Review

General nurses’ experiences

of end-of-life care in the acute
hospital setting: a literature review
Roisin McCourt, John James Power, Marie Glackin

Aim
The aim of this literature review was to explore
Abstract and analyse the current literature in relation to
Approximately 90% of the UK population spend some time in
the experiences of general (adult-trained) nurses
hospital in their final year of life, and more than half of the population
providing end-of-life care to patients in the acute
die in hospital. This review aims to explore the experiences of general
hospital setting. The definition of ‘end-of-life
nurses when providing end-of-life care to patients in the acute
care’ presented by Watson et al (2009, xxvii) in
hospital setting. Nine studies were identified through a literature
the Oxford Handbook of Palliative Care was
search, and each was then analysed and evaluated until themes
chosen to direct this review:
emerged. Six themes were drawn from the literature: lack of
education and knowledge, lack of time with patients, barriers arising
‘... referring to the care of a person during the last
in the culture of the health-care setting, communication barriers,
part of their life [when] it has become clear that
symptom management, and nurses’ personal issues. The themes cause
the person is in a progressive state of decline.’
concern about the quality of end-of-life care being provided in the
acute care setting. The literature appears to be consistent in the view
that terminally ill patients are best cared for in specialised care
Review methodology
Literature search
settings, such as palliative care units and hospices. However, increasing
The purpose of a literature review is to evaluate
demands on health services will result in greater numbers of dying
the current theoretical and scientific knowledge
patients being admitted to the acute hospital setting. It is therefore
surrounding a particular issue, resulting in a
paramount that general nurses’ educational needs are met to ensure
synthesis of what is known and what remains
they develop clinical competence to provide high-quality holistic
unknown (Burns and Grove, 2007). It also
end-of-life care.
involves a systematic and critical appraisal of the
Key words: Acute hospital setting l Palliative care l Nurses’
most important and relevant literature on a topic
experiences l End-of-life care
(LoBiondo-Wood and Haber, 2010). A time frame
of 2000–12 was decided to ensure that only rele-
vant and up-to-date research would be included in

Roisin McCourt is
Staff Nurse, Royal
Berkshire Hospital,
England; John James
Power is Lecturer,
Queen’s University
Belfast; Marie Glackin
is Lecturer, School of
Nursing and Midwifery,
I
n the UK, it is estimated that 90% of the
population spend time in hospital in their
final year of life, and more than half of the
population die in hospital (National End of Life
Care Programme, 2010). While exploring chang-
ing time trends in relation to place of death in
England, Gao et al (2013) found that hospital
was the commonest place of death, with 48% of
people with cancer dying in hospital, 24.5%
dying at home, and 16.4% dying in hospices
from 1999 to 2010. It is therefore evident that all
nursing staff will be involved with end-of-life
care at some stage in their career, regardless of
the review. The following databases were searched
using terms developed from background reading:
CINHAL Plus, MEDLINE, Embase, and Web of
Science. Table 1 provides a summary of the search
results using different key terms. Cross-referencing
and searching for government publications were
conducted to obtain further articles pertaining to
nurses’ experiences of end-of-life care in acute
hospitals. None of the publications found by these
means were included in the review, but they were
used to provide further information and support.
Inclusion and exclusion criteria
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Queen’s University
Belfast, 97 Lisburn
Road, Belfast, BT9 7BL,
Northern Ireland
Correspondence to:
Marie Glackin
m.glackin@qub.ac.uk
their specialty or level of training. Research
conducted by McCaughan and Parahoo (2000),
however, suggests that nurses at ward level have
a substantial lack of knowledge in relation to
palliative care and end-of-life issues.
Strict inclusion and exclusion criteria enabled
more precision and a greater focus on the search
topic when determining which papers to include.
The criteria were determined by initial wider
reading on this topic.

