The resuscitation status of a patient: a constant dilemma

Aspects of caring for dying patients which cause anxiety to first year student nurses

AIM

To examine what aspects of caring for dying patients cause anxiety in student nurses during their first year of training.

DESIGN

Qualitative descriptive study.

SETTING

A university in the UK delivering preregistration nurse education.

METHOD

A purposive sample of 38 student nurses who had just completed their first year of their programme consented to participate in the study. Data triangulation was employed, with data collected from students' reflective diaries and two focus group meetings.

FINDINGS

Eight themes emerged relating to students' anxiety about caring for dying patients: coping with the physical suffering of patients: what to do or say; the severing of the relationship with the patient; the type of death; cardiopulmonary resuscitation; last offices; coping mechanisms; and interventions that would improve the student experience.

CONCLUSION

Findings from the study suggest that it is aspects of the caring role, rather than personal fear of death, that form the source of much of students' anxiety.

End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?

OBJECTIVE

To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

DESIGN

Qualitative interview that applies a phenomenological approach.

SETTING

Two ICUs at one secondary and one tertiary referral hospital in Sweden.

PARTICIPANTS

Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

RESULTS

The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

CONCLUSION

This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.