Nurses' early experiences with patient death

Abstract

Chronic stress and ‘burnout’ have been extensively researched in nursing populations, but very little is known about the impact of specific acutely stressful or significant events. A novice nurse’s first encounter with patient death may pose considerable cognitive, emotional and clinical challenges. Using a mixed methods design, this study explored the clinical circumstances, impact and challenges and rewards of nurses’ early experiences with patient death. A convenience sample of practicing New Zealand Registered Nurses was recruited using email invitations. In the 1st phase, 174 participants completed an online questionnaire exploring the clinical circumstances, preparedness, support mechanisms and impact of their Earliest Memorable Patient Death (EMPD). A sub-sample of twenty volunteers then participated in the 2nd phase, individual semi-structured interviews, providing detailed descriptions of their EMPD experiences. Most nurses reported EMPDs during undergraduate training (61%) or first year of qualified practice (23%). Over 80% of EMPDs occurred in acute medical, surgical or specialty settings in public hospitals, some involving paediatric or sudden unexpected deaths. Whilst some participants described a rewarding, ‘learning experience’, others reported acute helplessness, guilt or marked ongoing distress. Whilst little can be done to control the clinical circumstances of nurses’ early death encounters, by better preparing and supporting novice nurses it may be possible to minimise more negative factors such as unexpected elements, feelings of inadequacy, exclusion and role conflicts, and facilitate coping, sharing the experience, personal and professional growth, and other positive outcomes. Nurses’ early experiences with patient death appear to have a powerful lasting impact on their professional and personal lives. The nature of these experiences may influence ongoing attitudes to care of the dying, future career direction and ultimately, patient care. The findings have significant implications for timing and content of future interventions better to prepare and support novice nurses experiencing patient death for the first time. Relatively little has previously been published about nurses’ early experiences with patient death, and the exploratory, inductive methodology underlying this research allowed the nature of these experiences to emerge. More research is needed in this important area.