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 Review

Studies were included if: Table 1. Combinations of search terms used

●●They were published in the English language Search terms CINAHL MEDLINE Embase Web of Science
●●They contained primary research data
1. General hospital 4255 10 510 17 034 50 550
●●They were focused primarily on general (adult-
trained without a qualification in oncology 2. Acute hospital 1112 1876 2574 64 290
nursing or palliative care) nurses’ experiences 3. 1 or 2 5346 12 337 19 521 64 284
of end-of-life care in the acute hospital setting 4. End-of-life care 4191 16 607 6229 14 251
●●They pertained to end-of-life care for adults 5. Terminal care 11 268 14 543 22 603 5284
(persons aged 18 years and older). 6. Palliative 26 259 45 012 20 764 33 073
Studies were excluded if:
7. Dying 8710 24 543 5095 386 163
●●The full research article was not translated
8. 4 or 5 or 6 or 7 39 730 85 296 43 933 425 327
into English
●●They were not primary research reports 9. Nurse experiences 780 40 41 24 017
●●The studies identified and reported the views of 10. Nurse attitudes 18 050 64 31 913 8927
specialist palliative- or oncology-trained nurses 11. 9 or 10 18 519 104 31 948 30 378
or nurses working in specialised areas 12. 3 and 8 215 241 328 6174
●●The studies did not report the views of general
13. 3 and 11 212 2 990 997
or adult-trained nurses.
14. 8 and 11 947 1 177 2246
Ten papers remained following application of
the inclusion and exclusion criteria. One paper 15. 3 and 8 and 11 20 1 13 100
used quantitative methods, eight used qualitative
methods, and one used mixed methods. The analysis. To provide comprehensive and quality
papers are summarised in Table 2. end-of-life care, nurses must have knowledge and
training at their disposal (Hopkinson et al, 2003;
Analysis Thompson et al, 2006; Wallerstedt and
The ten research studies were analysed using the Andershed, 2007). Thompson et al (2006), who
thematic analysis approach developed by used a grounded theory method in Canada,
Thomas and Harden (2008). Each paper was stated that there were barriers in relation to
carefully coded line-by-line according to ‘getting what’s needed’. This was in reference to
meaning and content such that descriptive physicians’ reluctance to prescribe high-dose
themes began to emerge. The majority of the analgesia for patients in severe pain owing to
descriptive themes were consistent throughout their fear of hastening death. This theme also
many of the selected studies, leading to the emerged following interviews with nurses carried
generation of six analytical themes: out by Mahtani-Chugani et al (2010) in Spain.
●●Lack of education and knowledge These nurses identified a lack of shared under-
●●Lack of time standing in relation to the goals of care for
●●Barriers arising in the culture of the health-care terminally ill patients. Nurses need to be
setting educated in order to advocate for their patients.
●●Communication issues Sasahara et al (2003) identified similar difficulties
●●Symptom management using a quantitative approach in the form of a
●●Nurses’ personal issues. survey questionnaire. An estimated 90% of the
The qualitative studies were evaluated using a nurses in this study had insufficient knowledge
framework proposed by Green and Thorogood regarding medications, particularly for symptom
(2011) comprising the following criteria: research control. The findings presented in the Italian
design, theory, transparency of procedures, analy- study by Toscani et al (2005), who used a mixed-
sis, presentation, value and ethics. The studies methods approach, were very similar. According
carried out by Sasahara et al (2003) and Toscani to Johnson et al (2007), in a mixed-methods
et al (2005) were evaluated under the following approach elements of qualitative and quantita-
criteria, as outlined by Morgan et al (2006): tive research are combined for the purpose of
research design, sampling methods, data collec- breadth and depth of understanding and collab-
tion, data analysis, reliability and validity, and oration. The notes of patients who had died
ethical issues. were surveyed by Toscani et al (2005) and then
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the nurses who had cared for the patients were

Themes from the literature interviewed. Toscani et al found that the major-
Lack of education and knowledge ity of the health professionals they interviewed
A lack of education and knowledge was one of were unable to recognise imminent death, even
the most common themes identified in the 24 hours before it occurred. The researchers

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 Review

Table 2. Summaries of the papers included in the review

Country Research Sample
Paper of origin design used Aim Summary of findings
Explore general nurses’ The nurses’ experiences were focused around six
Hopkinson et al experiences of caring for dying themes: the personal ideal, the actual, the unknown,
(2003) UK Qualitative 28 nurses people in hospital the alone, tension, and anti-tension
