4.2 RESEARCH FINDINGS ACCORDING TO CATEGORIES, THEMES AND SUB-
4.2.2 CATEGORY 2: EXPERIENCES OF CARING IN THE CONTEXT OF
4.2.2.3 THEME 3: MECHANISMS OF ADJUSTING WHILE CARING FOR
80 satisfied. If you just need money, money, money, you have lost the
concept of caring,” (Participant 1).
The third theme discusses the mechanisms used by nurses to adjust to caring for terminal patients in palliative care contexts and includes a sub-theme as illustrated below.
4.2.2.3 THEME 3: MECHANISMS OF ADJUSTING WHILE CARING FOR
81 Him… When you do so with your own strength, you cannot…”
(Participant 1).
As way of coping with the challenges of caring, I do what I would like done to me. So I care for my patients so they can feel cared for and loved. Eye for an eye, if I do good, some body, will do good for me,”
(laughing out loud), (Participant 6).
“….at the end of your nursing experience, you find that you need counseling yourself. We sometimes share with my staff, that it would be very helpful if there would be someone, sorely supporting the staff, so that we can cope with the situation because we are having a lot of experiences that are draining us. Sharing experiences of the day allows for psychological healing,” (Participant 3).
“There is a senior manager in my unit who always looks at negative side of things. Even when we have done the best we could, she comes in the unit and finds little and insignificant things that are not done, e.g. one bed that is not made properly, and makes a noise with such, like there is nothing else that was done well in the ward. We would appreciate a, “thank you for the good things we have done”.
So that we can be motivated to come to work the following day, and not discouraged by criticisms,” (Participant 4).
A sub-theme was identified within the theme of coping mechanisms as many of the nurses expanded specifically on how they coped with working with death on a regular basis. This is explained below:
Sub-theme 3.1: Accepting death as a reality of life
As with most other aspects of nursing, the nurse-patient relationship while caring for terminally ill patients is based on good collaboration with the patient. The participants, however, expressed that a good nurse-patient relationship posed difficulties for them as they develop these relationships in the full knowledge that their patients are likely to die. The nurses stated that the clinical conditions of terminally ill patients ultimately worsen and the awareness of death becomes a prominent feature in their lives, forcing them to change their goals and focus on specific end of life goals. This places a huge emotional burden on the nurses who
82 have become the confidants of their dying patients. It is therefore imperative that they have some kind of coping mechanism to relieve these emotional burdens.
The nurses explained that this necessitated a change of perception (paradigm shift) on their part and that they needed to recognize that death is a reality that is beyond their control, and understand the fact that HIV/ AIDS is a life threatening disease.
Some of the participants suggested that they needed to adapt to their circumstances and change their mind sets or perceptions in order to provide hopeful and realistic help to their terminally ill patients. This is illustrated in the abstracts as follows:
“We basically need to adapt to the reality of the situation of HIV/AIDS in-order to help the sick. The disease itself is reality and nothing can be changed as such. It’s me who has to change, and accept that patients with HIV/AIDS eventually have to die,” (Participant 2).
“We need to accept the reality of death, as a daily thing which I cannot change, especially patients who come gasping. Acceptance of the situation, and just to conform to the reality of our time, it’s the only way that helps me out,” (Participant 9).
Some nurses felt that exposure to death and dying provided them with opportunities to discover meaning in life through the lessons they learn from their patients, which helps them to become more spiritual and come to terms with their own mortality.
They noted, however, that it sometimes had negative effects, particularly on the younger nurses, whose behaviors demonstrated uncaring attitudes. One of the participants who had in the region of 20 years of experience or more in terminal care discussed the fact that death did not seem to have much impact on the younger nurses, sounding the warning that if they “seem to get used to deaths,” that they would end up being hard and lose respect for their patients. It became evident that
83 the attitude of “getting used to death” had serious consequences for the nurses as even their colleagues perceived them as failing to grieve over death. Another participant, with three years of experience, made a general comment that staff and relatives have become very blasé and insensitive about death, as seen by giggling, chatting and laughing while laying out the dead. These concerns are outlined in the following observations:
“The experience of death does not touch them (younger nurses) at all. Even when they are bringing the corpse to the mortuary, they talk something we never did. Exposure to the HIV/AIDS disease as well, makes some hard. They seem to be getting used to death such that it’s perceived as a routine (Banging with the fist on the table),”
(Participant 1).
“Routine death makes the relatives of patients or staff gets used to death; such that they don’t mourn. They take it (death) with the words, “Kade ngafelwa”, {I have long been experiencing losses}, no- wonder some nurses never show any sensitivity towards the dead, they chat, giggle or laugh as they layout, (Participant 9).