Registered nurses' experiences of end-of-life care in the acute care setting in Singapore

Author: Ambelorfam Manikam

Manikam, Ambelorfam, 2020 Registered nurses' experiences of end-of-life care in the acute care setting in Singapore, Flinders University, College of Nursing and Health Sciences

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Background: With its rapidly ageing population, Singapore’s approach to end-of-life (EOL) care is evolving. However, the provision of high-quality EOL care must be explored in the context of a multicultural society. With changes taking place in the health sector, it is an opportune time to explore the perceptions and experiences of nurses regarding EOL care and what it entails. Identification of the characteristics of effective nursing care for dying patients, especially in the acute care setting, is essential. Nurses working in acute care settings are responsible for caring for both acutely ill medical patients receiving curative treatments as well as patients who need EOL care. Little data are available on this increasing trend in the Singapore healthcare system. Therefore, it is essential to investigate the lived experiences of acute care nurses caring for dying patients.

Aim: The primary aim of this study is to explore the everyday care practices and experiences of Registered Nurses when caring for dying patients in an acute care setting in Singapore.

Methodology: This research study took a hermeneutic phenomenology approach guided by the philosophy of Hans-Georg Gadamer, whose concepts include belonging to tradition, situation, text, true questions, dialogue and fusion of horizons. A purposive sample of 16 Registered Nurses from acute medical, surgical, oncology, haematology and intensive care units participated in this study. Data were collected over a period of six months using 45-minute semi-structured interviews. A data analysis method developed by Fleming, Gaidys and Robb was applied to gain an understanding of the data through the lens of Gadamer’s philosophy.

Findings: Analysis of the 16 interviews resulted in the emergence of four overarching themes: (1) experiencing emotional labour, with supporting subthemes of helplessness, dealing with unanticipated or sudden deaths, feeling sad, feeling guilty and inadequate support at work; (2) barriers to providing optimal EOL care, with supporting subthemes of knowledge of symptom control, misconceptions of palliative care, conflicts of interest among healthcare professionals, switching roles and staffing constraints; (3) transforming and understanding EOL care, with supporting subthemes of building connections, providing support to patient and families and fulfilling wishes; and (4) ways of managing care effectively, with supporting subthemes of open communication, working as a team, palliative team support, addressing training needs and personal coping.

Conclusion: This study provided an in-depth understanding of the everyday care practices and experiences of nurse participants caring for dying patients in the context of the multicultural Singaporean society. This study also highlights the tenets of Gadamer, who promoted the exploration of knowledge from a range of vantage points. Adversities associated with caring for dying patients meant that nurse participants developed resilience, which contributed to their professional and personal growth. The findings have significant implications for EOL nursing education, nursing practice, health policy and future research on EOL care in acute care settings in Singapore. These recommendations provide a strategic focus for how to improve EOL care practices along the care continuum.

Keywords: registered nurses' experiences, end-of-life care, acute care setting, Singapore

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Associate Professor Ann Harrington