Abstract Objective: The purpose of this qualitative inquiry was to discover and describe the essence of the experiences of nurses with spirituality and end-of-life issues in an acute care setting. The individual nurse's definition of spirituality was also explored. The spiritual dimension of life integrates values and beliefs, and is fundamental to the way one thinks, acts and feels in health and illness. Research has shown spiritualty to be problematic in personal definition, literature and nursing practice. End-of-life care has also been found to be a disappointment for the general public. In advocating for the patient/family, nurses must communicate and coordinate holistic care at the end of life.
Design: The research was guided by the theory of Human Becoming, by Parse, as well as the phenomenology of practice as described by Max van Manen. Phenomenology was utilized to uncover meaning related to spirituality and end-of-life.
Population, Sample, Setting, Years: The population consisted of female nurses who were employed in the acute care setting (renal, oncology, and pulmonary)who did not have experience in hospice or palliative care. Intensity sampling was done to glean the end of life experiences of nurses' having direct contact with a patient presently or in the past. This involved inviting participants who have had experiences in direct patient care, who were suggested by others (nurse managers), and who had information-rich experiences that manifest the phenomenon. Eleven female nurses participated in the study during the fall of 1999.
Concept or Variables Studied Together: Spirituality and end-of-life issues.
Methods: Nurse managers met with the researcher to discuss the proposal. They received a packet to invite participants who had information-rich experiences. Names and telephone numbers of potential participants were forwarded to the researcher who then contacted them to discuss the research, invite them to participate and make an appointment for discussion. Discussions were recorded, transcribed and reviewed by the participant prior to analysis. The undisturbed reading and re-reading began with the intuiting, analyzing, and describing of the data in a simultaneous process to discover the essence of the phenomenon.
Findings: The analysis of the data created a framework that revealed the permeation of the concept of spirituality throughout the discussions related to end-of-life issues. Data was divided into three categories of past, present and future orientation. Past experiences contained two subcategories: personal experience and learning; present experinces contained four subcategories: engagement, introduction of end of life issues, environment and nursing action; and the third category,the future, concerned the self renewal activities of the nurse. Two models were presented. The first model depicted the intraexperience of the nurse's personal experience, with spirituality as the core of life radiating to all aspects of the nurse's life. The second model created a time framework to view the interexperience of the past, present and future orientations with the categories and subcategories experienced by the nurse within her universe.
Conclusions: The nurses perceive spirituality to be an integral part of life, affecting all decision making and necessary to find meaning and peace at the end-of-life for themselves and their patients/families. Spirituality continues to be a complex, individualized concept. Personal experiences with spirituality and end-of-life issues were incorporated into professional relationships and actions. Learning occured through life experiences and professional experiences not formal education. The hospital environment, policy, medical colleagues, and cultural perceptions affected the discussions and preparation of the patient. The variety of individual patient situations and families, along with the diversity of needs, make each encounter unique for decision making, creativity and compassion. Nursing actions expressed as spirituality in providing quality of life at the end of life were religious as well as existentially creative. Nurse participants recognized the role of renewal of self in coping with difficult experiences.
Implications: The results of this study provided knowledge that will facilitate a better understanding of what happens in conversations between the nurse and the patients/families concerning end-of-life issues and spirituality. Nurse educators will be able to use this information to revise present educational materials and to create better resources. Being the largest group of health care providers, nurses can take the lead in creating policies to enhance the quality of life at the end of life. Nurses need to be involved at the local, state, and national level within their professional organization, as well as the community.
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