Attitude toward care of the dying and practice of peaceful end-of-life care in community hospitals in China

AIM

To evaluate nurses' attitude toward caring for dying patients, their practice of peaceful end-of-life care in community hospitals, and the association between these two variables.

BACKGROUND

Community hospitals play an important role in the peaceful end-of-life care. For nurses, one of the key points of offering high-level care is to improve attitude. However, there are very few studies exploring how the attitude of nurses toward caring for dying patients relates to the practice of peaceful end-of-life care in community hospitals across China.

METHODS

A total of 363 questionnaires were included in this study. Simple random sampling was used to recruit participants from six community hospitals in China. A new instrument, Nurses' Practice of Peaceful End-of-Life Care Instrument (NP-PECI), was developed according to the Theory of Peaceful End of Life to assess the practice of nurses. Besides, Frommelt Attitudes toward Care of the Dying (FATCOD) was adopted to assess nurses for their attitude toward caring for dying patients.

RESULTS

The nurses' attitude toward caring for dying patients showed a significant positive correlation with their practice of peaceful end-of-life care statistically (r = 0.175, p < 0.01).

CONCLUSION

For community nurses, it is necessary to improve the attitude of nurses toward the practice of caring for dying patients, thus enhancing the outcome of peaceful end-of-life care.

IMPLICATIONS FOR NURSING PRACTICE

The Theory of Peaceful End of Life provides a theoretical framework and guideline on the practice of clinical nursing for quality control of peaceful end-of-life care, which is significant for improving the palliative care system. In the future, it is worth developing programs based on the Theory of Peaceful End of Life.

IMPLICATIONS FOR NURSING POLICY

For healthcare policy makers, this study can be helpful to refine the existing palliative care support policies and strategies targeted at community hospitals and their nurses.

A Hermeneutic Phenomenological Study of Aesthetics in Nursing Practice Among Hospitalized Cancer Patients in Nepal

Background: Aesthetics is the art of nursing that is expressive, subjective, and visible in the act of caring in nursing practice. Aesthetics in nursing practice satisfies holistic needs and achieves the quality of whole-person care. Purpose: The aim of this study is to describe the meanings of the lived experiences of cancer patients in terms of receiving care from the perspective of aesthetics in nursing practice. Methods: The hermeneutic phenomenological approach grounded on Gadamerian philosophy guided this study. Eleven Nepalese cancer patients who met the inclusion criteria shared their experiences through graphic illustrations (drawings) and interviews. Data were analyzed and interpreted following van Manen's phenomenological approach reflective of the four life worlds. The trustworthiness of findings was established following the criteria by Lincoln and Guba. Results: Thematic categories of the lived experience of cancer patients were revealed, reflecting the four life worlds: lived relation expressed as being nurtured as a family; lived space as appreciating the healing space; lived time as being hopeful; and lived body as receiving a new life. This experience was described as experiencing self and other while appreciating the healing space, being hopeful and nurtured as family and having a new life Implications for Practice: Aesthetics in nursing practice values on politely nurturing cancer patients as nurses' family members in a pleasant healing environment. Further, cancer patients experience having a new life.

Aesthetics in nursing practice as experienced by nurses in Indonesia: A phenomenological study

Background

While aesthetics in nursing practice brings out the beauty in nursing, studies regarding how aesthetics are implemented in practice are lacking.

Objective

To describe the meanings of aesthetics in nursing practice experienced by nurses in Indonesia.

Methods

This qualitative study employed a hermeneutic phenomenological approach based on Gadamerian philosophy. Thirteen nurses were asked to reflect on their experiences of providing aesthetics in their practice through drawing, followed by individual face-to-face interviews. Data were collected in a public hospital in West Sumatra, Indonesia. The interview transcripts and the pictures were analysed following van Manen's approach.

Results

Five thematic categories were revealed: 1) Engaging in caring for persons; 2) Full of compassion; 3) Sympathetic place of care; 4) A joyful time of care; and 5) Distracting the inconvenience in care.

