INTENSIVE CARE NURSES’ EXPERIENCES REGARDING PATIENT DEATH; A QUALITATIVE STUDY

Öz

Objectives: This study aimed to explore the experiences of intensive care nurses regarding patient death and the meanings they attribute to this process. Methods: This qualitative study was conducted using a phenomenological design. Data were collected through in-depth interviews with 19 intensive care nurses using a semi-structured interview form. The data were analyzed using inductive thematic analysis. Results: Three main themes and sixteen sub-themes were identified: reality of death, change and transformation, and need for support. The findings revealed that nurses experience death as a complex and multidimensional process involving emotional burden, personal and professional transformation, and various coping strategies. Conclusion: The findings indicate that intensive care nurses’ experiences of death constitute a dynamic process involving emotional burden, transformation, and meaning-making, shaped by both professional experience and institutional support. These results contribute to a better understanding of nurses’ adaptation to death and emphasize the importance of structured interventions to support their psychological well-being.

Anahtar Kelimeler

• Death
• Experience
• Intensive Care
• Nurse
• Qualitative Research

Etik Beyan

The research was conducted in accordance with the Declaration of Helsinki 1975. Ethics committee approval was obtained from the Social and Human Sciences Scientific Research Publication Ethics Committee of Istanbul Beykent University (E-45778635-050.99-91352 / 01.02.2023). The purpose of the study was explained to all participants and their consent was obtained. The names of the participants were kept confidential. In addition, the participant number and gender were stated instead of their names in their statements (e.g. E5-male nurse and P7-female nurse).

Teşekkür

The authors would like to express their sincere gratitude to all intensive care nurses who voluntarily participated in this study and generously shared their experiences. Their valuable contributions made this research possible.

YOĞUN BAKIM HEMŞİRELERİNİN HASTA ÖLÜMÜNE İLİŞKİN DENEYİMLERİ: NİTEL BİR ÇALIŞMA

Öz

Amaç: Bu çalışma, yoğun bakım hemşirelerinin hasta ölümüyle ilgili deneyimlerini ve bu sürece atfettikleri anlamı incelemeyi amaçlamaktadır. Yöntem: Araştırma fenomenolojik desende nitel bir çalışma olarak yürütülmüştür. Veriler, 19 yoğun bakım hemşiresi ile yarı yapılandırılmış görüşmeler yoluyla toplanmıştır. Elde edilen veriler tümevarımsal tematik analiz yöntemi kullanılarak analiz edilmiştir. Bulgular: Analiz sonucunda ölümün gerçekliği, değişim ve dönüşüm ile destek ihtiyacı olmak üzere üç ana tema ve on alt tema belirlenmiştir. Bulgular, hemşirelerin ölümü; duygusal yük, kişisel ve mesleki dönüşüm ile farklı baş etme stratejilerini içeren çok boyutlu ve karmaşık bir süreç olarak deneyimlediklerini göstermektedir. Sonuç: Yoğun bakım hemşirelerinin ölüm deneyimleri; duygusal yük, dönüşüm ve anlam oluşturma süreçlerini içeren dinamik bir yapıya sahiptir ve bu süreç hem mesleki deneyim hem de kurumsal destek ile şekillenmektedir. Elde edilen bulgular, hemşirelerin ölümle baş etme süreçlerini anlamaya katkı sağlamakta ve psikolojik iyilik hallerini desteklemeye yönelik yapılandırılmış müdahalelerin gerekliliğini ortaya koymaktadır.

Anahtar Kelimeler

• Hemşire
• Yoğun bakım
• Ölüm
• Deneyim
• Nitel araştırma

Etik Beyan

Araştırma, 1975 Helsinki Bildirgesi'ne uygun olarak yürütülmüştür. İstanbul Beykent Üniversitesi Sosyal ve Beşeri Bilimler Bilimsel Araştırma Yayın Etik Kurulu'ndan etik kurul onayı alınmıştır (E-45778635-050.99-91352 / 01.02.2023). Çalışmanın amacı tüm katılımcılara açıklanmış ve onayları alınmıştır. Katılımcıların isimleri gizli tutulmuştur. Ayrıca, katılımcıların ifadelerinde isimleri yerine katılımcı numarası ve cinsiyeti belirtilmiştir (örneğin, E5-erkek hemşire ve P7-kadın hemşire).

Teşekkür

Yazarlar, bu çalışmaya gönüllü olarak katılan ve deneyimlerini cömertçe paylaşan tüm yoğun bakım hemşirelerine içten teşekkürlerini sunmak isterler. Onların değerli katkıları bu araştırmayı mümkün kılmıştır.

