Table 1.
Selection process: articles were chosen for review through database searches from the past five years (July 2009-July 2014) and screened based on relevance of article title and abstract to the review topic. Two reviewers examined full-text articles to confirm inclusion for qualitative analysis.
| Author | Design/Sample/Measures | Results | Existential Themes |
|---|---|---|---|
| Gama et al (2014)(6) | A descriptive and correlational study; 360 nurses from the internal medicine, oncology, hematology and palliative care departments of five hospitals in the Lisbon area; socio-demographic and professional questionnaire, Maslach Burnout Inventory, Death Attitude Profile Scale, Purpose in Life Test and Adult Attachment Stale | No significant differences were found between medical departments in burnout scores. However, when compared to palliative care, the palliative care department which showed significant lesser levels of emotional exhaustion (t ¼ 2.71, p< .008) and depersonalization (t ¼ 3.07; p < .003) and higher levels of personal accomplishment |t ¼ 2.24; p < .027). | Palliative care nurses report purpose in life, personal accomplishment; burnout risk |
| Potash et al (2014)(7) | Quasi-experimental design; 69 participants enrolled in a 6-week, 18-hour art-therapy-based supervision group, 63 enrolled in a 3-day. 18-hour standard skills-based supervision group (n= 132) in Hong Kong; Maslach Burnout Inventory-General Survey, Five Facet Mindfulness Questionnaire, Death Attitude Profile-Revised | The art-therapy supervision based group saw significant reductions in exhaustion and death anxiety and significant increases in emotional awareness. | Emotion-focused coping; meaning-making through reflection |
| Peters-et el (2013)(8) | A review of 15 quantitative studies between 1990 and 2012 exploring nurses’ attitudes toward death | Three key themes identified were: level of death anxiety among nurses, death anxiety and attitudes towards caring for the dying, and importance of death education for performing such emotional work. Results indicated that the level of death anxiety for nurses working in general, oncology, renal, and hospice care hospitals or in community services was not high. In most cases, attitudes toward death significantly and inversely correlated to attitudes toward caring for dying patients. Younger nurses consistently demonstrated greater fear of death and more negative attitudes towards end-of-life patient care. | Death anxiety, importance of death education |
| Kutner & Kilbourn (2009)(9) | literature review, 103 articles cited | Review explores symptoms of grief in professional caregivers and potential impact of unexamined feelings on physician well-being and patient care. Reactions to patient deaths can lead to depersonalization, poor quality of care, and burnout, or conversely, professional fulfillment. Attention and educational efforts to promote communication skills, coping strategies, and personal reflection may help to address physician reactions to patient deaths. | Grief and emotional demands; burnout; importance of reflection and well-being |
| Fillion et al (2009)(11) | Randomized waiting-list group design; intervention group (n=56), waiting-list group (n=53) nurses in Canada; Job Diagnostic Survey, benefit finding instrument adaptation, Functional Assessment of Chronic illness Therapy, Shortened Profile of Mood States, ERI Questionnaire, Karasek’s Job Content Questionnaire, Nursing stress Scale, Johnson and Hall Scale, Organizational Policy, and Practices Scale, Intervention Satisfaction Questionaire | Nurses in the intervention group perceived more benefits to working in palliative care after the intervention and at follow up than the wait-list control nurses. Nurses reported satisfaction with the intervention content, but requested additional sessions and greater length of training. | Benefits of palliative care, intervention |
| Sinclair (2011)(12) | Semi-structured interviews and participant observation; n=6 leaders in palliative and hospice care, n=24 palliative and hospice care professionals in Canada | Authors found eleven specific themes, organized within three overarching categories (past, present and future). Early life experiences with death were common among participants and influenced their career path. Participants reflected on their own mortality, were motivated to live life moment to moment and cultivated a sense of spirituality. Participants also developed wishes for how they themselves would like to die, reported increased acceptance toward death, and curiosity surrounding an afterlife. | Reflection; living in the present; death acceptance; after life |
| Melo & Oliver (2011)(13) | Mixed methods approach; 150 heath care workers in Portugal who care for the dying enrolled in a six-day training course (n=35 palliative care, n=65 other settings), 26 non-palliative care health care workers used as control group; Maslach Burnout Inventory, Psych Tests Aim Inc, Barrett-Lennard Relationship Inventory. questions by the author | Findings indicate that the course led to significant reduction in burnout levels and dearth anxiety. Correlations were found between personal sense of well-being and professional fulfillment, and between professional fulfillment and empathy, congruence, and unconditional acceptance of patients. | Burnout risks; importance of self-care, time for reflection, a nd personal well-being |
| Leung et al (2012)(14) | Five session Meaning Centered Intervention (2 groups of n=7 nurses) in Canada; semi-structured interviews pre- and post-intervention, Interpretive phenomenology analysis | Nurses reported greater meaning in dealing with suffering of their patients and were inspired to engage further with patients. Three themes emerged: attention to boundaries between personal and professional involvement, awareness of a shared mortality resulting in enhanced empathy, and ability to link patient suffering to meaning. | Meaning-making, shared mortality, intervention |