Conclusion

Aesthetics in nursing practice is understood and experienced by Indonesian nurses in various ways, not only limited to the visual beauty, cleanness or tidiness of nursing intervention, but are expressed in other ways within caring, including providing care with compassion, applying the art of communication, relieving the pain, and applying innovation in care. These findings can be used to inform nurses in practising aesthetic nursing for enhancing the quality of care.

Aesthetic expressions as data in researching the lived-world of children with advanced cancer

Background

Understanding the true world of children needs a special method. Using aesthetic expressions through artworks with reflections assists nurse researchers in exploring children's feelings, thoughts, and behaviors in relation to their health and well-being.

Objective

This article focuses on the use of aesthetic expressions as innovative data sources in a study of the lived worlds of children experiencing advanced cancer.

Method

The use of aesthetic expressions in Gadamerian hermeneutic phenomenology and aesthetics, by means of van Manen's approach using draw and write, is examined as a suitable approach in a study of the lived worlds of children experiencing advanced cancer.

Results

The aesthetic expressions through the Draw-and-Write method of data generation were well-suited to a hermeneutic phenomenological study involving the group of Filipino children living with advanced cancer. The children drew images and figures of themselves, their families, classmates, friends, and teachers in several places and events during the series of two days. The drawings showed their facial expressions, home, parents, hospital stay, school activities, extracurricular activities, and other daily activities.

Conclusion

Aesthetic expression linked to art and connected to human experience drew the participants into different realms and expanded their perceptual capacities so that the fullness of the meaning of the experience was appreciated. The understanding of the experience through aesthetic expression provided sensitivity to and awareness of the variation of experience among children with advanced cancer. It is hoped that this paper can contribute to an understanding of aesthetic expressions as pathways to understanding and support health professionals as they embark on their goal of creating or restoring a comfortable relationship with children.

Predictors of nurses' caring practice for critically ill patients in critical technological environments: A cross-sectional survey study

Background

Caring practice for critically ill patients refers to the actions/behaviors/performance of nurses while caring for critically ill adult patients in the intensive care unit (ICU). Although the caring practice is vital in ICUs and complex due to the multitude of available technologies, research on ICU nurses' caring practice and its predictive factors are lacking.

Objective

This study aimed to explore the level of nurses' caring practice for critically ill patients in critical technological environments in China and its predictors.

Methods

This was a cross-sectional online survey study with 218 ICU nurses in 29 tertiary hospitals of Guizhou province, China, from 1^st to 30^th April 2020. Data were collected by using e-questionnaires made in the Questionnaire Star program, including the Demographic Data Questionnaire (DDQ), Practice of Technological Competency as Caring in Nursing Instrument (P-TCCNI), Influence of Technology Questionnaire (ITQ), and Nurses' Professional Value Scale (NPVS). The questionnaires were content validated by three experts. Cronbach's alpha coefficient was 0.96 for the P-TCCNI, 0.70 for the ITQ, and 0.95 for the NPVS. Links to the questionnaires were distributed by research assistants to WeChat groups including target participants. Statistical Package for the Social Science (SPSS) program version 26 (IBM Corporation, Armonk, NY, USA) was used for data analysis. Descriptive and inferential statistics were used to analyze the data. Multiple linear regression analysis using stepwise solution analysis was performed to identify unique predictors of nurses' caring practice.

Results

The level of nurses' caring practice for critically ill patients was high (mean = 87.30, standard deviation = 13.73). The professional value was a significant predictor of nurses' caring practice (β = 0.41, p = 0.00).

Conclusion

ICU nurses exhibited a high level of caring practice. Professional value was a significant predictor of ICU nurses' caring practice. Nursing administrators should understand the current situation of caring practice in critical technological environments and design strategies to maintain and improve ICU nurses' professional value to increase the level of caring practice.

Aesthetic expression of caring in nursing among Japanese undergraduate nursing students

BACKGROUND

Caring is the heart of nursing. However, not many understand the significance of caring in nursing from the perspectives of undergraduate nursing students, especially in Japan.

AIM

To describe caring in nursing among Japanese nursing students as learned and communicated through their aesthetic expressions.