Explore nurses’ perceptions of
using the Liverpool Care Nurses generally found the LCP had a positive impact
Pathway (LCP) in the acute on patients and their families as well as on nurses and
Jack et al (2003) UK Qualitative 15 nurses hospital setting doctors
Eight domains were identified: communication with
patients and families, knowledge and skill of nurses,
Explore difficulties treatment and informed consent, personal issues,
encountered by nurses in the collaboration as a team including patients and families,
Sasahara et al care of terminally ill cancer environment and system, collaboration among nurses,
(2003) Japan Quantitative 375 nurses patients in general hospitals and near-death issues
Explore essential elements in The study identified various personal difficulties that
de Araújo et al the care of terminally ill the nurses encountered when caring for terminally ill
(2004) Brazil Qualitative 14 nurses patients patients and coping with the reality of human suffering
Data on treatments and care in the proximity of death
Toscani et al Mixed Describe how people die in for patients and nurses’ perceptions of this care were
(2005) Italy methods 10 hospitals hospital general wards collected and analysed
Nurses’ perceptions of care needs were: creating a
Explore nurses' perceptions of safe haven for safe passage, facilitating and maintaining
Thompson et al quality end-of-life care on an lane change, getting what is needed, being there, and
(2006) Canada Qualitative 10 nurses acute ward manipulating the care environment
This study identified three common structures:
Wallerstedt and Obtain nurses’ perspectives on ambition and dedication, everyday encounters, and
Andershed caring for dying patients satisfaction and dissatisfaction in relation to the ‘actual’
(2007) Sweden Qualitative 9 nurses outside palliative care settings and the ‘ideal’ of end-of-life care in the acute setting
Explore nurses’ views on
barriers to providing palliative The barriers identified were: lack of clarity about
Mahtani-Chugani care for patients with non- prognosis, the hegemony of a curative approach,
et al (2010) Spain Qualitative 9 nurses oncological terminal diseases avoiding words, and the desire to cheat death
Six themes were identified: use of the LCP as a care
Explore nurses’ views on using tool, improved confidence, training and support,
the LCP in the acute hospital nursing and medical relationships, dying in hospital, and
O'Hara (2011) UK Qualitative 12 nurses setting end-of-life issues
Acknowledgment of dying is essential in providing
Explore challenges in nursing appropriate care. It should not be assumed that all
Bloomer et al care of the dying in the acute nurses are adequately prepared, educationally, socially,
(2013) Australia Qualitative 25 nurses hospital setting and emotionally, to provide such care

suggested that this could be the explanation for
11% of these patients dying alone in the acute
hospital setting.
By contrast, Wallerstedt and Andershed
(2007) noted that each encounter when caring
for a dying patient gave nurses invaluable expe-
of the Liverpool Care Pathway for the Dying
Patient (LCP). Each experience increased their
confidence and gave them the strength to accept
new challenges. The nurses in this study held the
LCP in high regard, as they had experienced a
shift in care from routine to patient-centred
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rience and knowledge that would benefit them
in their future career. In the study by Jack et al
(2003), nurses stated that their knowledge of
symptom control and their confidence in provid-
ing this care improved after the implementation
once the framework was introduced. This study
must be viewed in the context of the recent
review of the LCP led by Baroness Neuberger
(Department of Health, 2013a), who in her
summary stated that:

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‘We have recommended phasing out the LCP
and replacing it with a more personalised and
clinically sensitive approach.’ (p2)
Lack of time with patients
The busyness of the acute setting was reported as
being a major barrier to patient care in many of
the research studies reviewed (Hopkinson et al,
2003; Sasahara et al, 2003; Thompson et al,
2006; Wallerstedt and Andershed, 2007; O’Hara,
2011). This barrier was also reported in Florin et
al (2004), by both nurses and patients. Spending
time with family and friends and not being alone
are considered very important goals for people
approaching the end of life (Vig and Pearlman,
2003). Research suggests that successfully achiev-
ing this goal can enhance the quality of the dying
experience for terminally ill patients (Patrick
et  al, 2001), and in the hospice model of care
spending time talking with patients is considered
a major priority of nursing care (Hospice
Friendly Hospitals, 2012). Curtis et al (2002)
outlined health professionals’ responsibility to
spend time with terminally ill patients and their
families, offering reassurance and alleviating
fears and anxieties.
