Lived Experiences of ICU Nurses in Caring for Patients Who are Dying with COVID-19: Aesthetic Expression
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Abstract
Objectives: To explain the meaning of ICU nurses’ experiences in caring for end-stage COVID-19 patients through aesthetic expression. Methods: This study is a qualitative research employing a hermeneutic phenomenological approach. The participants were ten registered nurses working in ICUs of advanced tertiary hospitals under the Bangkok Metropolitan Administration, who were on duty during the COVID-19 outbreak in 2019. Data were collected through drawings and in-depth individual interviews using semi-structured interview guides from June 2024 to December 2024. Pictures and interview transcriptions were analyzed based on Waraporn Kongsuwan’s Aesthetic Nursing Theory. Trustworthiness of the study was established following Lincoln and Guba’s criteria. Results: The study found that participants described the meaning of ICU nurses’ experiences in caring for end-stage COVID-19 patients in four thematic categories: (1) “forced to grow up” – being unprepared but having to carry on, (2) caring for hope, (3) A noble profession and (4) joy in the last breath. Conclusion: The findings provide insight into the meaning of ICU nurses’ experiences in caring for end-stage COVID-19 patients. This understanding can serve as foundational information for improving care for COVID-19 patients and for developing nurses’ professional competence in all dimensions. Moreover, healthcare organizations should assess the physical and psychological impacts on nurses in order to promote their well-being in constrained and high-pressure contexts, thereby ensuring the continued delivery of high-quality nursing care.
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References
Dondorp AM, Hayat M, Aryal D, et al. Respiratory support in COVID-19 patients, with a focus on resource-
limited settings. Am J Trop Med Hyg. 2020; 102(6): 1191. doi:10.4269/ajtmh.20-0283.
Varghese PM, Tsolaki AG, Yasmin H, et al. Host-pathogen interaction in COVID-19: Pathogenesis, potential
therapeutics and vaccination strategies. Immunobiology. 2020; 225(6): 152008. doi:10.1016/ j.imbio.2020.
Courcelle R, Gaudry S, Serck N, et al. Neuromuscular blocking agents (NMBA) for COVID-19 acute
respiratory distress syndrome: a multicenter observational study. Crit Care. 2020; 24(1): 446. doi:10.1186
/s13054-020-03164-2.
Behesht AF, Pakzad R, Goudarzi RM, et al. Effect of prone position on respiratory parameters,
intubation and death rate in COVID-19 patients: systematic review and meta-analysis. Sci Rep. 2021; 11(1):
doi:10.1038/s41598-021-93739-y.
Lebreton G, Dorgham K, Quentric P, et al. Longitudinal cytokine profiling in patients with severe COVID-
on extracorporeal membrane oxygenation and hemoadsorption. Am J Respir Crit Care Med. 2021;
(11): 1433-5. doi:10.1164/rccm.202011-4140LE.
Badulak J, Antonini MV, Stead C, et al. Extracorporeal membrane oxygenation for COVID-19: updated 2021guidelines from the extracorporeal life support organization. ASAIO J. 2021; 67(5): 485-95. doi:10.1097/ mat.0000000000001422.
Lucchini A, Bambi S, Mattiussi E, et al. Prone position in acute respiratory distress syndrome patients: a
retrospective analysis of complications. Dimens Crit Care Nurs. 2020; 39(1): 39-46. doi:10.1097/dcc.0000
Mortazavi SS, Assari S, Alimohamadi A, et al. Fear, loss, social isolation, and incomplete grief due to
COVID-19: A recipe for a psychiatric pandemic. Basic Clin Neurosci. 2020; 11(2): 225-32.doi:10.32598/bcn.11.covid19.2549.1.
Simard J, Volicer L. Loneliness and isolation in long-term care and the COVID-19 pandemic. J Am Med Dir
Assoc. 2020; 21(7): 966-7. doi:10.1016/j.jamda.2020.05.006.
Chen C, Wittenberg E, Sullivan SS, et al. The experiences of family members of ventilated COVID-19 patients in the intensive care unit: A qualitative study. Am J Hosp Palliat Care. 2021; 38(7): 869-76. doi:10.1177/10499091211006914.
Johns S, Booth S, Venville A. Dying in hospital during COVID-19: Isolation, despair, and moral distress. Aust Soc Work. 2020; 73(4): 514-5. doi:10.1080/0312407x.2020.1808268.
Al Thobaity A, Alshammari F. Nurses on the frontline against the COVID-19 pandemic: An integrative review. Dubai Med J. 2020; 3(3): 87-92. doi:10.1159/000509361.
Rosa WE, Ferrell BR, Wiencek C. Increasing critical care nurse engagement of palliative care during the COVID-19 pandemic. Crit Care Nurse. 2020; 40(6): e28-e36. doi:10.4037/ccn2020946.
Kongsuwan W, Locsin RC. Aesthetic expressions illuminating the lived experience of Thai ICU nurses
caring for persons who had a peaceful death. Holist Nurs Pract. 2010; 24(3): 134-41. doi:10.1097/HNP. 0b013 e3181 dd4000.
