Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

Abstract

a b s t r a c tNurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress. Aim: The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer. Methods and sample: Nurses (registered and enrolled) from three urban in-patient hospices, an oncology clinic and a surgery clinic and a palliative homecare team were, prior to the start of a training program, invited to write down their experiences of a critical incident (CI), in which existential issues were featured. Results: Eighty-eight CIs were written by 83 nurses. The CIs were analyzed with qualitative content analysis. Two main themes were found: Encounters with existential pain experiences, which concerned facing death and facing losses; and Encountering experiences of hope, which concerned balancing honesty, and desire to live. Conclusions: This study points out that health care professionals need to be aware of patients' feelings of abandonment in exposed situations such as patients' feelings of existential loneliness. That there are some patients that express a desire to die and this makes the nurses feel uncomfortable and difficult to confront these occurrences and its therefore important to listen to patients' stories, regardless of care organization, in order to gain access to patients' inner existential needs.

Desire for hastened death: how do professionals in specialized palliative care react?

“…On the other hand, failure to discuss a DHD may negatively impact a SPC-HP's effort to establish a relationship and consequently the ability to provide effective support, which is similar to Schwartz's findings [25]. Browall et al [24] also showed difficulties of nurses in caring for patients expressing a severe DHD. The results here showed that a possibility of overburdening due to emotional involvement [32], close relationships, or over-identification with patients exists.…”

Effect of the duration of hospice and palliative care on the quality of dying and death in patients with terminal cancer: A nationwide multicentre study

“…Patients and caregivers often express concerns regarding psychological and physical issues, and frequently talk about causes of distress (Clayton, Reblin, Carlisle, & Ellington, 2014 (Chochinov et al, 2009). Experienced healthcare professionals are needed to meet patients' existential and spiritual needs and so they can develop self-insight regarding the finality of life (Browall, Henoch, Melin-Johansson, Strang, & Danielson, 2014 (Yun et al, 2010). Experienced healthcare professionals are needed to meet patients' existential and spiritual needs and so they can develop self-insight regarding the finality of life (Browall, Henoch, Melin-Johansson, Strang, & Danielson, 2014 (Yun et al, 2010).…”

“…To meet patients' needs to express their existential concerns, healthcare professionals may develop a relationship of trust through effective communication skills (Johnston & Smith, 2006;Mok & Chiu, 2004). Experienced healthcare professionals are needed to meet patients' existential and spiritual needs and so they can develop self-insight regarding the finality of life (Browall, Henoch, Melin-Johansson, Strang, & Danielson, 2014). The availability of sufficient time can make it possible for healthcare professionals to better support terminally ill cancer patients, because they can use diverse methods to promote personal growth, thus helping them move towards greater existential certainty.…”

Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review

“…This is explored further in another paper by the same authors (Bailey et al, 2011a) who describe how care of the dying is seen by nurses themselves as a predominantly nursing role, implying that nurses who are 'good' at their job, and manage to develop emotional intelligence as above, find reward in their practice, leading to a more positive experience for all concerned. The idea that care of the dying is the province of nurses predominantly is borne out by other literature and could be explored further (Lopera Betancur, 2015, Browall et al, 2014, Gagnon and Duggleby, 2014, Smith, 2012.…”