Barriers arising in the culture of the
health-care setting
Care of the dying patient vs care of the curative
patient was another theme that emerged from the
majority of the reviewed studies. The nurses
interviewed by Thompson et al (2006) expressed
concerns that trying to facilitate the ‘lane change’
from acute to palliative care was a major barrier
that negatively affected end-of-life care in their
acute setting. Nurses in the Hopkinson et al
(2003) study described their experiences of
end-of-life care in a very negative light. They felt
that any time spent with dying patients was
continually shadowed by the reality of the needs
of other patients under their care.
The physical surroundings of the acute ward,
such as the lack of private rooms and the ‘drab
décor’, was another area that nurses described as
negatively affecting care (Thompson et al, 2006).
These findings were consistent with those in
Sasahara et al (2003), as identified by nurses
working in Japanese hospitals. Over 70% of the
nurses who participated in this quantitative study
agreed that there were a lack of private rooms
for the families of dying patients. The Australian
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study (Bloomer et al, 2013) typically found that
care in a single room is favoured by patients and
clinicians, and is justified for the increased pri-
vacy and quietness that it provides. Bloomer et al
(2013) reported that nurses had openly lobbied
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Review
for and prioritised single room allocation to ❛Spending
dying patients, but that this need competed with time with
the need for ‘isolation’ for infectious patients. family and
In their Swedish study, Walllerstedt and
Andershed (2007) found that nurses also felt they
friends and
encountered many difficulties when trying to not being
combine care of the dying patient with curative alone are
treatment for patients in the same unit. They also considered
expressed the view that some of these barriers
were related to a lack of time due to the demands
very important
from the acute setting: goals for
people
‘... they [the patients] see you don’t have time approaching
.... On a hectic day with a lot of patients in and
out, and then it’s the cancer patients and
the end
palliative patients that have to give way, of life ...❜
unfortunately that’s how it is.’ (p37)
Nurses who participated in the Spanish study by
Mahtani-Chugani et al (2010) described how the
care that they provide is directly focused on the
disease or the damaged organ, i.e. not holistic.
These findings present the stark reality of terminal
care in the acute hospital setting. This study used
focus groups, and Litosseliti (2010) suggested that
focus groups are limited in their use as they often
report a consensus of opinions rather than the
actual lived experience of the participants.
Encouragingly, many of the nurses in the
Canadian study (Thompson et al, 2006) agreed
that once they could facilitate the ‘lane change’
they could establish a care plan that would reflect
the patient’s needs. They also stated that this
process was often facilitated when patients and
families had a clear understanding of the disease
pathology and outcomes and could actively
participate in decision-making processes.
Inappropriate use of active treatment
Another theme was referred to as the inappropriate
use of active treatments on patients nearing the
end of life. In the quantitative Japanese study,
approximately 70% of the nurses agreed that
they were inappropriately and actively treating
terminally ill patients (Sasahara et al, 2003). In
this instance, the terms ‘inappropriate’ and ‘active
treatment’ were used to describe unnecessary
procedures such as intravenous therapy,
venepuncture, and other invasive procedures.
