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Guiding the Process of Dying

The Personal Impact on Nurses

White, Dianne MS, RN; Meeker, Mary Ann DNS, RN, CHPN

Journal of Hospice & Palliative Nursing: October 2019 - Volume 21 - Issue 5 - p 390–396
doi: 10.1097/NJH.0000000000000539
Feature Articles

Some of the most ethically challenging and emotionally demanding aspects of nursing occur in caring for patients and their family at the end of life. The aims of this study were to examine the views of acute care nurses caring for patients during transition to comfort care, to describe the personal impact on nurses, and to identify nurses’ strategies for self-support and development of competence. Using a qualitative descriptive approach, we analyzed data from 26 semistructured interviews.

Nurses experienced moral distress in situations of continuing treatment when a cure was unlikely. In managing symptoms for patients, they struggled to foster an often-tenuous balance of patient comfort and calm without oversedation. They struggled to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care. Nurses reflected on their fears as new nurses caring for end-of-life patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them.

Nurses navigated challenges through support from nurse colleagues and effective leaders. They appealed to administrators to attend to care concerns arising from time-intensive nature of care. Mentoring and education facilitated assimilation to comfort-care nursing for novice nurses.

Dianne White, MS, RN, is PhD student, School of Nursing, University at Buffalo, New York; and assistant professor, Empire State College School of Nursing, State University of New York, Saratoga Springs.

Mary Ann Meeker, DNS, RN, CHPN, is associate professor and assistant dean for PhD program, University at Buffalo, School of Nursing, New York.

This project was made possible through funding provided by the Institute for Person Centered Care at the University at Buffalo.

Address correspondence to Dianne White, MS, RN, Empire State College, State University of New York, 113 West Ave, Saratoga Springs, NY 12866 (

The authors have no conflicts of interest to disclose.

Online date: March 27, 2019

© 2019 by The Hospice and Palliative Nurses Association.