Nurses' experiences of moving from cure-oriented to comfort-oriented care in the medical intensive care unit setting
Medical intensive care unit (MICU) nurses often struggle to balance technological competence, task proficiency, and attention to the psychosocial needs of patients. They routinely are involved in negotiations to maintain or withdraw life-support. Knowledge is limited, however, on how nurses move from aggressively attempting to extend life to letting life end. ^ The purpose of this qualitative research investigation was to explore nurses' experiences of moving from cure-oriented to comfort-oriented care in the MICU setting. The use of a descriptive qualitative research design with brief selective participant observation and focus group interviews was used to capture the nurses' experiences. The study took place in an eighteen-bed state-of-the-art MICU that was part of a 719-bed acute care hospital located in the northeastern United States. Nineteen female and five male nurses participated in the study. ^ The analytic process followed the method described by Miles and Huberman (1994) that included data reduction, data display, and conclusion drawing. Demographic data, focus group transcripts, and observational field notes were reviewed independently by two group facilitators. The data were also presented to the research participants for review. ^ Nurses did not describe a clear transition point moving from cure-oriented to comfort-oriented care. Several of the following factors influenced transitions in care: the patient's medical condition and illness trajectory, prognosis, response to medical interventions, length of time on the MICU, advanced directives, and degree of family consensus about treatment goals. Nurses reported that the age of the patient, the family's misunderstanding of the patient's illness, family discord, and shifting medical care decisions made providing patient care difficult. Developing consensus about the direction of medical therapy, exhausting treatment options, and patients' failing to respond to aggressive medical interventions helped nurses move toward comfort care. Nurses realized that patients might die and that there were fates worse than death. They acknowledged that witnessing a patient death was not similar to losing someone close or like a death in one's own family. Nurses utilized a variety of personal strategies to cope with transitions in patient care such as cognitive, affective, and behavioral strategies. ^
Health Sciences, Nursing
James Mark Badger,
"Nurses' experiences of moving from cure-oriented to comfort-oriented care in the medical intensive care unit setting"
Dissertations and Master's Theses (Campus Access).