UCLA

ABSTRACT OF THE DISSERTAION

Understanding the Process by Which Experienced Staff Nurses

Engage in Nursing Presence with Terminally Ill Patients

by

Mary Nugent Hersh

Doctor of Philosophy in Nursing

University of California, Los Angeles, 2015

Professor Sally Maliski, Chair

Modern healthcare threatens traditional nursing ethos by placing the relational aspects of nursing at risk. Staff nurses report decreased job satisfaction amid mounting tasks and sicker patients. Many leave nursing due to an inability to address patients' social, emotional and spiritual needs, which especially surface at end of life. Considering death is an inevitable, universal outcome and the frequency by which bedside nurses play central roles in patients' terminal care, the literature is stunningly void to describe how the nursing presence process unfolds with terminal, hospitalized patients.

Constructionist Grounded Theory formed the methodology guiding the study design and data analysis. Eleven staff nurses vividly recalled very meaningful interactions with dying patients; their detailed narratives yielded 17 memorable exchanges with end-of-life patients.

It was dying patients' vulnerability which triggered participants' awareness to assess patients' needs. Participants addressed these needs with a focused intentionality, spawned by participants' previous personal loss experiences or nurses' strong, professional beliefs. Many participants recalled making positive differences in previous patients' illness experiences and were determined to do so again. Participants acknowledged having little time in their nursing roles, yet also realized their dying patients' needed their time. Such divergent realities prompted the participants to prioritize time to address patients' end-of-life needs. Participants' determination to be of help, combined with their strategic use of time fostered meaningful nurse-patient interactions. These exchanges were punctuated by a range of courageous nursing actions intended to positively influence terminal patients' illness experiences. Participants candidly offered dying patients sage advice, some participants dauntlessly advocated for patients while other participants gently prepared patients for what was to come.

This research offers insight into ways bedside nurses continue to uphold traditional nursing ethos by safeguarding the relational aspects of nursing when caring for terminal hospitalized patients. Study findings reveal assorted ways determined staff nurses creatively use time, while also demonstrating a range of courageous nursing actions that resulted in very meaningful exchanges with dying patients.