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Identifying existential distress in people at the end of life

Some people nearing the end of life are more prone to feelings of distress than others

Some people nearing the end of life are more prone to feelings of distress than others

End_of_Life
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For people receiving palliative and end of life care, the certainty of their impermanent mortality often means thoughts of existence, life and death are foremost concerns.

Such apprehensions can often be challenging and distressing for patients and their families, as well as the professional staff caring for them.

This Irish study explains how the term ‘existential distress’ is used when people nearing the end of their lives exhibit profound suffering, related particularly to their thoughts on life and existence.

It discusses the experiences of palliative care nurses to show how they identified patients with existential distress and how they helped manage their needs.

Managing distress

Adopting a qualitative descriptive design conducted through semi-structured interviews, researchers recorded, transcribed and analysed the content of interviews with ten female nurses working as community or inpatient care nurses in an urban Irish hospice service. 

Four themes emerged from the interviews about how the nurses recognised and managed existential distress.

Participants suggested that they could sometimes predict which patients may be prone to experiencing distress.

They identified that young parents and people with a fervent faith or theology are more susceptible to distress, as are those who have poor coping strategies or histories of difficult and stressful life events, such as abandonment or abuse.

Emotional effects

Behavioural changes and communication difficulties were identified as indicators of potential existential distress.

The third theme reflects the emotional effect that caring for this patient group can have on the nurses, who described feelings of sadness, frustration, avoidance and satisfaction.

Being present and empathetic with patients was endorsed by most of the participants because it allows time for expressing and exploring their distress.

Lastly, the use of consensual sedation was acknowledged as a means of dealing with difficult to address distress that was leading to ‘deplorable quality of life when awake’.

Reference

  • Fay Z and OBoyle C (2019) How specialist palliative care nurses identify patients with existential distress and manage their needs. International Journal of Palliative Nursing. 25, 5, 233-243.

Compiled by Dion Smyth, lecturer-practitioner in cancer and palliative care at Birmingham City University

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