METHODS

The study employed hermeneutic phenomenology. Sixty-one Japanese nursing students in their second year of baccalaureate degree studies participated. Constituting the data were art-based graphic expressions, such as drawings and written reflections on the drawings, as a response to the question of how the participants describe their meanings of caring in nursing. The thematic analysis method was used to analyze and interpret the data. The trustworthiness of the research was established following Lincoln and Guba's criteria.

FINDINGS

Seven thematic categories were identified. These categories include (1) Engaging with others; (2) Knowing each other; (3) Being with other persons; (4) Nurturing intimate personal growth; (5) Supporting wholeness of persons; (6) Vacillating rhythm; and (7) Intensifying competency.

CONCLUSION

This study described the understanding of caring in nursing among undergraduate Japanese nursing students during their second year of study. The caring in nursing focused on reciprocal relationships, whole-person relating, and practice competency. Findings suggested that nurse educators should develop teaching-learning strategies for nursing students to continuously grow as caring persons.

Effects of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients: A randomized clinical trial

Background & Aim: Most mechanically ventilated patients reported decreasing comfort during their treatments, especially in Muslim patients. Nursing comfort care needs to be addressed by integrating daily Islamic rituals to fulfill the spiritual need and promote holistic comfort of Muslim patients with mechanical ventilation. This study aimed to investigate the effect of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients. Methods & Materials: A pretest-postest with control group design was used. Fifty-six participants recruited from intensive care units of three public hospitals in Indonesia were randomly assigned into either the intervention group (n=28) or control group (n=28) by matching technique based on gender, age, and duration using a ventilator. Those in the intervention group received nursing comfort care developed based on Kolcaba’s Theory of Comfort integrating with the daily Islamic rituals, while those in the control group received usual care. Comfort was measured on the first day before receiving the intervention and on the second day after the intervention was completed by using Comfort Questionnaire for Mechanically Ventilated Patients (CQMVP). Results:  Data analysis using an independent t-test found no significant difference between the intervention and control groups at baseline (t = .134, p .894). The mean of comfort score of patients in the intervention group after receiving the intervention was significantly higher than those in the control group (t=6.70, p< .05).  Conclusion:  Nursing comfort care integrated with daily Islamic rituals increased comfort in Muslim patients while receiving mechanical ventilation. Thus, this nursing comfort care program can be recommended to use in practice.

Aesthetic Expressions of the Life-World of Filipino School-Age Children with Advanced Cancer

OBJECTIVES

The purpose of this study was to describe the meanings of the life-world of school-age children with advanced cancer through aesthetic expression.

DATA SOURCES

Drawing, writing, and interviewing data from 10 school-age children with advanced cancer living in Negros Island, Philippines, who met the inclusion criteria of the study.

CONCLUSION

Five major thematic categories structured the participants' existential life-worlds with advanced cancer and were reflected within five lived-worlds as follows: lived body, poor body conditions but strong mind; lived relation, unlike the others; lived time, being in present while waiting for normal life; lived space, certain places of living and caring; and lived thing, supportive living by technology. The participants did not have control over the external events that happened to them, but their internal reactions made a powerful turning point. Advanced cancer made them tough and resilient to emotions. The negative problems dictated their response and allowed being unaffected by advanced cancer, and they were able to do it.

IMPLICATIONS FOR NURSING PRACTICE

The results presented by this study can be used to enhance positive feelings and emotions of school-age children with advanced cancer. Schooling should remain an active part of participants' life to provide them with a sense of normalcy to carry on with their social and academic development. A prearranged discussion with the teacher, principal, school nurse, and hospital team is important to help everyone know what to expect.

Grief reactions and coping strategies of Muslim nurses dealing with death

BACKGROUND

An intensive care unit (ICU) features high mortality rates. Witnessing subsequent deaths may affect nurses psychologically and spiritually. Islam has an influence on Muslims' life and death. Nevertheless, little is known about Muslim intensive care nurses' experiences of grief in dealing with the deaths of patients.

AIM AND OBJECTIVES

This study aimed to describe the grief reactions and coping strategies of Muslim nurses in dealing with the death of patients.

DESIGN

This is a qualitative study with a phenomenological approach.

