Witnessing tragedy: nurses' perceptions of caring for patients with cancer

This paper details one of the findings of a large phenomenological study into the effects of nurse-patient encounters on clinical learning and practice. Every nurse faces the challenge of caring for a patient with cancer at some point in his or her nursing career. The participants, 392 nurses, were asked to discuss a care episode from their practice and the impact this encounter had on clinical learning and practice. The data collection method was by way of a written narrative/clinical exemplar. Meaning units and themes were identified using the Nvivo computer program. The procedural method of Giorgi was followed in all phases of analysis. The participants provided a detached description of the patients' diagnoses but tended to become emotive when discussing the cancer treatment experience. Nurses detailed care episodes with insight and understanding of the consequences of cancer for the patient. Nurses used powerful language to illustrate the enormity of the cancer experience for the patient and family. Although the nurses recognized the emotional impact themselves, they attempted to understate it. Participants spoke of their frustration and their sadness when describing the nurse-patient encounters. The life-threatening potential of cancer for the patient and the perception of potential or actual suffering do impact on nurses, their learning and their clinical practice. This is particularly evident when the cancer experience for the patient is not predictable. Participants clearly felt the influence of patients' cancer experience, personally and professionally. Participants detailed learning from the encounters and reflected with great insight on themselves and their practice. Identifying the learning potential of nurse-patient encounters can contribute to change in clinical practice.