Kaynakça

1. Köktürk Dalcali B, Taş AS. What intern nursing students in Turkey think about death and end-of-life care? A qualitative exploration. J Relig Health. 2021;60(6):4417-4434. doi:10.1007/s10943-021-01330-6.
2. Fernández-Castillo RJ, González-Caro MD, Fernández-García E, Porcel-Gálvez AM, Garnacho-Montero J. Intensive care nurses' experiences during the COVID-19 pandemic: a qualitative study. Nurs Crit Care. 2021;26(5):397-406. doi:10.1111/nicc.12589.
3. Kudubes AA, Akıl Z, Bektas M, Bektas İ. Nurses' attitudes towards death and their effects on spirituality and spiritual care. J Relig Health. 2021;60(1):153-161. doi:10.1007/s10943-019-00927-2.
4. He S, Zhao H, Wang H, Chen F, Lv T, Li L, Zhang H. The mediating effects of attitude toward death and meaning of life on the relationship between perception of death and coping with death competence among Chinese nurses: a cross-sectional study. BMC Nurs. 2023;22(1):87. doi:10.1186/s12912-023-01245-5.
5. Stanzl N, Scammell J. Nurses' perceptions of supporting a good death in intensive care units. Int J Palliat Nurs. 2022;28(8):357-364. doi:10.12968/ijpn.2022.28.8.357.
6. Stokes H, Vanderspank-Wright B, Bourbonnais FF, Wright DK. Meaningful experiences and end-of-life care in the intensive care unit: a qualitative study. Intensive Crit Care Nurs. 2019;53:1-7. doi:10.1016/j.iccn.2019.03.010.
7. Cardoso MFPT, Martins MMFPDS, Trindade LDL, Ribeiro OMPL, Fonseca EF. The COVID-19 pandemic and nurses' attitudes toward death. Rev Lat Am Enfermagem. 2021;29:e3448. doi:10.1590/1518.8345.4769.3448.
8. Puente-Fernández D, Lozano-Romero MM, Montoya-Juárez R, Martí-García C, Campos-Calderón C, Hueso-Montoro C. Nursing professionals' attitudes, strategies, and care practices towards death: a systematic review of qualitative studies. J Nurs Scholarsh. 2020;52(3):301-310. doi:10.1111/jnu.12550.

9. Cybulska AM, Żołnowska MA, Schneider-Matyka D, Nowak M, Starczewska M, Grochans S, Cymbaluk-Płoska A. Analysis of nurses' attitudes toward patient death. Int J Environ Res Public Health. 2022;19(20):13119. doi:10.3390/ijerph192013119.
10. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi:10.1093/intqhc/mzm042.
11. Wasserman S, Pattison P, Steinley D. Social networks. In: Everitt BS, Howell DC, eds. Encyclopedia of Statistics in Behavioral Science. Wiley; 2005. doi:10.1002/0470013192.bsa720.
12. Erdoğan S, Nahcivan N, Esin MN. Research in Nursing: Process, Application and Criticism. Nobel Medical Bookstores; 2014.
13. Kümbetoğlu B. Qualitative Methods and Research in Sociology and Anthropology. 5th ed. Bağlam Publishing; 2017.
14. Chen YC, Del Ben KS, Fortson BL, Lewis J. Differential dimensions of death anxiety in nursing students with and without nursing experience. Death Stud. 2006;30(10):919-929. doi:10.1080/07481180600925351.
15. Kent B, Anderson NE, Owens RG. Nurses' early experiences with patient death: the results of an online survey of registered nurses in New Zealand. Int J Nurs Stud. 2012;49(10):1255-1265. doi:10.1016/j.ijnurstu.2012.04.005.
16. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa.
17. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods. 2017;16:1609406917733847. doi:10.1177/1609406917733847.
18. Levi P, Patrician PA, Vance DE, Montgomery AP, Moss J. Post-traumatic stress disorder in intensive care unit nurses: a concept analysis. Workplace Health Saf. 2021;69(5):224-234. doi:10.1177/2165079920971999.
19. Wang CP, Hung FM, Ling MS, Chiu HY, Hu S. Factors associated with critical care nurses' acute stress disorder after patient death. Aust Crit Care. 2022;35(4):402-407. doi:10.1016/j.aucc.2021.06.007.
20. Brown M. The caregiver's conflict: the toll of death and dying on nurses' mental health and wellbeing. BYU ScholarsArchive. 2022. Accessed September 18, 2023.
21. Sutton OR, Norton EA. Psychological needs of critical care staff and barriers to accessing support: a qualitative study. Nurs Health Sci. 2022;24(3):652-660. doi:10.1111/nhs.12958.
22. Omran T, Callis AMB. Bereavement needs of critical care nurses: a qualitative study. Dimens Crit Care Nurs. 2021;40(2):83-91. doi:10.1097/DCC.0000000000000460.
23. Green G, Gendler Y, Sharon C. Fighting for life and losing: intensive care unit nursing staff's experience with COVID-19 patient deaths during the first two waves: a qualitative study. Inquiry. 2022;59:469580221094327. doi:10.1177/00469580221094327.
24. Demirbağ S, Akan DD, Baysal E. On between death and life: intensive care nurses. OMEGA (Westport). 2024;89(4):1714-1735. doi:10.1177/00302228231198575.
25. Medina-Fernández J, Torres-Soto NY, Casco-Gallardo K, Ruiz-Lara A, Martínez-Ramírez B, Fuentes-Fernández E. Fear and coping with death in intensive care nurses: a structural model predictor of compassion fatigue. Invest Educ Enferm. 2023;41(1):e12. doi:10.17533/udea.iee.v41n1e12.