Unexpected deaths in medical wards during night shifts: a narrative analysis of nursing experiences

To explore nurses' narratives of unexpected patient deaths during nightshifts.

Despite the importance of patient care and safety during the night, little attention has been paid to this issue in scientific literature. Very few studies have investigated the outcome of night-time nursing care in patients, and there is a distinct paucity of knowledge regarding the experiences of nurses who discover a patient who has died unexpectedly during a night shift.

A qualitative study design using semi-structured interviews, interpreted by a narrative inquiry methodology, was adopted.

A purposeful sample of 15 nurses working in Italian medical wards who had found a patient who had died unexpectedly during a night shift, and who had given their informed consent were interviewed in the period from 2009-2011. An inductive content analysis of the narrated experiences was performed.

A patient's unexpected death during a night shift is something that nurses fear, and when it occurs, the experience is remembered as a nightmare. From the narratives of the participant nurses, five categories described what happened at night when a patient who had died unexpectedly was discovered: (1) the night started by nurses selecting patients needing intensive surveillance; (2) patients were reprioritised for intensive surveillance; (3) nurses were deceived by apparently normal findings; (4) nurses realised the failure of their protective role; and (5) as a consequence, more intrusive surveillance measures were adopted after the event.

From the narratives, a number of failures in cumulative and individual surveillance occurred during the night when a patient died unexpectedly. The deaths were recognised late, causing intense pain in nurses; this experience affected the following night shifts, when the nurses' surveillance was more intensive, insistent and intrusive towards patients, even if this was unnecessary.

The continuing belief that the night shift is a time when fewer nurses are needed means that the number of registered nurses is reduced and reliance is placed on nursing aides instead, placing patients at risk by compromising the effectiveness of surveillance and the consequent clinical decisions made by nurses and physicians.