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end of life, grounded theory, hospice, nurses, suffering



  1. Sacks, Jodi L. PhD, APRN, ANP-C, ACHPN
  2. Volker, Deborah L. PhD, RN, AOCN, FAAN


The purpose of this study was to develop an inductive theory describing the process that hospice nurses use to identify and respond to their patients' suffering. In addition, the study sought to describe the coping strategies that hospice nurses used when working with patients they considered to be suffering. Grounded theory methodology guided the study design with 22 hospice nurses participating in semistructured interviews. Participants responded to their patients' suffering within a 4-phase process of the nurse-patient relationship: observation, issue assessment, labeling the suffering, and intervention. In addition to signs of physical suffering, the participants identified other aspects of patient suffering: role losses, fear of the impending death, aloneness, and feelings of guilt or regret. While participants recognized the importance of self-care, they had difficulty naming strategies used to cope with patient suffering. Study findings can be used to develop effective interventions to alleviate patient suffering and mitigate its consequences on nurses. By understanding strategies that nurses use for coping with patient suffering, administrators could institute educational programs, build supportive environments, and develop policies to support their staff.