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Learning Objective #1: Describe and identify evidence for the state of the science on improving end-of-life care.

Learning Objective #2: Apply the five-point framework for authentic being-with dying to evaluate personal obstacles and openings toward better being-with dying.

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National studies and scholarly literature show that health professionals need to act more thoughtfully and tactfully in end-of-life encounters, and that we have not yet got a hold of the basic constitution of quality end-of-life care. This study explicated tacit knowledge and documented insights imbedded in the practice of nurses who are experienced in being-with dying. Being-with is defined as how nurses who attend to dying are as they be-with dying (what they say and do, and how they are present). Heideggerian philosophy articulates an ontological (what is deeper within) understanding of being-with that can inform ontic (day to day) end-of-life caring practices. Phenomenology as the philosophical framework and hermeneutics as the interpretive approach makes it possible to get to the root of conceptions that render being visible. How participants are when being-with dying and how their approach may have helped persons transition with dignity and peace, from dying to death is revealed in the narratives. The patterns were: (a) Accepting death as a condition of authentic being-toward death, (b) Personal experience enables connecting-with, (c) A clear, calm, open, unknowing and knowing state of mind as a condition of authentic being- toward- death, (d) Being-with as calling forth what another knows and (e) Being-with as situating and regulating interpersonal space. These patterns are not experienced or expressed linearly but holistically and woven together in a presence (being-with). A five point framework of factors toward authentic being-with dying offers a way to understand how good end-of-life care can happen. While we can use the framework to examine any relationship, encounter; it is enough for now, that it inform us of what changes are needed in personal and professional practice to support patients and families in end-of-life care, and to portray tenants of a newly understood model for authentic being-with dying.