Nurses' Experiences of Patients' Deaths in Complex Continuing Care: An Interpretive Description

Abstract

Complex continuing care (CCC) is a healthcare setting where many patients die. Previous research has demonstrated that patient deaths can be meaningful and challenging for nurses. However, little knowledge exists regarding how the unique features of CCC influence nurses’ experiences in managing patient deaths. The objective of this study was to explore nurses’ experiences when patients die and their perceptions of support surrounding these experiences. Using interpretive description methodology, 13 memorable patient death experiences were explored in semi-structured interviews with licensed nurses (n=12) and nursing leaders (n=1). Criterion and theoretical purposeful sampling were used to develop a rich understanding of nurses’ experiences when patients die. Concurrent data collection and analysis uncovered five key intersubjective themes which described nurses’ experiences with individual deaths and how nurses’ experiences change overtime which included: (a) Professionally experiencing patients’ deaths: 'Engaging your left brain;’ (b) Personally experiencing patients’ deaths: ‘I’m a human being too;’ (c) Seeking resolution in the experience: ‘It was a good resolution;’ (d) Integrating professional and personal experiences: ‘Applying what you learn in your nursing life into your personal life and vice versa,’ and; (e) Supporting One Another in a Culture of Acknowledging Patients’ Deaths and Nurses’ Experiences: ‘They expect us just to take it, the nursing profession is like that.’ These findings suggest that nurses need support to facilitate the interpersonal and intrapersonal aspects of their experiences with patient death. This support should be grounded in a unit culture which openly accepts patient death and acknowledges nurses’ experience. Just-in-time education, peer mentorship and targeted support may further facilitate nurses’ ability to find resolution when patients die and support their on-going journey towards integrating death experiences in their lives and practice.