Promises to keep a phenomenological study of ICU nurses' experiences caring for dying patients /

by 1953- King, Phyllis Ann

The purpose of this study was to describe the experience of nurses caring for dying patients in the critical care unit. Using a phenomenological approach based on the works of Merleau-Ponty, the researcher completed 14 interviews in which ICU nurses were asked to describe experiences of caring for patients who died while in their care. The interviews were transcribed verbatim and analyzed using a hermeneutical approach developed by Pollio and applied to nursing research by Thomas. Each interview was examined within the context of all the interviews to identify themes found throughout. The world of the ICU was grounded in the contexts of death, time, and others. The purpose of the ICU, and the nurses there, was to prevent death or to delay it for another day. When those efforts failed, nurses experienced loss and grief similar to the patients and families they cared for. When death had, or was going to occur, care changed from “a paradigm of curing to a paradigm of caring.” Marked as a transition point in time, roles of nurses changed from curing with technology to caring with compassion. An encompassing theme of promises to keep wove throughout the interviews as nurses described the implicit and explicit promises made to patients and families in their care with the moral obligations those promises entailed. Five sub-themes manifested within the encompassing theme including: (1)“it wasn’t time for someone to die”—“we see it coming a long way down the road;” (2)“just one more day”—“they had enough time;” (3)“a promise I couldn’t keep”—“I honor what I say;” (4)“nurses are in the game of reality”—“doctors can’t say that;” and (5)“it doesn’t end at the time of death”—“you feel very good, because you did your job.” Each sub-theme revealed unique promises, vi involving different responsibilities and eliciting different responses from the nurse. Study findings suggests that nurses assume moral obligations to provide compassionate care to dying patients and their families in environments that foster a “paradigm of curing” rather than a “paradigm of caring.” vii