5.3 EXPERIENCES OF CARING IN THE CONTEXT OF PALLIATIVE CARE
5.3.4 CONTRIBUTIONS OF THE CURRENT STUDY TO SCIENTIFIC
5.3.4.2 What this study adds to the body of knowledge
125 issues such as staff shortages and limited resources as hindrances to rendering nursing care.
Mechanism of coping in the context of caring for terminally ill patients:
HIV/AIDS suffering and death is particularly taxing and draining for the care- givers (Smit 2005). In a study by van Rooyen et al, (2009) the nurses adopted faith and prayer as coping mechanisms, and humor was identified as assisting coping in the care of terminal patients (Munro and Edward, 2008; Mulaudzi et al, 2011). Despite the challenges associated with palliative care in the care for terminally ill patients, the nurses in the current study identified meaningful coping strategies such as prayer and humor as having helped them to maintain meaning in their lives, prevent burnout from emotional stress and care for patients suffering from AIDS.
Accepting death related to HIV/AID as reality:
A study by van Rooyen et al, 2009 found that the nurses who resorted to an attitude of acceptance and care for patients in their terminal stages was a form of rationalization, as they could not run-away from patient care. Likewise, in this study, the nurses identified that in order to survive working in the palliative wards and cope with the high volume of suffering and death that they are continually exposed to, they had to change their mind-sets and accept that death is a reality of life.
126 1. Terminal illness requires long-term care:
It was noted that the patients who complied with the nurse’s educational interventions focusing on the benefits of the antiretroviral treatment and the dangers of not adhering to their treatment regimens experienced life-style changes, recovery and discharge from hospital, while those who refused to comply died as a result. Although AIDS is terminal, in the sense that there is no cure, the life-span of the patients can be prolonged through ARTS and emotional support.
2. Terminal Illness requires care so that patients die peacefully with dignity:
In the literature review, ways of assisting with dying are associated with euthanasia. In this study however, the nurses assisted their terminally ill patients to die by simply helping them to retain their dignity, keeping them as comfortable and peaceful as possible and through pain control.
3. Terminal Illness as an opportunity for new learning:
Apart from the curriculum provisions with HIV/AIDS basic information, the exposure to the care of terminally ill patients equipped the nurses with job- specific training, to address specific patient-driven needs, e.g. through bereavement and counseling courses.
4. Terminal illness raises consciousness on HIV/AIDS:
The nurses became conscious of the reality of their own mortality through their exposure to and care for the terminal patients with AIDS in palliative care context.
127 5. Experiences of nurses caring in palliative settings:
5.1 Social networking:
The nurses recognized that effective palliative care required a broad inter- disciplinary approach in order to maintain collaborative communication between the patients and the palliative care team to improve the quality outcomes for the terminal patients with AIDS.
5.2 HIV described “just as another condition”
Although Masur and Bethesda (2009) confirmed that most patients admitted into patients’ care units have HIV or need AIDS related treatments due to HIV/AIDS being the underlying cause, thus warning clinicians to be vigilant in their assessments of patients, the nurses in the current study perceived patients with TB and Pneumonia as synonymous to HIV/AIDS, as all patients received antiretroviral treatment. The nurses highlighted the description of HIV as “just as another condition” as a hindrance that alters their level of caring as it was perceived as monotonous care and limiting their academic progress due to lack of diversity.
5.3 Antecedents that lower levels of care:
In the current study, the participants highlighted that the fact that nurses may have internalized emotional issues, such as experiences of violence, abuse and personal infection with HIV, which would hinder their ability to provide quality care, and suggested that particular focus needs to be drawn on meeting not only the external organizational issues, but also the individualized
128 needs of the nurses with a view to promoting caring attitudes for terminally ill patients with AIDS.
5.4 Comparing oncology and palliative care units
Findings from various studies have revealed that caring for cancer patients is comparable to caring for AIDS patients in many respects. According to Bernard et al, (2001) and Lange et al, (2008), who conducted research in oncology units, registered nurses who have had longer exposure to the care of dying patients have more positive attitudes toward caring for dying patients than the younger nurses with limited exposure. Similarly, Mulaudzi, et al, (2011), in the context of caring for terminally ill patients, stated that nurses with over ten years of experience had more positive attitudes than those with less than ten years. In the current study, all the nurses, regardless of their age, had more than one year of experience in a palliative care setting of patients with AIDS and expressed positive attitudes towards death, seeing it as a preparation for a happy after life. The nurses’ experiences with respect to death were also similar. Nurses caring for both cancer patients and AIDS patients experienced feelings of sadness or helplessness due to their inability to assist the dying patients (Bernard et al, 2001; Smit, 2005), respectively. The current study showed that although nurses adopted a strategy to accept death as a reality of life, there were times when they became overwhelmed with the effects of caring for the terminally ill, particularly if they died prematurely or died very young.
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