| DeArmond (2012)(15) | Psycho-biographical and hermeneutic methods; n =17 hospice workers in California | 88% of participants classified experiences as a chance to reflect and look inward, and demonstrated personal growth. Participants described changes in personality such as less fear of death, more compassion, and peace. | Reflection; newfound life perspective |
| Mak et al (2013)(16) | A qualitative interpretive descriptive methodology; 15 nurses in three acute medical wards in Hong Kong | The nurses experienced great mental and physical strain. Four themes were derived from the findings: lack of prepared ness for patients’ deaths, reflecting on their own nursing roles for dying patients, reflecting on the meaning of death and their personal experiences of the death of their own family members, and coping with caring for dying patients. | Helplessness and depersonalization due to patient deaths; newfound life perspective; importance of self-care |
| Breen et al (2014)(17) | Semi-structured interview; n=38 health care professionals working in cancer and palliative care in Western Australia | A qualitative grounded theory analysis showed four themes: (1) the role health professionals play in supporting people who are experiencing grief and loss issues in the context of cancer, (2) ways of working with cancer patients and their families, (3) loss and grief experiences specific to the cancer context, and (4) the emotional demands of the work and necessary self-care | Emotional demands; importance of self-care |
| Zambrano et al (2014](18) | Qualitative, open-ended interviews; n=7 palliative medicine specialists in Australia | The analysis of participants’ interviews demonstrated three themes: being with the dying, being affected by death and dying, and adjusting to the impact of death and dying. | Emotional demands; rewards of work; meaning-making; importance of self-care |
| Wu & Volker (2009)(19) | Qualitative, hermeneutic, phenomenological approach, interviews were audio taped and analyzed with Colaizzi’s guidelines; n=14 Taiwanese hospice nurses | Four main themes emerged: entering the hospice specialty, managing everyday work, living with the challenges, and reaping the rewards. The greatest distress came when nurses could not attain the goal of care. Most nurses stated they are now more open-minded, better able to put life’s challenges into perspective, and more focused on living in the present since working in hospice. Hospice care gives nurses an opportunity to reflect on their own philosophy of death and meaning in life. | Emotional distress; newfound life perspective; living in the present; reflection on death and personal meaning in life |
| Sliter et al (2014)(21) | Multi-time point survey; final sample consisted of 162 female Registered Nurses in a hospital or acute care setting in the United States; Death and Dying subscale of the Expanded Nurses Stressors Scale. Shirom-Melamed Burnout Measure, Utrecht Work Engagement Sale, Revised DA Scale | Trait death anxiety was associated with more burnout and less work engagement. The relationship between mortality cues (eg. dealing with injured and dying patients) and burnout was stronger for those higher in death anxiety. | Death anxiety, burnout risk |
| Strang et al (2014)(22) | Five group reflection sessions were recorded, transcribed and analyzed using qualitative content analysis; n= 98 nurses from hospital, hospice, and homecare teams in Sweden | Three domains emerged: content of existential conversations with patients, process of dealing with these conversations, and meaning of these conversations for nurses. Nurses reported feelings of burden, exhaustion, and feeling empty when the situation was hopeless. Nurses also reported greater appreciation for life and ability to put trivialities into perspective. | Emotional demands; burden; newfound life perspective; meaning in work |
| Seccareccia & Brown (2009)(23) | Qualitative method of phenomenology; n= 10 palliative care physicians in Toronto and Ontario | Participant; reported that spirituality influenced practice and practice influenced their spirituality. Participants described that caring for the dying shaped their own self-actualization and they shared a sense of awe for patients and families. | Spirituality; self-actualization |
| Fegg et al (2014)(24) | Cross-sectional survey; 140 health care professionals (HCPs) working in three palliative care units and three maternity wards in Munich Germany; sociodemographic data, Idler Index of Religiosity, Schwartz Value Survey, The Schedule for Meaning in Life Evaluation | No differences between the groups were found in overall Meaning in Life satisfaction scores. Palliative are HCPs were significantly more religious than Maternity ward HCPs; they listed spirituality and nature experience more often as areas that give them meaning. Also, hedonism was more important for Palliative care HCPs, and they had higher scores in openness-to-change values (stimulation and self-direction). | Palliative HCPs endorse creativity, experiential, and attitudinal scources of meaning; highly spiritual |
| Peters et all (2013)(25) | Mixed methods design including questionnaire and interview; n=28 emergency dept nurses, n= 28 palliative care nurses in Melbourne, Australia.; demographics data, Death Attitude Profile-Revised Scale, Clinical Coping Skills Questionnaire-Peters | Nurses held low to moderate Fear of Death (44%)r Death Avoidance (34%), Escape Acceptance (47%), Approach Acceptance (59%) and moderate Death Anxiety (53%). Emergency nurses reported higher death avoidance and significantly lower coping stills than palliative care nurses. Both reported high acceptance of the reality of death [Neutral Acceptance 82%), and stated they coped better with a patient who was dying than with the patient’s family. | Death anxiety; lower death avoidance in a culture where death and dying is expected |