Gadamer HG. The enigma of health: The art of healing in a scientific age. 1 st ed. Cambridge: Polity Press;1996.
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022; 292: 114523. https://doi.org/10.1016/j.socscimed.2021.114523
Kongsuwan W. Aesthetic nursing theory, practice, and research: Caring for person at the end of life. 1 st ed. Songkhla: Siam Printing; 2022.
Lincoln Y, Guba EG. Naturalistic inquiry. Newbury Park (CA): Sage; 1985.
Khanantai C, Thongthawee B, Chatreewatanakul B. The critical care competency for COVID-19 patients
of intensive care nurses in bangkok metropolitan administration hospitals. Nurs J CMU. 2023; 50(2): 41-55. Thai.
Benner P. From novice to expert. Am J Nurs. 1982; 82(3): 402-7.
Sarnkhaowkhom C, Promkanya A, Pomisrikeaw S, et al. “Novice nurse and novel coronavirus”experiences of novice nurses caring for patients diagnosed with COVID‐19 in Thailand. Nurs Open. 2022; 9(6): 2887-98. doi:10.1002/nop2.996.
Fernández-Basanta S, Espremáns-Cidón C, Movilla-Fernández MJ. (2022). Novice nurses’ transition to the clinical setting in the COVID-19 pandemic: A phenomenological hermeneutic study. Collegian. 2022; 29(5): 654-62. doi:10.1016/j.colegn.2022.04.001.
Goh KJ, Wong J, Tien JCC, et al. Preparing your intensive care unit for the COVID-19 pandemic: Practical considerations and strategies. Crit Care. 2020; 24(1): 215. doi:10.1186/s13054-020-02916-4.
Galbadage T, Peterson BM, Wang DC, et al. Biopsychosocial and spiritual implications of patients with COVID-19 dying in isolation. Front Psychol. 2020; 11: 588623. doi:10.3389/fpsyg.2020.588623.
Wykowski JH. Finding your voice to champion hope in the intensive care unit. ATS scholar. 2022; 3(3): 343-6. doi:10.34197/ats-scholar.2022-0032VL.
Berntzen H, Rustøen T, Kynø NM. “Hope at a crossroads”–Experiences of hope in intensive care patients: A qualitative study. Aust Crit Care. 2024; 37(1): 120-6. doi:10.1016/j.aucc.2023.07.037.
Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, et al. Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. J Pers Med. 2022; 12(8): 1295. doi:10.3390/jpm12081295.
Galehdar N, Toulabi T, Kamran A, et al. Exploring nurses' perception of taking care of patients with coronavirus disease (COVID‐19): A qualitative study. Nurs Open. 2021; 8(1): 171-9. doi:10.1002/nop2.616.
Farahani MA, Nargesi S, Saniee N, et al. Factors affecting nurses retention during the COVID‐19 pandemic: A systematic review. HRH. 2024; 22(1): 78. doi:10.1186/s12960-024-00960-7.
Aydın M, Aydın Avci İ, Kulakaç Ö. Nurses as the leading fighters during the COVID-19 pandemic: Self-
transcendence. Nurs Ethics. 2022; 29(4): 802-18. doi:10.1177/09697330211065848.
Villar RC, Nashwan AJ, Mathew RG, et al. The lived experiences of frontline nurses during the coronavirus disease 2019 (COVID-19) pandemic in Qatar: A qualitative study. Nurs Open. 2021; 8(6): 3516-26. doi:10.1002/nop2.901.
Nasaif H, Aldiabat K, Alshammari M, et al. The lived experiences of nurses caring for patients with COVID-
in Arabian Gulf Countries: A multisite descriptive phenomenological study. Glob Qual Nurs Res 2023; 10: 23333936231155052. doi:10.1177/23333936231155052.
Asadi N, Royani Z, Pourkhajoei S. Care intertwined with anxiety and helplessness: the experiences of ICU nurses from COVID-19 disease’s end of life-a qualitative study. BMJ open. 2025; 15(1): e087329.7. doi:10.1136/bmjopen-2024-087329.
Kim Y, Kim DH. Nurses' experience of end-of-life care for patients with COVID-19 : A descriptive phenomenology study. Nurs Health Sci. 2024; 26(2): e13124. doi:10.1111/nhs.13124.
Kongsuwan W, Dahal P. A hermeneutic phenomenological study of aesthetics in nursing practice among hospitalized cancer patients in Nepal. Res Theory Nurs Pract. 2023; 37(2): 163-79. doi:10.1891/RTNP-2021-0015.
Aksoy B, Kasikçi E. The concept of a good death from the perspectives of nurses caring for patients diagnosed with COVID-19 in intensive care unit. Omega (Westport). 2025; 91(3): 1422-36. doi:10.1177/00302228231156945.
Jamenez OJB, Trajera SM, Ching GS. Providing end-of-life care to COVID-19 patients: The lived experiences
of ICU nurses in the Philippines. Int J Environ Res Public Health. 2022; 19(19): 12953. doi:10.3390/ijerph 191912953.
