Experiences of Critical Care Nurses in End-of-life Care to Adult Patients in the Critical Care Unit, Kenyatta National Hospital

Abstract

Background: Critical care nurses’ (CCNs) role in the critical care unit (CCU) changes from life-sustaining to promoting comfort in end-of-life care (EOLC) resulting in different experiences. End-of-life care is inevitable owing to the high mortality rates experienced in the CCU especially in the African countries. Owing to this, CCNs ought to acquire specific skills required to effectively provide EOLC within the CCU. Objective: To explore the experiences of CCNs in EOLC to adult patients in the CCU at Kenyatta National Hospital (KNH). Methodology: This was a qualitative study employing descriptive phenomenology design to explore the experiences of CCNs in the CCUs in EOLC. 21 interviews were conducted, guided by the study tool. The main areas of interview were; understanding of EOLC by the CCNs, CCNs preparedness in provision of EOLC and barriers to EOLC. Interviews were transcribed verbatim and subjected to inductive analysis using the content analysis method. The findings were then thematically presented. Ethical approval was sought from institutions’ ethical committee. Results: The study involved 21 CCNs. A majority of the nurses were between 30-40 years of age, had bachelor’s degree and had working experience of over 7 years. The study identified 3 themes: Promoting a dignified end, professional preparedness and inadequate resources. Critical care nurses viewed EOLC as centered on patient comfort and comprehensive biopsychosocial support. While demonstrating inadequate preparedness, nurses emphasized the importance of training, especially in communication skills like empathy and self-awareness. Barriers to optimal EOLC included inadequate equipment, such as a shortage of syringe pumps, insufficient counseling support for nurses dealing with patient loss, and the absence of SOPs Conclusion: While nurses exhibit a commendable understanding of EOLC, the findings underscore a notable gap in the preparedness of CCNs. This inadequacy necessitates targeted training, improved communication competency, and therapeutic support to bridge existing gaps and elevate the standard of care. Importantly, the study captures a spectrum of experiences among CCNs, ranging from adherence to expected standards to instances falling below benchmarks. These varied experiences contribute significantly to the overall understanding of EOLC within critical care settings