This is the second of two entries from Carsten Juul Jenson, a colleague from Denmark, who is undertaking a PhD in self-blame among nurses.
In my PhD thesis, I employed institutional ethnography (IE) with participant observations, interviews and analysis of political documents to inquire newly qualified nurses’ (NQN) work at death and with dying patients in medical units. NQNs who are unfamiliar working with death and dying may consider themselves as failed nurses (murderers) if patients die; death could be perceived as a mistake. In patient safety hospitals, the political goals of quality improvements are related to health, survival and hardworking productivity. Though, as I emphasize below “is isn’t your fault”, NQN cannot be found guilty of the deaths of older acute ill patients with comorbidities in the medical unit in which they work.
One NQN, Anja raises her voice: “I, am afraid of killing patients” and Martha said: “I do kill the patients”, which I present in a poetic representation with inspiration from critical feminism. It is Martha’s first week in a medical unit, which starts on the first day of Martha’s employment. I followed Martha in the morning round to check patients’ health conditions:
Ole, Christian, Hans, Christa and Andrew die.
No, it can´t be true?
Look at Carsten who looks back at Ole.
Carsten says: “I think he is….”
I have to go in there. He isn’t breathing.
I just have to look at my notes – he is not supposed to be resuscitated
I have to learn it
I have to feel what his skin feels like
He´s cold, but not that cold.
His skin feels weird but not as spooky as I had imagined
Christian died today too
I almost cried because his daughter cried
Hans died on Tuesday
Christa died on Wednesday
Andrew died on Friday
I was able to manage the first one, but enough is enough
No, I´m not allowed to cry
Nurses don’t cry
I can’t help it – my eyes get filled with tears
I DO KILL THEM
Most activities in hospitals including medical rehabilitation units, health promotion, resuscitation and identification of critical illness use various “early warning” tools. The clinical guideline for these activities no longer apply if patients are incurably ill, although, as Rebecca says: “I would rather not give her the death blow,” when she must give an incurably ill woman morphine.