METHODS

Semi-structured individual interviews were conducted. Fourteen participants from an ICU in an Indonesian tertiary public hospital participated in this study. Data were analysed by thematic analysis. Trustworthiness was established by Lincoln and Guba's criteria.

RESULTS

The findings identified four reactions of grief, four factors influencing reactions of grief, and three coping strategies used in dealing with death in an ICU. The reactions of nurse's grief were crying, being sad, feeling disappointed, and feeling guilty. These reactions were related to several factors including the circumstances of the patient's death, nurse's expectation of patient's recovery, relationships with the patient, and the reactions of family. Coping management strategies used by nurses in dealing with their grief comprised: sharing with colleagues, avoiding dying and death situations, and engaging in spirituality.

CONCLUSIONS

The Muslim ICU nurse participants experienced their grieving through a variety of psychological reactions influenced by several factors. Personal coping strategies were revealed in dealing with their grief. However, avoiding dying and death situations affected their duty.

RELEVANCE TO CLINICAL PRACTICE

Attention to nurses' grief should be paid to maintain their psychological well-being and quality of end-of-life care. Providing formal support to enhance grief management is recommended.

Effect of Nursing Intervention Integrating an Islamic Praying Program on Labor Pain and Pain Behaviors in Primiparous Muslim Women

BACKGROUND

Labor pain has always been a priority issue for primiparous women. Pain behaviors appear as a response to labor pain. This study aimed at examining the effect of nursing interventions integrating an Islamic praying (NIIIP) program on labor pain and pain behavior.

MATERIALS AND METHODS

In this experimental design, 42 women in the control group received the usual care; 41 in the experimental group received the usual care and an NIIIP program from the 32nd week of pregnancy. This was done by providing childbirth education which they then practiced at home every day until they entered the labor room in the Bhinneka Bhakti Husada Hospital and Community Health Center Pamulang, Indonesia. They conducted 30 min of reciting from the Quran, stroking, positioning during their inter contractions, just breathing during contractions at the 1st, 2nd, 3rd h after cervical dilation of 3-4 cm. The visual analogue scale (VAS) and pain behaviors observation scale (PBOS) were used to measure pain and pain behaviors. Repeated measures of the ANOVA and t test were used to analyze the data.

RESULTS

There were significant differences in experience of labor pain ([F = 113.07, df (1, 81), p < 0.001] and pain behavior ([F = 147,49 df (1, 81), p < 0.001] between the control and experimental groups. There were significant statistical differences of over four times at the points of pain [F = 82.84, df (2, 182), p < 0.001] and pain behaviors [F = 165.55, df = (2, 189), p < 0.001].

CONCLUSIONS

The program effectively resulted in lower pain and increased pain behaviors.

Lived Experience of Grieving of Thai Buddhist Husbands Who Had Lost Their Wives From Critical Illness

PURPOSE

To describe the meanings of the lived experiences of grieving of Thai Buddhist husbands who had lost their wives from critical illnesses.

DESIGN

Hermeneutic phenomenological approach using van Manen's concepts. Seven husbands from southern Thailand who met the inclusion criteria participated in the study.

METHODS

Individual in-depth interviews were conducted and recorded on tape, while the interview data were transcribed and analyzed following van Manen's phenomenological approach. Trustworthiness was established using Lincoln and Guba's criteria.

FINDINGS

Five thematic categories described the meanings of the experiences, which were reflective of the four lived worlds of body, relation, space, and time. The lived world of body was "loss of thoughtful focus and energy," the lived world of relation was characterized by "surrendering attachment with the deceased" and "attachment to the children," the lived space reflected "social connection," and lived time was "healing time."

CONCLUSIONS

The grief experience did not seem to be complicated, and the hoped-for experience was being healed through surrendering attachment with the deceased while maintaining attachment with children and social connection. The model of grieving may contribute to the knowledge of nursing care processes, specifically in palliative and end-of-life care, and other care processes for healthcare professionals.

CLINICAL RELEVANCE

Hospital administrators can clearly support a bereavement service to provide a continuum of after-death care for Buddhist males. Nurses and healthcare providers can develop a bereavement care process by valuing the religious principles integrating social interaction for male bereaved husbands.