These findings were also supported by Toscani
et al (2005), whose results using a descriptive
approach showed that many patients continued
to be exposed to invasive treatments and specific
therapies (blood transfusions, intravenous fluids)
despite death being imminent. There are
disadvantages to using a descriptive approach,
however, in that the researchers tend not to
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❛... the ability analyse their data in any ‘interpretative depth’
of a nurse to (Polit and Beck, 2010).
communicate The unsuitability of the acute health-care
setting for terminally ill patients is demonstrated
therapeutically by the statistic that 11% of patients died alone
is a critical across acute hospital settings in Italy (Toscani
factor in how et al, 2003). This was attributed to the busyness
patients of the acute wards and the nurses not having
time to spend with dying patients owing to the
perceive their demands from other acutely ill patients. The
illness ...❜ nurses interviewed by Hopkinson et al (2003) in
the UK also witnessed the inappropriate use of
active treatments on many occasions.
Communication barriers
Nine of the reviewed studies (Hopkinson et al,
2003; Jack et al, 2003; Sasahara et al, 2003;
de Araújo et al, 2004; Toscani et al, 2005;
Wallerstedt and Andershed, 2007; Mahtani-
Chugani et al, 2010; O’Hara, 2011; Bloomer
et al, 2013) yielded findings in relation to barriers
to effective communication in the acute hospital
setting, particularly reflecting inadequacies in the
approach to communication in the palliative care
context. The wider literature suggests that the
ability of a nurse to communicate therapeutically
is a critical factor in how patients perceive their
illness (Funnell et al, 2008). This is particularly
important for nurses providing end-of-life care to
patients, as communication is seen as the corner-
stone of such care (Ferrell and Coyle, 2010).
Symptom management
Symptom management was a strong theme in
much of the reviewed literature (Hopkinson et al,
2003; Jack et al, 2003, Toscani et al, 2005;
Thompson et al, 2006; O’Hara, 2011). The find-
ings presented by Toscani et al (2005) revealed a
worrying lack of concern about pain and symptom
control in Italian hospitals, consistent with the
findings of the SUPPORT study (SUPPORT
Principal Investigators, 1995) in the USA, where
perhaps more than half of dying patients received
inadequate pain control at the end of life. Other
inadequately addressed symptoms included nausea
and vomiting.
Symptom management is seen as one of the
most important aspects of end-of-life care. In
particular, pain is believed to be one of the most
feared symptoms in patients with a terminal
illness, and unalleviated pain continues to be a
concern for terminally ill patients worldwide
(Smeltzer et al, 2008). In a supportive study by
Singer et al (1999), the researchers explored
patients’ experiences of and opinions on the
quality of end-of-life care they were receiving.
The patients identified five domains, of which
514
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adequate pain and symptom management was
considered the most important. Similar findings
emerged from another supportive study carried
out by Steinhauser et al (2000), where over 70%
of participants (patients, families, and care
providers) considered pain and symptom
management to be one of the most important
aspects of end-of-life care.
By contrast, the nurses interviewed by O’Hara
(2011) spoke positively when asked about
symptom management while using the LCP. The
nurses all agreed that there had been a vast
improvement in pain and symptom management
as a result of implementation of the framework.
These opinions were also evident in the findings
presented by Jack et al (2003).
Nurses’ personal issues
The majority of the reviewed papers reported
themes relating to the personal issues and feelings
of the nurses involved. These issues included:
●●A sense of inadequacy in the provision of
effective and quality end-of-life care in acute
hospital settings
●●The stress and fatigue resulting from dealing
intensively with dying patients
●●Lack of support with regards to providing
effective palliative care from ward managers
and also at an organisational and structural
level within health care
●●A sense of being alone and not being able to
seek support from others
●●Tension or dissidence arising between the quality
of care they knew they should be delivering
and what they could actually deliver in practice
●●A sense of incompetence and impotence when
managing significant numbers of dying patients.
It was evident from some of the studies that
being comfortable with death and dying is an
essential element of providing high-quality care
and minimising stress and burnout (Thompson
et al, 2006). Jack et al (2003) also suggested that
the implementation of the LCP brought major
benefits, with nurses describing a greatly enhanced
quality of care and improved overall experience in
providing end-of-life care in acute settings.
