Managing competing care demands in acute healthcare settings : lived experiences of nurses simultaneously providing acute care and end-of-life care

Abstract

Background: Nursing care plays a major role in the provision of end-of-life care for patients and their families (Noome et al., 2016). Studies have found that nurses face challenges when providing end-of-life care in acute settings (Oliveira et al., 2016; Adams et al., 2011; Hopkinson, Hallett & Luker, 2005). Hence, it should not be presumed that all nurses are sufficiently skilled to deliver end-of-life care (Bloomer et al., 2013). Although various barriers that cause these challenges have been identified in the provision of end-of-life nursing care (Bloomer et al., 2013), no study has explored how nurses simultaneously manage these challenges and meet, competing demands in this context. Therefore, exploring this dearth of research is vital in understanding how nurses negotiate care decisions between curative and end-of-life care patients in acute healthcare settings. This study intends to contribute to the existing body of knowledge of end-of-life care nursing and explore how nurses with these experiences navigated the demands. Method: A qualitative approach was identified to explore the research question and Interpretative Phenomenological Analysis (IPA) proposed by Smith, Flowers, and Larkin (2009), was selected as the research methodology. This methodology requires that the researcher acknowledges participant experiences in interpreting and understanding the phenomenon. Twelve (12) acute care nurses were interviewed using in-depth semi-structured interviews to engage in and capture their lived experiences. Results: Data from all twelve interviews were transcribed and the IPA of interview transcripts was completed. Three interpretative layers were identified as interwoven between the four superordinate themes. These interpretative layers were; (i) the actions of managing competing demands i.e. “the doing”, (ii) the effect of managing competing demands on the core of the nurses i.e. “the being”, (iii) and the interrelation of the above interpretative layers leading to the “recurrence” phase of managing competing demands. The four superordinate themes identified were; (i) problem-solving strategies, (ii) multidimensional coping, (iii) the “weight” endured and (iv) an attack of self. Conclusion: This study is still in progress and a definite conclusion has not been reached. It must, however, be noted that managing competing care demands requires a multi-layered and multidimensional approach for the patients as well as the acute care nurses providing dying care.