The lived experience of family caregivers caring for patients dependent on life-sustaining technologies

PURPOSE

The purpose of this study was to describe the meaning of the lived experience of family caregivers caring for their loved ones who were dependent upon life-sustaining technologies while in the hospital.

METHODS

This study followed van Manen's hermeneutic phenomenological approach to generate and analyze data to describe the experience of ten family caregivers who met the following inclusion criteria: a family member who participated actively in caring for the loved one who was dependent upon technologies for human care. Data were collected using individual in-depth interviews. The interview transcriptions were analyzed using van Manen's phenomenological approach, while Lincoln and Guba's criteria were used to establish trustworthiness of the study.

FINDINGS

Four thematic categories structured the meaning of the experience: Being an invisible person; supporting patients' wholeness; struggling to trust technologies for human care; and living in uncertainty. These thematic categories were reflective of Van Manen's four lived worlds of body, relation, space, and time.

CONCLUSION

Understanding the experience of family caregivers challenges nurses to express their technological competencies in caring more fully in their human care. Locsin's theory of Technological Competency as Caring in Nursing was used to explain and describe the meaning of the experiences of family caregivers caring for patients who were dependent upon technologies for human care, and foster nursing practice as caring in nursing.

Lived experiences of intensive care nurses in caring for critically ill patients

BACKGROUND

Caring for critically ill patients requires competent nurses to help save and secure the lives of patients, using technological developments while maintaining humanistic care. Nepal is a developing country with limited advanced technologies and resources. It is important to understand nursing care for critically ill patients under these shortages.

AIM

To describe the lived experiences of intensive care nurses in caring for critically ill patients in intensive care units.

METHODS

A hermeneutic phenomenological study was conducted. Purposive sampling was used to recruit 13 nurses from three intensive care units, who met the inclusion criteria. Face-to-face, in-depth individual interviews with an audio recorder were used to collect the data. The interview transcriptions were analysed and interpreted using van Manen's approach. Trustworthiness was established following the criteria of Lincoln and Guba.

FINDINGS

Seven thematic categories emerged from the experiences of nurses and were reflected within the four life worlds of space, body, relation and time. The categories were: low technology of care and insufficient resources (lived space); physical and psychological distress and requiring competency in caring (lived body); connecting relationship as a family, trusting technology of care, and realizing team working (lived relation); and less time to be with the patient as a whole person (lived time).

CONCLUSIONS

This study provides an understanding of the lived experience of nurses caring for critically ill patients, with inadequate support that can affect holistic care of patients and nurses' health.

RELEVANCE TO CLINICAL PRACTICE

Intensive care nurses need to enhance their knowledge and skills related to the use of technologies and patient care by attending training programs and gaining further education. This study recommends that hospital administrators should support sufficient facilities and technologies of care and, in particular, increase the competency of nurses in caring for critically ill patients as the whole person.

Lived experience of caring for dying patients in emergency room

BACKGROUND

Dying often occurs in hospitals and frequently in emergency rooms. Understanding caring for critical and dying patients is necessary for quality nursing.

PURPOSE

This study described the meaning of nurses' lived experience of caring for critical and dying patients in the emergency rooms.

METHODS

This study was conducted in three emergency rooms of tertiary hospitals in southern Thailand. Twelve nurses met the inclusion criteria: nurses working in emergency room for at least 2 years, and experienced caring for critical and dying patients in an emergency department. Data were collected using in-depth individual interviews. Data transcription and analysis used van Manen's hermeneutic phenomenological approach. Trustworthiness was established following Lincoln and Guba's criteria.

FINDINGS

Experiences of caring for critical and dying patients revealed four thematic categories: defying death; no time for palliative care; lacking support for family; and privacy for peaceful deaths. These thematic categories reflected van Manen's four lived worlds of body, time, relations and space.

CONCLUSIONS

The study described the meaning of the experience of caring for critical and dying patients while supporting the development of nursing knowledge for palliative and end-of-life care in emergent settings.

IMPLICATIONS FOR NURSING POLICY

Findings of the study influence nursing policies toward enhancing education of nurses regarding palliative and end-of-life care in emergency settings. These findings can also influence the value of caring-healing environments for critical and dying patients and their families. Policies can focus on practice and education of families particularly about end-of-life care for critical and dying patients.

