title: The unexpected force of acute stroke leading to patients' sudden death as described by nurses.
abstract: Stroke occurs suddenly and unexpectedly and its consequences can mean the difference between life and death. Research into stroke is extensive but largely focused on patients who survive. The aim of the study was to describe how nurses experience the patient's death and dying, when patients are afflicted by acute stroke and whose lives cannot be saved. The study had a descriptive design with a hermeneutical approach. Interviews were carried out with ten nurses in stroke units at three hospitals. Data were interpreted using hermeneutic textual interpretation based on Gadamer's philosophy. The study shows that sudden death, when unexpected forces intervene in the lives of patients afflicted by acute stroke, was described by the main theme sudden death - the unexpected force and the following three sub-themes: death comes unexpectedly and without warning to the patient; the relatives are at the mercy of the unexpected and the nurses find themselves in demanding situations. The new understanding emphasizes that the unexpected and demanding situations the nurses are put in can be understood as ethical dilemmas and value conflicts because they are not free to give their time to preserving the dying patient's dignity and are not able to give the good care they wish to. A more flexible organization could support the nurses in making use of the creative forces in the unexpected event which an acute stroke that leads to death constitutes.
authors.affiliation: The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Göteborg, Sweden. asa.rejno@hotmail.se
authors.forename: Åsa
authors.initials: Å
authors.lastname: Rejnö
authors.forename: Ella
authors.initials: E
authors.lastname: Danielson
authors.forename: Iréne
authors.initials: I
authors.lastname: von Post
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003645:Death, Sudden; D005260:Female; D006801:Humans; D009726:Nurses; D020521:Stroke / Q000401:mortality*