Registered Nurses' experiences of End-of-Life (EOL) care in the acute setting in Singapore

Abstract

Background: Singapore is a multi-cultural society and has a resident population of 5.3 million people, 3.8 million citizens who are permanent residents and 1.5 million non-residents. Generally, the health of Singaporeans has been good. However, it is estimated 65% of the population spend time in hospital in their final year of life and about 61% die in hospitals. A review of the literature highlighted that EOL care can be stressful and the complexity surrounding death and dying can cause emotional and psychological distress to nurses. There is also a dearth of qualitative studies on nurses' EOL care practices and experiences within the context of acute care. Given the paucity of studies in the local and acute care context there is a need to understand Registered Nurses care practices and experiences on EOL care in acute hospitals. Aim: The primary aim of this study is to understand the EOL care practices and experiences among the Registered Nurses working in acute hospitals in Singapore. Methodology: The Hermeneutic Phenomenology underpinning Hans-George Gadamer's philosophy guided this study. Data was collected on 16 Registered Nurses using the purposeful sampling method following ethics approval. Data was collected over a period of eight months using semi-structured interviews. Each interview lasted for 45 minutes. Fleming's et al 2003 five stages of analysis were used as they were able to retain the philosophical underpinnings of Gadamer who does not offer a framework of analysis. Findings: Three themes emerged from the analysis of each interview. They were confronting challenges; understanding EOL care; and managing care effectively. Confronting challenges supporting sub-themes were (i)experiencing emotional labour; and (ii) barriers to providing palliative care. Understanding EOL care and its supporting sub-themes were (i) building connections; (ii) providing support to patients and family; and (iii) fulfilling wishes. Managing care effectively and its supporting themes were (i) open communication; (ii) working as a team; (iii) palliative team support; (iv) addressing training needs; and (v) personal coping. Conclusion: This study has led to an in-depth understanding of care practices and experiences of Registered Nurses in the context of an acute care setting in Singapore. The findings identified the need for continuous Education in End-of-Life and Palliative Care for Registered Nurses in acute hospitals. There is also a need to have a strong support system to address the physical and mental well-being of all registered nurses caring for the dying in the acute care settings. The findings also suggest there is a need to shift the misconception and continuously educate the family and patients about the principles of palliative care.