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dying trajectory, end of life, energy, premortem surge



  1. Schreiber, Tanya P. DNS, PHCNS-BC, ACHPN
  2. Bennett, Marsha J. DNS


Anecdotal accounts offered by nurses suggest that some individuals in the final phase of dying experience a sudden, unexpected surge of energy and enhanced mental clarity, varying in intensity and duration. However, no studies have previously examined this phenomenon. The Delphi method was used to systematically collect observations, opinions, and perceptions of the phenomenon, labeled premortem surge (PS), from a panel of certified and advanced certified hospice and palliative nurses, to identify PS distinguishing characteristics and manifestation in the final phase of dying. Three Delphi rounds of questionnaires were disseminated via an online survey tool. Sixty-four expert panelists answered 8 semistructured, open-ended questions. Narratives, thematically analyzed, generated 58 statements regarding PS. In 2 subsequent Delphi rounds, 41 panelists completed the process, rating their level of agreement/disagreement with each statement on a Likert scale, resulting in 40 consensus statements meeting the predetermined criterion score. This Delphi study is the first to generate a consensus of identified PS characteristics and implications for family and nurses by a panel of end-of-life care nurse experts.