Stress in the workplace can have many adverse
effects on nurses’ physical and mental health and
their role and work (Bourbonnais et al, 1999; de
Lange et al, 2004; Hall, 2004). Mojoyinola
(2008) concluded that stress among nurses often
manifests as physical symptoms, such as back
© 2013 MA Healthcare Ltd
pain, headache, and high blood pressure. These
findings imply that nurses’ physical and mental
health are both adversely affected by stress.
These findings are consistent with those of Weigel
et al (2007), who found high levels of apprehension
International Journal of Palliative Nursing 2013, Vol 19, No 10

associated with ‘hospital’ nurses caring for dying
patients. Bloomer et al (2013, p762), in their
reviewed Australian paper, commented that
following their observational study:
‘What appeared as frantic activity in the hours
or minutes before a patient’s death is more
likely a representation of death anxiety, denial
and withdrawal, where nurses focus on care
tasks and disengage as a way of coping.’
Summary of findings
It is evident from the analytical themes that there
are many issues in relation to general nurses
caring for terminally ill patients in the acute
hospital setting. In seven of the nine reviewed
studies the nurses reported a lack of education
and knowledge as being a significant obstacle in
the provision of comprehensive, holistic end-of-
life care to patients and their families. These
obstacles were worsened by barriers to effective
communication that existed between nurses,
patients, and their relatives. The management of
symptoms such as pain, nausea, vomiting, and
dyspnoea was reported as a source of stress and
anxiety for general nurses working in the acute
hospital setting. The emotional nature of caring
for terminally ill patients, a perceived lack of
knowledge regarding symptom management, the
environment of the acute setting, and the perceived
lack of time due to the demands from acutely ill
patients were acknowledged as problematic for
general nurses in five of the reviewed studies.
Implications for practice
This literature review gives the reader a view of
the provision of end-of-life care as described by
general nurses across the world. The following
are recommendations drawn from this review:
●●The culture of the care setting should be
addressed and modifications made to meet the
individual needs of the patient instead of the
culture of the care setting dictating the
provision of care
●●Improving education on the palliative
approach to care should begin with nursing
students and continue in the clinical health-
care setting (Kwekkeboom et al, 2005). It is
evident from the supportive literature that
minimal interventions in relation to education
and training can greatly improve the quality of
care in the acute hospital setting
© 2013 MA Healthcare Ltd
●●Improved education for nurses in the acute
hospital setting could dramatically improve the
quality of end-of-life care. A change in com-
mon practices, from curative intent to caring,
could also enhance care
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Review
●●Nurses in the acute hospital setting should be ❛Stress in the
educated regarding end-of-life care based on workplace can
the recommendations from the review of the have many
LCP (Department of Health, 2013b).
●●Appropriate training is required to facilitate
adverse effects
the change from curative acute care to holistic on nurses’
end-of-life and palliative care. Similarly, man- physical and
agement structures in the health service should mental health
be made aware of their role in and responsibility
for providing adequate support for nurses.
and their role
and work ...❜
Conclusion
The reviewed papers, although few in number,
have presented various themes that are negatively
affecting the provision of end-of-life care in the
acute hospital setting. Caring for terminally ill
patients is an area that general nurses in the
acute setting find particularly difficult. Dealing
with the emotional responses of patients and
families and their own emotions is something
nurses find stressful, frustrating, and upsetting.
These difficulties are further compounded by
time constraints, lack of experience and educa-
tion, communication issues, and poor symptom
management. Through advanced education,
training, and support for general nurses, many of
these barriers could be overcome.
Many nurses and health professionals think
terminally ill patients would be better cared for
in a specialist setting, such as palliative care units
or hospices. The current state of health services
and the projected increase in chronic and malig-
nant diseases, however, suggest that this ideal
solution is a long way from fruition. With more
than half of people in the UK dying in the acute
hospital setting (National End of Life Care
Programme, 2010), more effective provision of
end-of-life care in this setting must be sought. I●
JPN
Declaration of interests
This study had no external sources of funding. The authors
have no conflicts of interest to declare.