Thai nursing students' experiences when attending real life situations involving cardiac life support: A Phenomenological study

BACKGROUND

During the last few years, manikin simulations have been used for cardiac life support training procedures in medical and nursing education. However, some nursing students have experienced attending real events involving cardiac life support during their clinical practice.

OBJECTIVE

This study aims to describe the meaning of experience of Thai nursing students when attending real situations of cardiac life support.

METHODS

A hermeneutic phenomenological study was used. Third and fourth year bachelor of nursing students at a university in the southern region of Thailand who had the experience of attending real situation of cardiac life support were purposely selected as the informants. The data were generated from individual in-depth interviews with eighteen nursing students. Van Manen's approach was used to analyze the data. Trustworthiness was established using the criteria set out by Lincoln and Guba.

RESULTS

Essential themes situated in the context of the four existential grounds of body, time, space, and relation emerged. These were: being worried and fearful while desiring to participate in cardiac life support procedures; enhancing self value; knowing each moment is meaningful for one's life; having time to understand the reality of life; being in a small corner; appreciating such opportunities and the encouragement given by nurses and the healthcare team; and feeling empathy.

CONCLUSIONS

Besides learning in classrooms and practicing in labs, experiencing real situations is beneficial for nursing students in learning cardiac life support. This study provides information that can be used for clinical teaching management in the topics relating to cardiac life support.

Lived experience of patients being cared for in ICUs in Southern Thailand

BACKGROUND

Technologies in ICUs are increasingly saving human lives. The challenge for nursing in ICUs is to use technologies competently in order to know patients more fully within the harmonized view of technology, nursing and human care.

PURPOSE

The purpose of this study was to describe the meaning of the experiences of patients who were dependent on technologies while being cared for in ICUs.

METHOD

A hermeneutic phenomenological approach was used to describe the experiences of 10 participants who were discharged from adult ICU units in Southern Thailand. Lincoln and Guba's criteria for trustworthiness was used to establish the rigour of the study.

FINDINGS

Four thematic categories structured the meaning of the participants' experiences: Living suffering; Harmonizing living; Being in trust and security; and Transitioning to a better life. These thematic categories were reflective of the four lived worlds of corporeality, relationality, spatiality and temporality.

CONCLUSION

The description of being cared for was based on the narratives of patients who were discharged from ICUs in Southern Thailand. In conclusion, the lived experience of being cared for with technologies in ICU was described as living suffering within trust and security, and harmonizing living while transitioning to a better life.

RELEVANCE TO CLINICAL PRACTICE

The findings of the study could be used to design innovative nursing strategies and interventions to enhance understanding of human health and well-being while maintaining and advancing competencies in the use of technologies for human care.

Thai Buddhist families' perspective of a peaceful death in ICUs

AIM

To describe the concept of a peaceful death in intensive care units (ICUs) from the perspective of Thai Buddhist family members.

METHODS

This descriptive qualitative study was based on data generated from individual in-depth interviews of nine Thai Buddhist family members from the southern region of Thailand whose loved ones died in adult ICUs. Colaizzi's phenomenological approach was used to analyse the data. Rigour for the study was established by Lincoln and Guga's guidelines for qualitative research studies.

FINDINGS

Five core qualities emerged that made-up the concept of a peaceful death as described by Thai Buddhist family members who cared for their loved ones while they were dying in ICUs. These core qualities were 'knowing death was impending, preparing for a peaceful state of mind, not suffering, being with family members and not alone, and family members were not mourning'.

CONCLUSION

Thai Buddhist family members described what they meant by a peaceful death. 'This was: preparing for a peaceful state of mind in knowing that one's impending death is not a situation of suffering or being alone, but rather a time of being with family members who are not yet mourning one's death.' The findings support that family members should participate in promoting a peaceful death for their loved ones dying in ICUs.

IMPLICATIONS FOR PRACTICE

The five core qualities of a peaceful death reported in this study could be used as a framework for nurses to create nursing practice interventions for quality end-of-life care for Thai Buddhists.

