How are new graduates straight from nursing school coping with the emotional challenges of withdrawing care to intensive care patients is one of the questions researcher Jo Spiers is seeking answers to.
Spiers, who has been nursing in intensive care units for 12 years, wants to interview new graduates nurses currently working in ICU and other critical care environments throughout New Zealand to find out more about their experience of end-of-life care in ICUs.
She says she has had a longstanding interest in end of life care in the ICU setting. As a young nurse she started working in ICU seven months after graduating and recalls her first years in ICU as being a very emotive time as she dealt with experiences she had never come across before.
In the past new graduate nurses were rarely recruited straight into ICU but Spiers says increasingly in New Zealand’s larger ICUs, and around the world, nurses are going straight from nursing school to dealing with the emotionally charged issue of the withdrawal or limitation of treatment.
Aware of the ‘huge’ learning experience it was for new graduates starting in intensive care she decided to focus her Masters of Nursing research project on how do they cope with the additional challenge of the complex end of life care discussions and decisions that they are quickly part of in ICU nursing. With the aim of also gaining a better understanding of how to support new graduates.
Spiers says originally intensive care units were set up with a curative aim and traditionally dying in ICU was seen as a medical failure. “But the shift in the last few decades has been very much to look more at quality of life and also quality of death.”
Most deaths in ICU are anticipated and follow discussions with families about end of life care and the withdrawal or limitation of treatment. Most ICU patients die between four-six hours after withdrawal of treatment like ventilators that have been prolonging or maintaining their life
Increasingly ICUs were also initiating conversations with patients and their families whose loved one might survive this ICU admission but have chronic conditions that they are going to die from in the near future.
“It’s a very different thing (EOLC) to learn then it is to learn about using a ventilator or the common drugs in ICU. Those are much easier things to learn and to teach,” says Spiers.
Usually graduates starting in ICU have a six week orientation and then starting to look after the less sick patients – and potentially that does mean looking after patients whose treatment may be withdrawn. “Just the amount of learning that they have to in a very short space of time and the pressure that they are under – it is a very challenging time and end of life care puts another element there which is a very challenging area of practice.”
Spiers says her reading of the literature shows that EOLC is a challenging but highly valued part of ICU nursing. “And I’m expecting it to be the same for new graduates and expecting to hear examples of new graduates providing end of life care of really high quality. As while they might not come to ICU with experience of death they come out of nursing schools well equipped to provide empathic care.”
She was also keen to hear from new graduates about what would have made EOLC an easier learning experience for them.
Any new graduates working in ICU interested in being part of the project can email her on firstname.lastname@example.org. Interviews can be carried out via zoom, telephone or in-person.