Abstract
Aim: The aim of this study was to explore the experiences of junior registered nurses providing end of life (EOL) care in an acute hospital setting. Similarities and differences between acute hospital specialties were also explored. The objective was to understand how junior nurse's perspectives and experiences of providing EOL care may be similar or different across difference specialities, and how this could inform better patient care whilst empowering the future generations of registered nurses.
Background: The nursing workforce within New Zealand are responsible for providing a significant amount of EOL care. Quality EOL care involves nurses attending to the physical, spiritual and psychological needs of the patient, whilst communicating and offering support to the family. Providing EOL care is a privilege for many nurses, however there are challenges for junior nurses who have limited clinical experience to base their practice off. As the population lives longer, trajectories predict significant demand on the palliative care services. Improving the practice of junior nurses when providing comprehensive palliative care for dying patients is essential to reduce the burden to those with a life-limiting condition.
Method: Qualitative description was utilised to gain an in-depth understanding of the experiences from a group of junior nurses working within general medical, general surgical and neurology/neurosurgical wards within an acute hospital. A focus group was undertaken for each of the three wards and the data was analysed using Braun and Clarke's six step process to thematic analysis.
Findings: Drawing on the focus group data, four main themes were identified: voice in the middle, emotional influences, contextual considerations, and EOL education. The first theme, voice in the middle highlights the advocating role of the nurses and the challenges this role may present. The second theme, emotional influences, describes the emotional experiences of the junior nurses and the impact of these emotions for them both personally and professionally. The third theme, contextual considerations, details the nurse's working environment and how this impacts provision of EOL care. The fourth theme, EOL education describes the education junior nurses received regarding EOL care whilst highlighting knowledge gaps. Together, these four themes reveal the experiences of the junior nurses when providing EOL care within the acute hospital setting.
Recommendations for practice: The recommendations made from this study are to promote an education programme for junior nurses focused on improving their EOL conversation skills. Providing debriefing opportunities for nurses should they need this and identifying a palliative care 'champion' is also recommended to improve the support available to the junior nurses. Providing continuing education in palliative care is important for succession planning for the future of the specialty. Further research is recommended to understand the differences of experiences for nurses working within different specialties and to determine the effectiveness of EOL communication education in junior nurses.