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Being on the Frontline

Nurses' Experiences Providing End-of-Life Care to Adults With Hematologic Malignancies

Grech, Antonia MSc; Depares, Joanna PhD; Scerri, Josianne PhD

Journal of Hospice & Palliative Nursing: June 2018 - Volume 20 - Issue 3 - p 237–244
doi: 10.1097/NJH.0000000000000433
Feature Articles

The aim of this study was to explore the experiences of nurses providing end-of-life care to patients with hematologic malignancies, in a hematology oncology setting, in an acute general hospital. A qualitative hermeneutic phenomenological design was used, and 2 sets of semistructured interviews were conducted with 5 female nurses. The transcribed texts were analyzed using Interpretative Phenomenological Analysis. Two main themes emerged: “battling against medical futility” and “struggling with the emotional burden of care.” Nurses perceived that the transfer of these patients at end of life to intensive critical care settings, coupled with the particularly aggressive treatments and corresponding symptom burden, prevented them from experiencing a dignified death. Consequently, nurses struggled with a gamut of emotions that included feelings of helplessness, distress, and compassion fatigue. Providing nursing care at end of life was perceived to be particularly challenging with the younger patients or with those who reminded them of family members. The findings highlight the unique challenges experienced by these nurses and the need to support them in their work with patients having hematologic malignancies at end of life within a well-resourced setting.

Antonia Grech, MSc, is senior nursing manager, Sir Anthony Mamo Oncology Centre, Malta.

Joanna Depares, PhD, is lecturer, Department of Nursing, Faculty of Health Sciences, University of Malta.

Josianne Scerri, PhD, is head, Department of Mental Health, Faculty of Health Sciences, University of Malta.

Address correspondence to Antonia Grech, MSc, Sir Anthony Mamo Oncology Centre, Mater Dei Hospital, MSD 2090 (

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.