An exploration of the perceptions and practice of community nursing staff within two care settings in relation to spiritual distress at the end of life

High quality end of life (EOL) care requires a range of holistic approaches. Patients approaching the end of their lives frequently experience a variety of debilitating and distressing symptoms(e.g. nausea, breathlessness, or pain). Patients may also experience spiritual distress: a multifaceted form of existential anxiety which can include fear, regret, loss of connection, loss of hope, and loss of meaning. Spiritual distress within EOL care appears to be influenced by a lack of international consensus regarding definition, uncertainty regarding assessment tools and their use, and variation in specific interventions used to help relieve such distress. This conceptual ambiguity appears to directly influence patient care, both in the identification and assessment of spiritual distress and in relation to specific interventions utilised to alleviate such distress. The assessment of spiritual distress in a community context is also problematic: most published studies to date are based within acute hospital settings. None would appear to describe how spiritual distress is perceived/experienced by community nurses within different care settings or attempt to evaluate spiritual distress as experienced by patients dying within their own homes. Likewise, literature describing the use of assessment tools within a community setting, specific interventions to alleviate such distress, and how practitioners perceive the effectiveness of such interventions appears scarce. This study explores the perceptions of twenty-one community nurses (11 hospice, 10 NHS) regarding spiritual distress, as observed in EOL community-based patients. An initial literature review first attempts to situate spiritual distress within the wider backdrop of spirituality, spiritual care and spiritual needs. A qualitative investigative study was then undertaken using semi-structured interviews. Textual data were subsequently transcribed and analysed using thematic analysis, as described by Braun and Clarke (2006). The study's findings suggest that spiritual distress is a challenging phenomenon for practitioners to effectively manage within community nursing. Ambiguity associated with such distress would also appear to directly influence the quality and delivery of nursing care for EOL patients within both care settings.