THE LIMITS OF SUFFERING - CRITICAL CARE NURSES VIEWS OF HOSPITAL-CAREAT THE END OF LIFE

This study explores critical care nurses' beliefs, motivations, and ex periences regarding end of life care. We performed a content analysis of the text comments provided by 468 U.S. critical care nurses in resp onse to an anonymous mail survey about euthanasia. These comments reve al that these U.S. critical care nurses' feelings about issues surroun ding the end of life are extremely complex. Eight themes emerged from 37 coded concepts, and the median number of themes volunteered per nur se was three. Among the most prevalent themes were patient concerns (5 3%), family concerns (33%), clinical circumstances (42%), the nurses' personal concerns (38%), and external or structural issues (68%). A pr ofound sense of compassion and often conflicting forces were noted wit hin and across themes. The nurses' comments offer a unique perspective on the care of critically ill patients and reveal much about that car e that should be improved. In particular, (1) some nurses are frustrat ed about their limited role in the management of patients at the end o f life, given their special understanding of these patients' experienc es and wishes; (2) considerable confusion remains about the most appro priate way to care for these patients; and (3) the environment of some critical care settings may be unable to foster the compassion that ma ny patients need. (C) 1997 Elsevier Science Ltd.