The Meaning of Nurses' Caring for Clinically Deteriorating Patients
Over recent years, the care of deteriorating patients has improved with technological advances. The global ageing population means patients are often presenting with more complex co-morbidities and therefore are deteriorating from an increasingly complicated baseline. Nurses comprise the largest sector of the health care work force and often have frequent patient contact therefore are most likely to be in a position to detect deterioration and act on it. Much is known about many aspects of clinical deterioration, especially regarding detection and management, however little is known about how nurses experience the clinical deterioration of their patients. This study reveals and explores the stories of ten Registered Nurses working in Acute Assessment Units caring for clinically deteriorating patients. This research uses the perspectives of hermeneutic phenomenology, drawing on the works of Heidegger and van Manen to explore the meaning of nurses’ caring for clinically deteriorating patients. The 10 participants recruited were Registered Nurses working in Acute Assessment Units across the Auckland region and who self-identified as having cared for a deteriorating patient. Semi-structured interviews were conducted with participants and transcribed verbatim by the researcher. Coherent stories were recrafted from the transcripts and returned to the participants for verification. Common notions were identified through hermeneutic interpretation. The findings of this research uncovered three main themes; Being connected, Being there as nurse, and Being with. The nurses’ stories revealed that their experiences of caring for deteriorating patients were deeply human and at times strongly linked to their own identities. The findings show that the way nurses experience patient deterioration cannot be separated from who they are as people, and the complex parts of themselves that they bring to their role in their connectedness and sharing of situations with patients. The results of this research provide an insight into the realities faced by nurses in their everyday experiences of caring for deteriorating patients and highlights the complexity of the emotional work and caring that takes place in their work. Recommendations have been made to support nurses in their care of deteriorating patients through increased education and practice changes to encourage reflection and acknowledgement of the emotionality faced in their nursing care.