Perceptions of dying well and distressing death by acute care nurses

- Death may be sudden and unexpected for the patient and family and, in some cases, for the nurses and other staff.
- Continuing the work at hand, rather than acknowledging the distress of the nurses is a barrier to good end of life care.
- Dying well was described as comfort/pain control, loved ones at bedside, maintenance of dignity, and respect for wishes.
- Promotion of dying well includes education about death, end of life symptoms, what to expect, and advance directives.
- Nurses experience distress caring for dying patients and need to identify personal coping strategies to reduce stress.

AimThis study aims to identify perceptions of nurses practicing in four adult inpatient units regarding their actions to provide quality end of life care for dying patients, their definitions of dying well, and their symptoms of distress and actions they took for relief.BackgroundNurses caring for patients who are dying want them to have the best death possible; however, many nurses are not prepared for every death which may occur.MethodsQualitative questionnaire data were collected from 49 nurses on four adult inpatient nursing units to analyze nurse perceptions of distressing death and dying well.ResultsThree main concepts emerged describing the nurses' definition of dying well: emotional and spiritual support for the patient and family, patient and family control, and promotion of a peaceful environment. Eight categories of nursing actions to promote dying well were identified, which include communication with disciplinary team/nursing staff, provision of optimal physical care, demonstration of caring and compassion, supporting dignity in death for patient/family, education of patient/family to support dying well, emotional support for patient/family, advocacy for dying well, and fostering a peaceful environment. Symptoms of distress among nurses, and actions for relief were also indicated by participants.ConclusionFuture research is indicated to expand the sample to more hospitals and more disciplines. Administrators need to enhance their policies such as event debriefing or shifting workloads to support nurses caring for dying patients. They also need to offer nurses education in providing end of life care and how to become more resilient in the face of trauma. Nurses need to be aware of their symptoms and practices to relieve their stress such as crisis debriefing. They also need to seek education on how to educate patients and families about the process of dying and the value of comfort care.