Qualitative Critique: End Of Life Care To Dying Patients

Qualitative Critique
Christi Garrick
NUR 518
March 3, 2013
Veta Massey

Qualitative Critique Nurses have provided end of life care to dying patients for centuries. The impact of death on families has been well documented, but there is very little information regarding the impact of death on nurses (Gerow et. al. 2010). Gerow et. al. (2010) conducted a study to describe the lived experiences of nurses dealing with the death of patients. The research question or purpose of the study involves the concept of the nurses experiences related to the death of patients. The study followed a qualitative phenomenological design directed toward discovering the meaning surrounding a specific concept, such as the experiences of nurses related
to death of patients (Gerow et.al. 2010). Polit and Beck (2012) state phenomenological approach is useful when the phenomenon is poorly defined. Topics of phenomenology are fundamental to life experiences of humans such as topics of suffering, violence, and chronic pain (Polit & Beck, 2012). Therefore, phenomenological design is appropriate for the study of impact of death of patients on nurses. Purposive sampling was the method used to obtain participants for the study. Polit and Beck (2012) define purposive sampling as selecting cases that will most benefit the study. Nurses who had experienced the death of a patient were eligible to participate regardless of specialty. Eleven Caucasian female nurses were recruited, ages 29-61, with three to 43 years of experience. The setting was chosen by the participant and the researchers went to them. Data collection was consistent with a qualitative study. Semi-structured interview guides were used for consistency. According to Polit and Beck (2012) when researchers want to ensure certain topics are covered, topic guides are used as a part of the semi-structure interview process. The focus of the interviews was the perceptions, experiences, feelings, and actions of nurses surrounding the death of patients (Gerow et. al. 2010). Rights of subjects were protected by approval provided by the University of Kansas Institutional Review Board. An introductory letter was sent to prospective participants explaining the study and an invitation to participate. The study was explained verbally prior to obtaining written consent (Gerow et. al. 2012). Data saturation is evidenced by all 11 participants having cared for a patient who died.
Data analysis followed Van Manen’s descriptive and interpretive phenomenological research activities, moving from investigating to rejecting then describing through the process of writing and rewriting (Gerow et. al. 2012, p. 123). Polit and Beck (2012) state Van Manen’s method is a common approach used when researchers wish to grasp the meaning of the experience which is the focus of the study. In the process of writing analyzed results the researcher’s goal is to give meaning to the studied phenomenon. Heideggerian hermeneutic was also used as an interpretive approach. Scientific rigor is supported with the credibility, dependability, conformability, authenticity, and transferability of the study. Credibility is supported by research was a prolonged engagement with the topic of study. The interviews and analysis occurred over a three- month period. The interpretive phenomenological analysis occurred over a six-month period, and member checking occurred at the end of each interview (Gerow et. al.
2010). Dependability is supported by use of an audit trail that consisted of electronically recorded interviews and transcribed interviews. The audit trail also consisted of written and rewritten narratives, discussion notes, and written discussion as the theme of the study evolved (Gerow et. al. 2010). Careful attention to maintaining a reflective journal and the audit trail support the confirmability of the study. Authenticity is proven by the written narrative is congruent with participant’s experiences. Transferability is seen through written interpretations in a clear, concise, meaningful way with the hope that other nurses will transfer the results to his or her own situations as appropriate (Gerow et. al. 2010). The study concludes by clearly identifying four themes involved in nurse’s experience with death of patients. The first them is a give and take relationship between patient and nurse takes precedence over a professional relationship. The second theme is the nurse’s first experience with death of a patient forms the basis of how he or she will respond to other patient deaths. The third theme is nurse’s spiritual beliefs impact how well he or she copes with death. The last theme identified is that maintaining professionalism requires compartmentalizing grief (Gerow et. al. 2010). The authors suggest further research would be beneficial to gain a better understanding of nurse’s responses to death of patients.
Gerow et. al (2010) believe further study is needed to determine level of support and education nurses received prior to or after experiencing death of a patient. Further research into grief experiences based on specialty of nursing would be beneficial. The authors suggest that nurses in rural areas may experience greater degree of grief because of personal relationships with patients and families. Gerow et. al. (2010) also recommend studying how past or current experiences of personal loss affect the grieving process of nurses dealing with death of
patients. Nursing is not only physically demanding but also emotionally demanding as well. Nurses experience different emotions when caring for others. Management and organizational leaders need to recognize grieving is a normal emotion and provide support for nurses to maintain healthy professional lives (Gerow et. al. 2010).

References

Gerow, L., Conejo, P., Alonzo, A., Davis, N., Rodgers, S., & Domain, E.W. (2010). Creating A curtain of protection: Nurses’ experiences of grief following patient death. Journal Of Nursing Scholarship, 44(3), 215-222.
Polit, D.F. & Beck, C.T. (2012). Nursing research: Generalizing and assessing evidence in nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott
Williams & Wilkins.