The limits of suffering: critical care nurses' views of hospital care at the end of life

Abstract

This study explores critical care nurses' beliefs, motivations, and experiences regarding end of life care. We performed a content analysis of the text comments provided by 468 U.S. critical care nurses in response to an anonymous mail survey about euthanasia. These comments reveal that these U.S. critical care nurses' feelings about issues surrounding the end of life are extremely complex. Eight themes emerged from 37 coded concepts, and the median number of themes volunteered per nurse was three. Among the most prevalent themes were patient concerns (53%), family concerns (33%), clinical circumstances (42%), the nurses' personal concerns (38%), and external or structural issues (68%). A profound sense of compassion and often conflicting forces were noted within and across themes. The nurses' comments offer a unique perspective on the care of critically ill patients and reveal much about that care that should be improved. In particular, (1) some nurses are frustrated about their limited role in the management of patients at the end of life, given their special understanding of these patients' experiences and wishes; (2) considerable confusion remains about the most appropriate way to care for these patients; and (3) the environment of some critical care setting may be unable to foster the compassion that many patients need.