The aim of this study sets out to better understand nephrology nurses’ lived experiences of dying and deaths of patients with ESKD following withdrawal of dialysis. A qualitative research design using an interpretative phenomenological approach was used to explore the experiences of a purposive heterogeneous sample of eight nephrology nurses who were working in private dialysis units. Information was gathered by phenomenological conversations and feed-back sessions. Colaizzi’s phenomenological method was employed to formulate four main themes: 1. Emotional trauma 2. Detachment 3. Loss of altruistic values in nursing 4. being-with-death For the participants in this study, emotional trauma was the most significant. The participants experienced a sense of powerlessness which caused emotions of hopelessness and anger and subsequently a sense of premature mourning and detachment. This state of hopelessness proved to be an obstacle in patient care, resulting in the altruistic values of nursing to be no longer applied. The participants’ ontological confrontation of being-with-death was evident, as they came to terms with the reality of their own death. Recommendations are offered to address the educational aspects of death and dying for nephrology nurses. This study endorses the need for further research into patients with ESKD ‘end-of-life’ which can influence how healthcare professionals should treat these patients during this phase.

Psychosocial support is said to be an inherent component of nursing care and a major focus of palliative care. Literature exists which outlines perceptions of the psychosocial needs of patients and how psychosocial support should be provided. However, there is a lack of empirical evidence on how psychosocial support is operationalised in practice. This study provides a valuable and substantial new contribution to the evidence on the psychosocial needs expressed by patients in a hospice ward and how nurses immediately respond to these needs within their everyday practice. A study gathering data via observations with matched interviews of patients and nurses, organisational, documentary, and demographic variables, was conducted over an eight month period. Thirty-eight nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data was analysed using constant comparative qualitative techniques. Patients expressed a wide variety of psychosocial needs, often only signalling them whilst receiving care for other reasons. Considering these needs in relation to Maslow’s (1943) hierarchy of needs suggests that in-patients more commonly express prerequisites to physiological care and ‘lower level’ safety needs rather than the more thoroughly researched and espoused ‘higher’ level psychosocial needs. The nurses reacted to these psychosocial needs with a range of responses which indicated a diminishing level of immediate support: ‘dealing’, ‘deferring’, ‘diverting’ and ‘ducking’. The majority of the nurses were observed using each of these responses at some point during data collection. A variety of the responses were used for each type and context of psychosocial need. These responses were influenced by the ward’s workplace culture. This study demonstrates a requirement for more thorough consideration of the true psychosocial needs of patients, which appear to vary dependent on the context of care. Consideration should be v given to workplace culture and its influence over psychosocial support, with nurses being supported to expand their response repertoire so that patients’ psychosocial needs are acknowledged more. Increasing nurses’ knowledge of the reality of psychosocial support through education and research will encourage formalisation of the place of psychosocial support in the planning, documentation and provision of care. This study shows that ward nurses can offer psychosocial support as an inherent component of their everyday work. Findings derived from this research indicate that developing an understanding of how patients express psychosocial needs in practice, through a consideration of Maslow’s (1943) hierarchy of needs, may increase recognition and support of psychosocial needs and enable nurses to respond more comprehensively.