The personal transitioning of emergency room nurses when care changes from curative to end-of-life: The rural influence

• Main Author: Rolland, Roberta Ann
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2014
• Subjects: Health care management; Health education; Nursing
• ISBN: 9781321091953; 1321091958

With the advances in technology and medicine, we are seeing more aggressive efforts and extreme measures to treat the gravely ill and severely injured. When curative efforts are exhausted and the focus of care changes to end-of-life; the nurse's focus must change as well. The nurse's role with aggressive curative efforts may involve an intense clinical focus; while end-of-life care may entail an intense psychosocial focus. Emergency room (ER) nurses commonly experience these two intense foci of care back to back. Rural ER nurses face unique obstacles with limited resources. Understanding the experiences of rural ER nurses will help in developing support for nurses caring for patients and families at end-of-life. This study explored the personal transitioning of ER nurses when the focus of care changes from curative to end-of-life. Further, rural influences on this transition were examined. Grounded theory method was used involving semi-structured interviews with rural and urban ER nurses (N = 10). Urban nurses (n = 4) were included as a contrasting group. Twenty-nine concepts emerged and were arranged in five categories: preparing caring, immersion, making sense, changing gears, and reflecting. A matrix was created using three sub-processes: focus, feelings, and conflict. The core category, caring driven – where the needs are, was identified and a model was created. Both rural and urban ER nurses related to the model and moved through the categories in a forward sequence. Differences were found among the two groups with the sub-process of conflict. Staff resources and connectedness had a greater effect on the transitioning of ER nurses. Knowledge and experience affected both groups. Implications for nursing include strategies to improve staff resources, end-of-life education, and personal support.