:  27 June 2016

Margareta Karlsson*
Affiliation:
Department of Caring Science, Åbo Academy University, Vaasa, Finland Department of Health Care Sciences, University West, Trollhättan, Sweden
Anne Kasén
Affiliation:
Department of Caring Science, Åbo Academy University, Vaasa, Finland Faculty of Professional Studies, Nord Universitet, Bodø, Norway
Carola Wärnå-Furu
Affiliation:
Department of Caring Science, Åbo Academy University, Vaasa, Finland
*
Address correspondence and reprint requests to Margareta Karlsson, Department of Caring Science, Åbo Academy University, Vaasa, PB 311, FI-65101 Vaasa, Finland. Department of Health Care Sciences, University West, SE-461, 86 Trollhättan, Sweden. E-mail: [email protected].

Abstract

Objective:

When registered nurses care for patients at the end of life, they are often confronted with different issues related to suffering, dying, and death whether working in hospital or community care. Serious existential questions that challenge nurses’ identities as human beings can arise as a result of these situations. The aim of our study was to describe and gain a deeper understanding of nurses’ existential questions when caring for dying patients.

Method:

Focus-group interviews with registered nurses who shared similar experiences and backgrounds about experiences in end-of-life care were employed to gain a deeper understanding about this sensitive subject. Focus-group interviews were performed in hospice care, in community care, and in a palliative care unit in western Sweden. A qualitative hermeneutic approach was employed to interpret the data.

Results:

Nurses’ existential questions balanced between responsibility and guilt in relation to their patients, between fear and courage in relation to being professional caregivers and fellow human beings, and between hope and despair in relation to the other's and their own death.

Significance of results:

Nurses in end-of-life care experience various emotions from patients related to things physical, spatial, and temporal. When nurses encounter these emotions as expressing a patient's suffering, they lead to challenges of balancing between different feelings in relation to patients, as both professional caregivers and fellow human beings. Nurses can experience growth both professionally and as human beings when caring for patients at the end of life.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2016 

