Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Nursing care for patients on the edge of life: Nurses’ experiences of nursing care in intensive and nursing home related to questions of withholding or withdrawing curative treatment
Karlstad University, Faculty of Social and Life Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.

Place, publisher, year, edition, pages
Fakulteten för samhälls- och livsvetenskaper , 2007.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2007:33
Keywords [en]
life - sustaining treatment, nursing care, nursing home, ICU, phenomenology, phenomenography
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-1141ISBN: 978-91-7063-136-8 (print)OAI: oai:DiVA.org:kau-1141DiVA, id: diva2:4933
Public defence
2007-09-21, Ericssonsalen, 9C204, Karlstad Universitet, Karlstad, 09:00
Opponent
Supervisors
Available from: 2007-09-07 Created: 2007-09-07
List of papers
1. Good nursing care for ICU patients on the edge of life
Open this publication in new window or tab >>Good nursing care for ICU patients on the edge of life
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:kau:diva-1892 (URN)
Available from: 2007-09-07 Created: 2007-09-07 Last updated: 2010-08-11Bibliographically approved
2. Good nursing care and its hindrances for patients between being seriously ill and dying in nursing homes: a phenomenographic study
Open this publication in new window or tab >>Good nursing care and its hindrances for patients between being seriously ill and dying in nursing homes: a phenomenographic study
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:kau:diva-1893 (URN)
Available from: 2007-09-07 Created: 2007-09-07 Last updated: 2010-08-11Bibliographically approved
3. Being an intensive care nurse related to questions of withholding or withdrawing curative treatment
Open this publication in new window or tab >>Being an intensive care nurse related to questions of withholding or withdrawing curative treatment
2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 1, p. 203-211Article in journal (Refereed) Published
Identifiers
urn:nbn:se:kau:diva-1894 (URN)10.1111/j.1365-2702.2006.01427.x (DOI)
Available from: 2007-09-07 Created: 2007-09-07 Last updated: 2017-12-07Bibliographically approved
4. Nurses' lived experiences related to nursing care in nursing homes when questions concerning life-sustaining treatment or not were raised
Open this publication in new window or tab >>Nurses' lived experiences related to nursing care in nursing homes when questions concerning life-sustaining treatment or not were raised
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:kau:diva-1895 (URN)
Available from: 2007-09-07 Created: 2007-09-07 Last updated: 2010-08-11Bibliographically approved

Open Access in DiVA

fulltext(540 kB)3494 downloads
File information
File name FULLTEXT01.pdfFile size 540 kBChecksum MD5
6ef7beb3ee260147a5dcbaf203efea08c9d95e114a2dc9f6a1d283a4ac90bc1f1a7f8303
Type fulltextMimetype application/pdf

By organisation
Faculty of Social and Life Sciences
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 3494 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2367 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf