O-17 ‘Sometimes their death is prolonged, not their life’: the experiences and needs of high dependency nurses when caring for patients approaching withdrawal of life-sustaining treatment: a qualitative study

Background

Nurses in critical care are frequently required to facilitate the withdrawal of life-sustaining treatments and provide end-of-life care for deteriorating patients. Providing this care has been shown to cause nurses distress, potentially leading to stress, burnout and cumulative grief. Despite a wealth of research looking at the experiences of intensive care unit nurses regarding end-of-life care, there remains a lack of research focusing on the period of care leading up to withdrawal of life-sustaining treatment and the experiences of high dependency unit (HDU) nurses.

Methods

15 qualified nurses took part in digitally recorded individual interviews, conducted within one HDU in in the North West of England. Interviews were analysed using qualitative thematic analysis. University and NHS Ethical approval were obtained.

Results

Participants reported difficulty caused by conflict in decision making, which they perceived to prolong treatment and suffering for patients who were not expected to survive. Resulting in moral distress, especially in situations where they voiced their concern that the patient was dying but the decision was made to continue life-saving treatments. Coping mechanisms were reported and the need for de-briefing or a talking therapy service was highlighted. The lack of education focused on how to provide optimal care and how to cope with this situation were highlighted

Conclusion

HDU nurses need time to talk about their experiences in caring for this patient group and education to support them to provide optimal end-of-life care in critical care settings is needed. The impact of this study has resulted in several local changes including debriefing sessions and development of a bespoke education programme has begun to ensure nurses are adequately prepared when caring for deteriorating patients approaching life-sustaining treatment withdrawal.