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References

REFERENCES

Barbour, R. (2008). Doing focus groups. London: Sage.Google Scholar
Bergdahl, E., Benzein, E., Ternestedt, B.-M., et al. (2013). Co-creating possibilities for patients in palliative care to reach vital goals: A multiple case study of home care nursing encounters. Nursing Inquiry, 20(4), 341351.CrossRefGoogle ScholarPubMed
Buber, M. (2011). Det mellanmänskliga [The Interpersonal] [in Swedish] . Original German Title: Elemente des Zwischenmäncschlichen [Elements of the Interpersonal]. Ludvika: Dualis Förlag AB.Google Scholar
Eriksson, K. (1997). Vårdandets idé [The caring idea] [in Swedish] . Stockholm: Almqvist & Wiksell.Google Scholar
Gadamer, H.-G. (2008). Philosophical hermeneutics. Berkeley: University of California Press.Google Scholar
Gadamer, H.-G. (2013). Truth and method. London: Continuum.Google Scholar
Georges, J.-J. Grypdonk, M. & Dierrckx de Casterle, B. (2002). Being a palliative care nurse in an academic hospital: A qualitative study about nurses’ perceptions of palliative care nursing. Journal of Clinical Nursing, 11, 785793.CrossRefGoogle Scholar
Grove, S.K. & Burns, N. (2013). The practice of nursing research: Appraisal, synthesis, and generation of evidence. St. Louis: Saunders Elsevier.Google Scholar
Johansson, K. & Lindahl, B. (2010). Moving between rooms. Moving between life and death: Nurses’ experiences of caring for terminally ill patients in hospitals. Journal of Clinical Nursing, 21, 20342043.Google Scholar
Kaasalainen, S., Ploeg, J., McAiney, C., et al. (2013). Role of the nurse practitioner in providing palliative care in long-term care homes. International Journal of Palliative Nursing, 19(10), 477485.Google Scholar
Karlsson, M., Roxberg, Å., Barbosa da Silva, A., et al. (2010). Community nurses’ experiences of ethical dilemmas in palliative care: A Swedish study. International Journal of Palliative Nursing, 16(5), 224231.Google Scholar
Karlsson, M., Karlsson, C., Barbosa da Silva, A., et al. (2012). Community nurses’ experiences of ethical problems in end-of-life care in the patient's own home. Scandinavian Journal of Caring Sciences. 27(4), 831838. Epub ahead of print Oct 5.CrossRefGoogle ScholarPubMed
Karlsson, M., Berggren, I., Kasén, A., et al. (2015). A qualitative metasynthesis from nurses’ perspective when dealing with ethical dilemmas and ethical problems in end-of-life care. International Journal for Human Caring, 19(1), 4048.Google Scholar
Kitzinger, J. (1994). The methodology of focus groups: The importance of interaction between research participants. Sociology of Health & Illness, 16(1), 103121.Google Scholar
Krueger, R.A. (1994). Focus groups: A practical guide for applied research. Newbury Park, CA: Sage.Google Scholar
Levinas, E. (1969). Totality and infinity: An essay an exteriority. Pittsburgh: Duquesne University Press.Google Scholar
Morita, T., Tsuneto, S. & Shima, Y. (2002). Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. Journal of Pain and Symptom Management, 24, 447453.CrossRefGoogle Scholar
Morita, T., Miyashita, M., Kimura, R., et al. (2004). Emotional burden of nurses in palliative sedation therapy. Palliative Medicine, 18, 550557.Google Scholar
Ödman, P.-J. (1997). Pedagogikhistoria och hermeneutic [The history of pedagogy and hermeneutics] [in Swedish]. Pedagogisk forskning i Sverige [Educational Research in Sweden] , 2(2), 119134.Google Scholar
Ödman, P.-J. (2007). Tolkning, förståelse, vetande: Hermeneutik i teori och praktik [Interpretation, understanding, knowing: Hermeneutics in theory and practice] [in Swedish] . Stockholm: Norstedts Akademiska Förlag.Google Scholar
Qvarnström, U. (1993). Vår död [Our death] [in Swedish] . Stockholm: Liber.Google Scholar
Ranheim, A. (2009). Caring and its ethical aspects: An empirical philosophical dialogue on caring. International Journal of Qualitative Studies on Health and Well-Being, 4, 7885.Google Scholar
Rasmussen, B.H. & Edvardsson, D. (2007). The influence of environment in palliative care: Supporting or hindering experiences of “at-homeness.” Contemporary Nurse, 27(1), 119131.Google Scholar
Rydenlund, K. (2012). Vårdandets imperative I de yttersta livsrummen: Hermeneutiska vårdande samtal inom den rättpsykiatriska vården [The imperative of caring in extreme living-spaces: Hermeneutical caring conversations in forensic psychiatric care] [in Swedish] . Doctoral dissertation. Vaasa, Finland: Åbo Akademi University.Google Scholar
Sasahara, T., Miyashita, M, Kawa, M., et al. (2005). Factors associated with difficulties encountered by nurses in the care of terminally ill cancer patients in hospitals in Japan. Palliative & Supportive Care, 3, 1522.Google Scholar
Söderlund, M. (1998). En Mänsklig atmosfär. Trygghet, Samhörighet och Gemenskap: God vård ur ett patientperspektiv [A human atmosphere. Security, togetherness and community: Good care from a patient perspective] [in Swedish] . Doctoral dissertation. Uppsala: Uppsala University.Google Scholar
Söderlund, M. (2004). Som drabbad av en orkan: Anhörigas tillvaro när närstående drabbas av demens [Struck by a hurricane: Relatives’ experiences of living with a next of kin suffering from dementia and needing to be cared for] [in Swedish] . Doctoral dissertation. Vaasa, Finland: Åbo Akademi University.Google Scholar
Söderlund, M. & Eriksson, K. (2006). The role of interpretation in caring science. International Journal for Human Caring, 10, 3037.Google Scholar
Tønnessen, S., Nortvedt, P. & Førde, R. (2011). Rationing home-based nursing care: Professional ethical implications. Nursing Ethics, 18, 33863396.Google Scholar
Vanderspank-Wright, B., Fothergill-Bourbonnais, F., Brajtman, S., et al. (2011). Caring for patients and families at the end of life: The experiences of nurses during withdrawal of life sustaining treatment. Dynamics, 22(4), 3135.Google Scholar
Wlodarczyk, D. & Lazarewitz, M. (2011). Frequency and burden with ethical conflicts and burnout in nurses. Nursing Ethics, 18(6), 847860.Google Scholar
World Medical Association (2014). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Available from http://www.wma.net/en/30publications/10policies/b3/.Google Scholar