Claire Minton1, Lesley Batten2. 1. School of Nursing, Massey University, Palmerston North, New Zealand. 2. MidCentral Health, Palmerston North, New Zealand.
Abstract
BACKGROUND: The literature regarding nurses' experiences of caring for chronically critically ill (CCI) patients is scant, however, there are subtleties within the literature, identifying nurses are often challenged providing care to this patient group. This can lead to feeling frustrated, lack of control, and distress. AIMS AND OBJECTIVES: As part of a larger study, this paper reports nurses' experiences of caring for patients during a prolonged critical illness in the intensive care unit (ICU). DESIGN: A longitudinal, qualitative, instrumental, multi-case study consisting of six cases from four New Zealand ICUs was conducted. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. The principles of consolidated criteria for reporting qualitative research were applied in reporting the methods and findings. METHODS: Patients, family members, nurses, and other health care professionals constituted the participant groups in the larger body of work. Data were collected from observations, conversations, interviews, and document review. Data were analysed by identifying themes, developing vignettes, and trajectory mapping. RESULTS: Nurses' experiences of caring for CCI patients in the ICU can be framed by a prolonged critical illness trajectory that is unpredictable, problematic, and prolonged. Nurses experienced distress in one of the phases in the trajectory because of uncertainty about a positive outcome for the patient related to multiple complications, with anxiety, delirium, and the suffering they witnessed. Nurses were frustrated and challenged to meet all the patient's needs because of the many tasks they needed to complete over the shift. CONCLUSION: Understanding the trajectory of a prolonged critical illness from the perspective of nurses, allows for challenges to be identified and is the first step in improving practice through the education of nurses. RELEVANCE TO CLINICAL PRACTICE: Understanding the challenges posed by caring for CCI patients will assist in improving their interactions and prioritizing their care for nurses.
BACKGROUND: The literature regarding nurses' experiences of caring for chronically critically ill (CCI) patients is scant, however, there are subtleties within the literature, identifying nurses are often challenged providing care to this patient group. This can lead to feeling frustrated, lack of control, and distress. AIMS AND OBJECTIVES: As part of a larger study, this paper reports nurses' experiences of caring for patients during a prolonged critical illness in the intensive care unit (ICU). DESIGN: A longitudinal, qualitative, instrumental, multi-case study consisting of six cases from four New Zealand ICUs was conducted. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. The principles of consolidated criteria for reporting qualitative research were applied in reporting the methods and findings. METHODS: Patients, family members, nurses, and other health care professionals constituted the participant groups in the larger body of work. Data were collected from observations, conversations, interviews, and document review. Data were analysed by identifying themes, developing vignettes, and trajectory mapping. RESULTS: Nurses' experiences of caring for CCI patients in the ICU can be framed by a prolonged critical illness trajectory that is unpredictable, problematic, and prolonged. Nurses experienced distress in one of the phases in the trajectory because of uncertainty about a positive outcome for the patient related to multiple complications, with anxiety, delirium, and the suffering they witnessed. Nurses were frustrated and challenged to meet all the patient's needs because of the many tasks they needed to complete over the shift. CONCLUSION: Understanding the trajectory of a prolonged critical illness from the perspective of nurses, allows for challenges to be identified and is the first step in improving practice through the education of nurses. RELEVANCE TO CLINICAL PRACTICE: Understanding the challenges posed by caring for CCI patients will assist in improving their interactions and prioritizing their care for nurses.