title: Perceptions of dying well and distressing death by acute care nurses.
abstract: This 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.
  
  
  
  Nurses 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.
  
  
  
  Qualitative questionnaire data were collected from 49 nurses on four adult inpatient nursing units to analyze nurse perceptions of distressing death and dying well.
  
  
  
  Three 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.
  
  
  
  Future 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.
authors.affiliation: Carolinas HealthCare System, Office of Clinical and Translational Research, 1540 Garden Terrace, Suite 502, Charlotte, NC 28203, United States. Electronic address: Christine.becker@carolinashealthcare.org.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Becker
authors.affiliation: Carolinas HealthCare System, Carolinas Medical Center - University, 8800 North Tryon, Charlotte, NC 28262, United States. Electronic address: Greg.wright@carolinashealthcare.org.
authors.forename: Greg
authors.initials: G
authors.lastname: Wright
authors.affiliation: Carolinas HealthCare System, Carolinas Medical Center - University, 8800 North Tryon, Charlotte, NC 28262, United States. Electronic address: kristin.schmit@carolinashealthcare.org.
authors.forename: Kristen
authors.initials: K
authors.lastname: Schmit
mesh_terms: D000223:Adaptation, Psychological; D016223:Advance Directives; D001291:Attitude of Health Personnel; D006801:Humans; D009741:Nursing Staff, Hospital / Q000523:psychology*; D012297:Right to Die; D013315:Stress, Psychological; D013727:Terminal Care
keywords: Distressing death; Dying well; Nurse perceptions; Nursing stress