Bloomer MJ, Endacott R, O’Connor M, Cross W (2013)
The ‘dis-ease’ of dying: challenges in nursing care of the
dying in the acute hospital setting. A qualitative observa-
tional study. Palliat Med 27(8): 757–64
Bourbonnais R, Comeau M, Vezina M (1999) Job strain and
evolution of mental health among nurses. J Occup Health
Psychol 4(2): 95–107
Burns N, Grove SK (2007) Understanding Nursing
Research: Building an Evidence-based Practice. 4th edn.
Saunders Elsevier, Philadelphia
Curtis JR, Patrick DL, Engelberg RA, Norris K, Asp C,
Byock I (2002) A measure of the quality of dying and
death: initial validation using after-death interviews with
family members. J Pain Symptom Manage 24(1): 17–31
de Araújo MMT, da Silva MJP, Francisco MCPB (2004)
Nursing the dying: essential elements in the care of
terminally ill patients. Int Nurs Rev 51(3): 149–58
de Lange AH, Taris TW, Kompier MAJ, Houtman ILD,
Bongers PM (2004) The relationships between work
515
 Review
❛Through characteristics and mental health: examining normal,
reversed and reciprocal relationships in a 4-wave study.
advanced J Work Stress 18(2): 149–66
Department of Health (2013a) The Liverpool Care Pathway
education, should be replaced. http://bit.ly/18FsNyy (accessed 27
training and September 2013)
Department of Health (2013b) More Care Less Pathway: A
support for Review of the Liverpool Care Pathway. http://bit.
ly/1fWrFdb (accessed 27 September 2013)
general nurses, Ferrell BR, Coyle N (2010) Oxford Textbook of Palliative
many of these Nursing. 3rd edn. Oxford University Press, Oxford
Florin J, Ehrenberg A, Ehnfors M (2004) Patients’ and
barriers could nurses’ perceptions of nursing problems in an acute care
setting. J Adv Nurs 51(2): 140–9
be overcome.❜ Funnell R, Koutoukidis G, Lawrence K (2008) Tabbner’s
Nursing Care: Theory and Practice. 5th edn. Elsevier, Sydney
Gao W, Ho YK, Verne J, Glickman M, Higginson IJ (2013)
Changing patterns in place of cancer death in England: a
population-based study. PLoS Med 10(3): e1001410
Green J, Thorogood N (2011) Qualitative Methods for
Health Research. 2nd edn. SAGE, London
Hall D (2004) Work-related stress of registered nurses in the
acute hospital setting. J Nurses Staff Develop 20(1): 6–14
Hopkinson JB, Hallett CE, Luker KA (2003) Caring for
dying people in hospital. J Adv Nurs 44(5): 525-33
Hospice Friendly Hospitals (2012) Quality Standards for End-
of-Life Care in Hospitals. http://hospicefoundation.ie/wp-
content/uploads/2013/04/Quality_Standards_for_End_of_
Life_Care_in_Hospitals.pdf (accessed 7 October 2013)
Jack BA, Gambles M, Murphy D, Ellershaw JE (2003)
Nurses’ perceptions of the Liverpool Care Pathway for
the dying patient in the acute hospital setting. Int J Palliat
Nurs 9(9): 375–81
Johnson RB, Onwuegbuzie A, Turner LA (2007) Towards a
definition of mixed methods research. J Mixed Methods
Res 1(2): 112–33
Kwekkeboom KL, Vahl C, Eland J (2005) Companionship
and education: a nursing students experience of palliative
care. J Nurs Educ 44(4): 169–76
Litosseliti L (2010) Research Methods in Linguistics.
Continuum International Publishing Group, New York
LoBiondo-Wood G, Haber J (2010) Nursing Research:
Methods and Critical Appraisal for Evidence-based
Practice. 7th edn. Mosby Elsevier, Philadelphia
Mahtani-Chugani V, Gonzalez-Castro I, De Ormijana-
Hernandez AS, Martin-Fernandez R, Fernandez de la
Vega E (2010) How to provide care for patients suffering
from terminal non-oncological diseases: barriers to a
palliative approach. J Palliat Med 24(8): 787–95
Morgan GA, Gliner JA, Harmon RJ (2006) Understanding
and Evaluating Research in Applied and Clinical Settings.
