Why Do Nurses Hesitate to Bring Up Spiritual Concerns?

Betty R. Ferrell, PhD, RN


September 06, 2017

Day-of-Death Communications

Even hospice nurses, who are used to facing such issues as death and dying, often feel that their communication skills are less effective when discussing difficult topics. A recent study by Clayton and colleagues[1] focuses on this very specific aspect of palliative care—the support provided by nurses on the actual day of the patient's death.

This research was conducted by an interdisciplinary research team at the University of Utah. The research group used novel methods, including audio recording of home visits, to analyze the care provided to patients and their family caregivers. In previous work, this research group found that audiotaping home visits by nurses and analyzing the communication that took place has afforded a rare view of the care provided by hospice nurses within the homes of seriously ill and dying patients.[2]

In this study, they report communications (telephone conversations or home visits) from a total of 27 nurses that took place on the day of death of 42 patients. Eleven patients died before the nurse arrived in the home, three died during the visit, and 30 died after the visit.

The analysis of the recorded conversations showed that nurses primarily focused on physical aspects of care (80% of conversations) and providing emotional support (14%). Only 6% of the content of the communications was about spiritual concerns.


One area emphasized by the authors was the minimal amount of conversation related to spiritual care concerns. The finding that spirituality was an infrequent topic of conversation was surprising, given that the period for this analysis was the day of death, and given the emphasis in national palliative care guidelines[3] and other literature on spirituality as a central domain of care.[4,5,6,7] If spirituality isn't discussed by hospice nurses on the day a patient dies, it seems unlikely that it was a prominent topic in communications during the days and weeks preceding death, or in nonhospice encounters with patients and families. Much greater attention is needed to improve the quality of communication provided by nurses to patients and families.


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