Nursing Care of the Chronically Critically ill: An Exploratory Descriptive Study

Abstract

Background:There is an emerging group of intensive care unit (ICU) patients known as the chronically critically ill (CCI). This patient group is steadily increasing worldwide (Nelson et al., 2004).No published literature was located that focused on the nursing experience of caring for CCI patients, however studies alluded to CCI patients as frustrating to look after.This is pertinent because these patients are costly to care for and considered burdensome to nurses and physicians. (Daly, Rudy, Thompson & Happ, 1991). In a working environment where turnover and shortage of nursing staff is evident and predicted to worsen, this is cause for real concern about future resourcing for this patient group (Carasa & Nespoli, 2002). Research Aims: The aim of this study was to explore and describe nurses' experiences of caring for CCI patients. ICU nurses are the key providers of bedside care to all ICU patients. They have valuable contributions concerning the planning and implementation of patient-focused care, including that of long-stay and CCI patients. Method: A qualitative approach was used with an exploratory descriptive design. Semistructured interviews were conducted which generated in-depth description of participant experiences. Findings: Six key themes are identified: 1. Nursing autonomy and control 2. Work-related stress, compassion fatigue and staff allocation 3. The CCI patient in the ICU environment 4. Teamwork, nursing practice and continuity of care 5. The culture of ICU 6. Withdrawal of care and palliation. Summary: Six nurses from two tertiary level ICUs within New Zealand were interviewed using a semi-structured approach. Participants were encouraged to comment on several issues including access to training and resources, cultural issues within ICU and any suggestions for how CCI patient care might be improved.The interviews were transcribed to allow a thorough content analysis. These topics were explored and generated recommendations for changing practice.