Taylor and Francis eLibrary, New Jersey
McCaughan E, Parahoo K (2000) Medical and surgical
nurses’ perceptions of their level of competence and edu-
cational needs in caring for a patient with cancer. J Clin
Nurs 9(3): 420–8
Call for peer reviewers
International Journal of Palliative Nursing is very grateful for the advice provided by its pool
of dedicated volunteer peer reviewers and always appreciates new offers from experienced
clinicians and academics interested in helping out.
If you would like to be considered for the peer review panel, please send a brief CV and details
of your particular areas of expertise or interest to the Editor, Craig Nicholson:
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onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 26, 2015. For personal use only. No other uses without permission. . All rights r
Mojoyinola JK (2008) Effects of job stress on health,
personal and work behaviour of nurses in public hospi-
tals in Ibadan Metropolis, Nigeria. Ethno-medicine 2(2):
143–8
National End of Life Care Programme (2010) Improving End
of Life Care. The Route to Success in End of Life Care –
Achieving Quality in Acute Hospitals. NEoLCP, UK
O’Hara T (2011) Nurses’ views on using the Liverpool Care
Pathway in an acute hospital setting. Int J Palliat Nurs
17(5): 239–44
Patrick DL, Engelberg RA, Curtis JR (2001) Evaluating the
quality of death and dying. J Pain Symptom Manage
22(3): 717–26
Polit DF, Beck CT (2010) Essentials of Nursing Research:
Appraising Evidence for Nursing Practice. 7th edn.
Lippincott Williams and Wilkins, New York
Sasahara T, Miyashita M, Kawa M, Kazuma K (2003)
Difficulties encountered by nurses in the care of termi-
nally ill cancer patients in general hospitals in Japan.
J Palliat Med 17(6): 520–6
Singer PA, Martin DK, Kelner M (1999) Quality end-of-life
care: patients’ perspectives. JAMA 281(2): 163–8
Smeltzer SC, Bare BG, Janice HL, Kerry CH (2008) Brunner
and Suddarth’s Textbook of Medical-Surgical Nursing.
11th edn. Lippincott, Williams and Wilkins, Philadelphia
Steinhauser KE, Christakis NA, Clipp EC, McNeilly M,
McIntyre L, Tulsky, JA (2000) Factors considered impor-
tant at the end of life by patients, families, physicians and
other care providers. JAMA 284(19): 2476–82
SUPPORT Principal Investigators (1995) A controlled trial
to improve the care of seriously ill hospitalized patients:
The Study to Understand Prognosis and Preferences for
Outcomes and Risk of Treatments (SUPPORT). JAMA
274(20): 1591–8
Thomas J, Harden A (2008) Methods for the thematic
synthesis of qualitative research in systematic reviews.
National Centre for Research Methods, London. http://
bit.ly/1dS26b3 (accessed 27 September 2013)
Thompson G, McClement S, Daeninck P (2006) Nurses’
perceptions of quality end-of-life care on an acute medi-
cal ward. J Adv Nurs 53(2): 169–77
Toscani F, Di Giulio P, Brunelli C, Miccinesi G, Laquintana D
(2005) How people die in hospital general wards: a
descriptive study. J Pain Symptom Manage 30(1): 33–40
Vig EK, Pearlman RA (2003) Quality of life while dying: a
qualitative study of terminally ill older men. J Am Geriatr
Soc 51(11): 1595–601
Wallerstedt B, Andershed B (2007) Caring for dying patients
outside special palliative care settings: experiences from a
nursing perspective. Scand J Caring Sci 21(1): 32–40
Weigel C, Parker G, Fanning L, Reyna K, Gasbarra DB
(2007) Apprehension among hospital nurses providing
end-of-life care. J Hospice Palliat Nurs 9(2): 86–91
Watson M, Lucas C, Hoy A, Wells J (2009) Oxford Hand-
book of Palliative Care. 2nd edn. Oxford University
Press, Oxford
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