title: Existential encounters: nurses' descriptions of critical incidents in end-of-life cancer care.
abstract: Nurses working with cancer patients in end of life care need to be prepared to encounter patients' psychosocial and spiritual distress.
  
  
  OBJECTIVE
  The aim of this study was to describe nurses' experiences of existential situations when caring for patients severely affected by cancer.
  
  
  METHODS
  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.
authors.affiliation: School of Health and Education, University of Skövde, Sweden; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden. Electronic address: maria.brovall@ki.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Browall
authors.affiliation: University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Ingela
authors.initials: I
authors.lastname: Henoch
authors.affiliation: Mid Sweden University, Department of Nursing, 831 25 Östersund, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Melin-Johansson
authors.affiliation: University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden.
authors.forename: Susann
authors.initials: S
authors.lastname: Strang
authors.affiliation: University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden; Mid Sweden University, Department of Nursing, 831 25 Östersund, Sweden.
authors.forename: Ella
authors.initials: E
authors.lastname: Danielson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005086:Existentialism / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology*; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D029181:Spirituality; D013315:Stress, Psychological; D013548:Sweden; D013727:Terminal Care / Q000523:psychology*
keywords: Cancer; Critical incidents; End of life care; Existential encounters; Nurses' experiences