Nurses’ Experience in Providing Transitional Care in Families of Critically and Terminally Ill Patients Deciding to Terminate Treatment: A Case Study

Abstract

   Objective: To explore the experience of nurses who provided transitional care in the families of critically and terminally ill patients who decided to terminate treatment
   Design: Descriptive qualitative case study
   Methodology: A total of 16 nurses were selected by means of purposive sampling to be the study informants, based on these criteria: 1) prior experience in caring for at least one family who had decided to terminate treatment, in accord with the hospital’s guideline; and 2) willingness to participate in the study. Data were collected between August 2019 and May 2020, via in-depth interviews with 10 of the nurses and via one focus group discussion with the other six. Elo and Kyngäs’s content analysis method was employed for data analysis. Trustworthiness of the study was established using Lincoln and Guba’s guideline.
   Results: According to the study, the participating nurses’ experience was divided into two stages: before and after the patients’ treatment termination decisions. Before treatment termination decisions, the nurses: 1) build a good rapport and confdence; 2) regularly provide information; and 3) coordinate meetings for family members. After treatment termination decisions, nursing care included: 1) communicating the patients’ decisions; 2) protecting the patients’ rights; 3) controlling the patients’ distressful symptoms; 4) coordinating ongoing care; 5) helping the patients to die peacefully; and 6) providing psychological support for the patients’ relatives. Two types of factors were found to affect the nurses’ transitional care in the treatment termination situation. The care-system-related factors were: 1) initial preparation of the patients and their families; 2) provision of suffcient information for the families; 3) support by the palliative care teams; and 4) presence of a clear guideline. The main family-related factor concerned mutual consent by family members. Finally, the nurses’ feelings arising from caring for these patients were: 1) delight in having made some merits; 2) moral guilt; and 3) moral conflict.
   Recommendations: The study findings could increase an understanding of the role of nurses in providing transitional care in the families of critically and terminally ill patients who have made a decision to terminate life-sustaining treatment and of main factors facilitating a smooth transition. These fndings can promote development of smooth transitional palliative care, in order to raise the quality of death in terminal patients and improve the quality of life amongst family members.