End -of -life transition experiences of ICU nurses: Mindful realization

Despite significant advances and efforts over the last two decades in the management of end-of-life care and prognostication of death, experiences of dying in the Intensive Care Unit (ICU) have not improved. Current ICU end-of-life care often lags behind human compassion that enhances well-being, provides comfort, and relieves suffering during the dying process. The purpose of this study was to understand the perceptions and meanings constructed by ICU nurses who have experienced the realization that restorative care (life-sustaining therapies) is failing and the patient is actively dying.;Qualitative descriptive methodology informed by van Manen's hermeneutic phenomenology and directed by Colaizzi's analytic approach guided the research process. A purposeful sampling strategy was used to select ten nurses who currently worked in ICU and had cared for adult dying patients. In-depth non-structured phenomenological interviews were used to generate data. Interviews were audiotaped, transcribed, and all identifiers removed.;Phenomenological analysis led to identification of significant statements and formulated meanings that revealed themes across all interviews. The common themes were: Recognition of Dying, Timing, Emotional Manifestations, and Humanistic Transition. Significant statements, formulated meanings, and themes were integrated into a narrative exhaustive description that was distilled down to identify the fundamental structure of "Mindful Realization with a Desire to Share" the big picture.;Mindful realization is an essential skill to facilitate awareness of dying patterns. In this study, "Mindful Realization" of the big picture offered a link that illuminated the ability to assess and evaluate whether the patient was dying, while being sensitive to patient suffering. Once the nurses came to "Mindful Realization", they had "a Desire to Share" that insight with the others in hopes of improving the quality of the dying process for the patient and family.;This study is significant for providing insight into understanding "Mindful Realization" of ICU nurses caring for patients who were transitioning from a restorative state into active dying and has immediate application and translation into clinical practice. This study can serve as the foundation for improving end-of-life experiences within the ICU environment.