Thai Nurses’ Experience of Caring for Persons Who Had a Peaceful Death in Intensive Care Units

This phenomenological study describes the lived experience of caring for persons who had a peaceful death in the intensive care units. Ten intensive care nurses in south Thailand participated in individual interviews. Van Manen’s approach was utilized to synthesize data. The lived experience of Thai nurses caring for persons who had a peaceful death is: understanding the other through valuing experience and enhancing relationships with others by recognizing time is short and is a priority. Boykin and Schoenhofer’s theory of nursing as caring provided the theoretical lens for interpreting the meaning of the phenomenon.

Thai Buddhists' experiences caring for family members who died a peaceful death in intensive care

AIM

To describe the meaning of Thai Buddhists' lived experiences caring for family members who died a peaceful death in intensive care units.

METHODS

The study made use of hermeneutic phenomenology. The participants were nine family caregivers from the southern Thailand region. Data was generated from individual interviews, and Van Manen's approach was used to analyse and interpret the data.

FINDINGS

Nine themes structured the experiences and were reflected within the four lived worlds of relationality, corporeality, temporality, and spatiality. The participants struggled when making decisions about their family member's life in the context of changing hope. Feelings of stress and exhaustion were common. The participants valued empathetic understanding as a means for maintaining relationships with others in giving and receiving compassionate care. Caring for the self in order to give mindful care and doing one's best in the moment also significantly contributed to achieving a peaceful death.

CONCLUSION

The findings suggest nursing practice guidelines for models of family-centred care and family participation in end-of-life care in intensive care units.

Knowing the occasion of a peaceful death in intensive care units in Thailand

The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit.

Thai Buddhist intensive care unit nurses' perspective of a peaceful death: an empirical study

AIM

To describe the concept of a peaceful death from Thai Buddhist intensive care unit (ICU) nurses' perspectives.

METHOD

A descriptive qualitative study of data generated from individual in-depth interviews of ten intensive care nurses who practiced in adult ICUs in the southern region of Thailand. Content analysis was used to analyse the data.

FINDINGS

Four core qualities of a peaceful death emerged as described by Thai Buddhist nurses who practised in the ICUs. These core qualities are: peaceful mind; no suffering; family's acceptance of patient's death; and being with others and not alone.

CONCLUSION

Thai Buddhist nurses described a peaceful death as 'a situation in which persons who are dying have peace of mind, and do not show signs and symptoms of suffering. Peaceful death occurs when family members declare acceptance of their loved one's dying and eventual death. Such a death is witnessed by relatives and friends and the dying person is not alone.' The findings encourage nurses to be with, and provide palliative care for, dying patients and families.

Aesthetic expressions illuminating the lived experience of Thai ICU nurses caring for persons who had a peaceful death

This article, through art and aesthetic expression, illustrates and illuminates the experiences of persons caring for those who had peaceful deaths in intensive care units (ICUs) in southern Thailand. Aesthetic expression, categorized as a descriptive thematic experience, enhanced the appreciation of the experiences, which has implications for holistic end-of-life care.

Promoting peaceful death in the intensive care unit in Thailand

BACKGROUND

Having a peaceful death is a common wish among Thai people. Thai culture and religious beliefs offer practical ways to enhance having a peaceful death. Dying in an intensive care unit (ICU) is unnatural and oftentimes painful for the patient and their loved ones. Promoting a peaceful death is one of the least understood yet critical roles of nurses who practise in ICUs.

PURPOSE

To explore the ways that ICU nurses in Thailand could promote peaceful death and to attempt a definition of the concept of 'peaceful death'.

METHOD

Data were generated from ICU nurses' descriptions of peaceful death. These were given during in-depth telephone interviews, tape-recorded and analysed using the grounded theory method of analysis.

FINDINGS

ICU nurses promote peaceful death through a three-dimensional process: awareness of dying; creating a caring environment; and promoting end-of-life care.

CONCLUSIONS

The study provided opportunities for nurses to understand and influence the practice of promoting peaceful death in ICUs in Thailand. Further research is needed to enhance the practices and processes necessary for promoting peaceful death among ICU patients. It is anticipated that this will advance policy changes in nursing care processes in Thailand.