Nurses’ experiences of futile care in patients with advanced illness in the surgical setting

Abstract

Background: A universal definition of futile care is yet to be achieved, although there is a general consensus that it is the provision of care or treatment that is not expected to improve the patients’ medical condition. Apart from costing millions of healthcare funds worldwide, the delivery of futile care results in physical, emotional and ethical challenges for nurses. Regardless of the emerging body of literature on futile care, few studies focus on nurses’ experiences of futile care in patients with advanced illness in the surgical setting. Objective: The overall aim of this study is to explore nurses’ experiences on the provision of futile care to patients with advanced illness in the surgical setting. The objectives address nurses’ understanding of futile care, an examination of how futility affects these nurses and their care provision and the coping strategies that they adopt. Design: Phenomenology was used to inform methodology, using Interpretative Phenomenological Analysis (IPA) principles. Setting: Surgical wards in the local acute general hospital. Participants: Seven nurses working in the surgical setting. Methodology:Purposeful sampling was used to recruit participants. Participants took part in semi-structured interviews between October 2022 and January 2023. The data was transcribed ad verbum and analysed using IPA. Results: Three super-ordinate themes and associated sub-themes emerged in relation to experiences of the nurses. The themes are: (1) Experiencing futility (2) Feeling controlled (3) The Patient and Family. Conclusion: The findings show that participants experience physical, emotional and ethical challenges in their daily work when exposed to futile care, as they maintained that these interventions only served to prolong patients’ suffering, affect patients’ dignity and resulted in waste of resources. The participants feel demotivated when ordered to perform futile duties and bemoaned the lack of hospital policies on futile care. Furthermore, whilst the family is considered by the participants as an important form of support to the patient, false hopes or unrealistic expectations on their part, could result in the provision of futile care. This study has provided knowledge in relation to what nurses are experiencing when exposed to the futile care of patients with advanced illness in the surgical setting. Implications for clinical practice and management, education and training, and further research are included.