Experiences of Post Anaesthetic Unit Recovery Nurse facilitating Advanced Directives in the immediate postanaesthetic
Majella McKinnon1, Frank Donnelly1, Josephine Perry1
1Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia.
Aims:
The aims of this study were to develop an understanding of the lived experience of the Post Anaesthetic Unit Recovery Nurse facilitating Advanced Directives and implications for patient-centred care.
Design:
Interpretive phenomenological analysis.
Methods:
Homogenized purposive sampling of six Registered Nurses using in-depth semi-structured interviews. Interviews were conducted between June-July 2018. Analysis was performed using interpretive phenomenology analysis.
Results:
Post Anaesthetic Recovery Nurses experienced a 'Grey Zone' when facilitating Advanced Directives postanaesthetic. The 'Grey Zone' is defined through four themes; The 'Trigger' of the anaesthetic characterized by physiological instability; 'Confusion and Frustration' featuring balancing of roles as a clinician and advocate during patient decline; 'Consistent Paternalism' by medical staff in the consideration of Advanced Directives; and 'Disempowerment' where nurses faced issues of advocacy, personal distress, a lack of literature or protocols, and handover of information.
Conclusion:
The lived experience of nurses facilitating Advanced Directives postanaesthetic may be distressing. Further research is required to understand the implications of Advanced Directives following an anaesthetic. Education and development of protocols are recommended to optimize patient-centred care.
Impact:
Post Anaesthetic Unit Recovery Nurses experienced a 'Grey Zone' when facilitating Advanced Directives, defined through four themes. Advanced Directives may appear to be clear, however, the anaesthetic may trigger physiological instability leading to confusion and frustration in interpretation and application of Advanced Directives. Confusion and Frustration were experienced while the attitudes of Consistent Paternalism were encountered when advocating for patient wishes, resulting in Disempowerment. Post Anaesthetic Unit Recovery Nurses may become empowered through acknowledging and describing the 'Grey Zone'.
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