Review Of Related Literature

Swenson’s study showed that people with a fundamentalist religious

background were forward looking toward death, whereas those with little

religious activity were more likely to be evasive or avoid talking about the

subject. Swenson also found out that those in homes for the aged tended a

look forward to death, whereas those living alone or with a spouse evaded

the issue. More educated people tended to prepare for their own deaths

more fully. People in good health were more likely to evade the

consideration of death. (p.133, 1980)

Kubler-Ross identified stages of dying that support the statements of

Worcester and others. She also pointed out some of the differences between

dying in today’s world and dying some years ago (Kubler-Ross, 1970).

Formerly, people died in their own homes surrounded by their relatives,

friends, and familiar environment. Now, they are usually sent to hospital that

has much lifesaving equipment but offers little that is familiar or supportive

and much that is anxiety-provoking. As a result, dying can be a lonely and

sometimes a needlessly long, drawn-out process, which is “impersonalized,

dehumanized and mechanized” (Kubler-Ross, 1971).

Death is no longer recognized as a natural part of life process but, rather,

something to be avoided as long as possible. Hospitalization tends to

strengthen current taboos associated with death and dying. Death is seen by

health professionals as a failure to cure. Guilt makes them overprotective of

the dying patients. Relatives are kept at a distance and may find it difficult to

maintain closeness to their dying loved ones. Emotional expressions are

usually not encouraged because it might be disturbing to others in the

milieu. Opportunity to the health personnel to learn about death and become

comfortable with the experiences is curtailed, if not actually prohibited, in

most hospital environments. (pp 135-136. 1980)

The first perspective views the chronically ill person as a failure. This is

the patient who does not respond to the "miracle" of modern medicine, and

somehow the lack of recovery is often perceived as the patient's fault. This

attitude of blame accounts for some of the worst psychological abuses of

patients by health practitioners and caretakers, an attitude typified by the

too-frequently heard statement, "Stop complaining. You simply must adjust."

Unfortunately, the sick person may also adopt this punishing attitude toward

himself or herself. Sadly, the word "adjust" too often means "resign," "settle

for less than a desirable existence," and "surrender." At its worst, "adjust" is

just another way of saying "You are now a nonperson without the right to

experience strong passions, desires, or fierce and unyielding hope." All the

anger and blame inherent in this attitude is misdirected: the patient rather

than the disease becomes the target. (Internet Source, 1985)

The high level of care required by patients in the intensive care unit is

often felt to be in conflict with the goals of the patients who will die there.

Advance directives are frequently not in place to direct the care of the dying
patient. The highly technical curative culture of the ICU may negatively

impact the ability of patients and their families to make critical care

decisions. ICU nurses may feel inadequately prepared to care for dying

patients. Suggestions for improving the care delivered by nurses to dying

patients in the ICU are offered based on available research.

Caring for dying patients is often an uncomfortable situation for

nurses. Nurses tend to limit involvement with and actually withdraw from

dying patients, according to Quint. (as cited in Miller et al., 2001)

This happens for a variety of reasons ranging from lack of education to

the natural behavior that occurs in anxiety provoking situations. Nurses may

also feel a sense of frustration and powerlessness because of their inability

to change the ultimate outcome for the patient or the grief felt by the family.

(Chapple, 1999)

The reasons for this behavior in ICU nurses can be expanded to include

the curative goal of ICU care and the lack of empirical data to support how

care of the dying ICU patient can best be delivered (McClement & Degner,

1995).

The highly technical environment of the ICU may overwhelm the

senses of laypersons, causing them to feel more stressed and confused and

less able to make decisions. There is often a lack of communication between

the ICU medical staff, whose goal is to utilize technology for the cure of the
patient, and the patient’s family, whose goal is simply for their loved one to

return home to share life with them. When the patients and their families

are confused and conflicted, negative feelings may result. This may cause

families to respond with increased anxiety and decreased coping abilities.

The ICU nurse can have a positive impact by responding in a

compassionate manner that helps decrease the anxiety patients and families

might feel in this situation. Research into the care of patients who had

recently died in Canadian ICUs discovered the highest degree of satisfaction

among those surviving family members who felt health care providers had

treated them with compassion and care. The degree of compassion shown to

the family members of the dying patient was rated as more important even

than how the providers had treated the patient (Heyland, O’Callaghan, &

Cook, 2003).

Kalkman, Marion, R.N., M.D., et.al. New Dimensions in Mental Health-

Psychiatric Nursing. United States Of America: McGraw-Hill,Inc., 1980.

LeMaistre, JoAnn. After The Diagnosis. P.O. Box 4848, Dillon, CO 80435:

Alpine Guild, Inc., 1985.

McNutt, Stacey. The Influence of Nursing on End of Life Care in the Adult ICU:

How Nurses Can Act to Improve Care of Dying Patients and their Families.

Ferris State University, 2010.

Miller, P.A., Forbes, S., & Boyle, D.K. (2001, July). End-of-life care in the intensive care unit: A
challenge for nurses. American Journal of Critical Care. 10(4). Retrieved November 23, 2004
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Chapple, H., (1999). Changing the game in the intensive care unit: letting nature

take its course. Critical Care Nurse. 19(3), 25-34.

McClement, S.E., & Degner, L.F., (1995, Sept/Oct). Expert nursing behaviors in care of
the dying adult in the intensive care unit. Heart and Lung. 40, 408-419.

Heyland, D.K., O’Callaghan, C.J., & Cook, D.J. (2003, July). Dying in the ICU:

Perspectives of family members. Chest. 124(1), 392-397.