Purpose: The purpose of this research was to discover the essence and meaning of the lived experience of the hospice care nurse as primary provider of end-of-life care. Prior to this research, little was known about the hospice care nurses in the United States.
Philosophical Underpinning: This qualitative research was underpinned by constructivism and the philosophy of Husserl known as descriptive phenomenology.
Methods: Moustakas’ (1994) method was used to discover the lived experiences of 12 hospice care nurses who have at least 2 years of experience as the primary provider of end-of-life care. The semi-structured interviews were transcribed verbatim to capture the true essence and meaning of the hospice nurses experience providing care to patients and families daily.
Results: The four strong themes that emerged from this research are Feeling Attachment, Managing Workload, Lacking Support, and Providing Education. These themes clearly describe the essence and meaning of the lived experience of the hospice care nurses.
Conclusion: To this researcher’s knowledge, this is the first qualitative research about the lived experience of the hospice care nurse as primary provider of end-of-life care in the United States. The demand for productivity has stretched the hospice nurses to the brink of exhaustion. All of the hospice care nurses expressed the need for individual counseling and support. It is my hope that this research will draw attention to the dynamics surrounding hospice nursing and the educational needs of health care providers and the general population.
Implications for Nursing Practice and Policy Making: Although nursing is known as a “caring” profession, very little is done to make sure that the profession is supporting hospice nurses. Hospice organizations need to institute measures to ensure hospice nurse fulfillment and well-being. The role of the hospice care nurse is pivotal and must be investigated due to the demands of the aging population, along with cost containment and patient satisfaction. Attempts to keep profits high for the corporations has caused stress and anxiety for loyal hospice care nurses and other support staff who provide quality end-of-life care for patients and families. The need for hospice nurses will skyrocket with the aging of the baby boomer generation and multi-system health problems that contribute to the complexity of end-of-life care. Federal and state regulation requirements are demanding increased documentation and quality measures for every patient receiving hospice care. Federal and state lawmakers need to consider the ramifications of regulations on hospice staff nationwide. This research clearly shows the need for legislation regarding nurse-patient ratios in hospice care. “Despite rapid growth in the hospice industry, with concomitant increases in the hospice workforce, little is known about how satisfied hospice staff are with their jobs” (Casarett et al., 2011, p. 916). Globally, the World Health Organization (2014) gives a low-level estimate of 20 million people a year (including 6% children) who need end-of-life palliative care. Hospice organizations must understand the value of these nurses and how to maintain a viable workforce.
Implications for Nursing Research and Education: A gap in research was revealed about hospice care nurses in the United States. Investigation and identification of interventions that support hospice care nurses coping with death and dying on a daily basis is essential. In addition, research to understand diverse patient cultures and develop culturally competent information is needed to break down the barriers to hospice education. To improve patient care, the myths about death, dying, and medication need to be demystified through education at the community level. Research into the reluctance and resistance of physicians toward hospice is necessary to promote early referrals and quality end-of-life care. Hospice care nurses are needed locally and globally, and the dissemination of this study could influence funding resources for future research. This research may add to the body of nursing knowledge, improve working conditions for hospice nurses, and impact quality patient care.