Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T13:11:03.291Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors influencing nurse spiritual care practices at the end of life: A systematic review

Published online by Cambridge University Press:  07 December 2021

Rita Mascio Open the ORCID record for Rita Mascio [Opens in a new window] ,
Megan Best ,
Sandra Lynch ,
Jane Phillips  and
Kate Jones
Rita Mascio*
Affiliation:
Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
Megan Best
Affiliation:
Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
Sandra Lynch
Affiliation:
Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
Jane Phillips
Affiliation:
School of Nursing, University of Queensland, Brisbane, Queensland, Australia
Kate Jones
Affiliation:
Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
*
Author for correspondence: Megan Best, University of Notre Dame, PO Box 944, Broadway, NSW 2007, Australia. E-mail: megan.best@nd.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients.

Methods

A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses’ spiritual/existential care practices toward adult end-of-life patients.

Results

The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources.

Significance of results

A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

Keywords

Barriers and facilitatorsEnd of lifeNurseSpiritual/existential careSystematic review
Type
Review Article
Information
Palliative & Supportive Care , Volume 20 , Issue 6 , December 2022 , pp. 878 - 896
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abu-El-Noor, N (2016) ICU nurses’ perceptions and practice of spiritual care at the end-of-life. Online Journal of Issues in Nursing 21(1), 6. doi:10.3912/OJIN.Vol21No01PPT05Google ScholarPubMed
American Association of Colleges of Nursing (2016) CARES: Competencies and Recommendations for Educating Undergraduate Nursing Students. Available at: https://www.aacnnursing.org/Portals/42/ELNEC/PDF/New-Palliative-Care-Competencies.pdf.Google Scholar
Arman, M (2007) Bearing witness: An existential position in caring. Contemporary Nurse 27(1), 84–93. doi:10.5172/conu.2007.27.1.84CrossRefGoogle Scholar
Atkins, L, Francis, J, Islam, R, et al. (2017) A guide to using the theoretical domains framework of behaviour change. Implementation Science 12, 1–18. doi:10.1186/s13012-017-0605-9CrossRefGoogle ScholarPubMed
Attard, J, Ross, L and Weeks, KW (2019) Design and development of a spiritual care competency framework for pre-registration nurses and midwives. Nurse Education in Practice 39, 96–104. doi:10.1016/j.nepr.2019.08.003CrossRefGoogle ScholarPubMed
Bailey, ME, Moran, S and Graham, MM (2009) Creating a spiritual tapestry. International Journal of Palliative Nursing 15(1), 42–48. doi:10.12968/ijpn.2009.15.1.37952CrossRefGoogle ScholarPubMed
Balboni, MJ, Sullivan, A, Amobi, A, et al. (2013) Why is spiritual care infrequent at the end of life? Journal of Clinical Oncology 31(4), 461–467. doi:10.1200/JCO.2012.44.6443CrossRefGoogle ScholarPubMed
Balboni, MJ, Sullivan, A, Enzinger, AC, et al. (2014) Nurse and physician barriers to spiritual care provision at the end of life. Journal of Pain and Symptom Management 48(3), 400–410. doi:10.1016/j.jpainsymman.2013.09.020CrossRefGoogle ScholarPubMed
Bar-Sela, G, Schultz, MJ, Elshamy, K, et al. (2019) Human development index and its association with staff spiritual care provision: A Middle Eastern oncology study. Supportive Care in Cancer 27(9), 3601–3610. doi:10.1007/s00520-019-04733-0CrossRefGoogle ScholarPubMed
Batstone, E, Bailey, C and Hallett, N (2020) Spiritual care provision to end-of-life patients: A systematic literature review. Journal of Clinical Nursing 29(19-20), 3609–3624. doi:10.1111/jocn.15411Google ScholarPubMed
Belcher, A and Griffiths, M (2005) The spiritual care perspectives and practices of hospice nurses. Journal of Hospice and Palliative Nursing 7(5), 271–279. doi:10.1097/00129191-200509000-00014CrossRefGoogle Scholar
Bone, N, Swinton, M, Hoad, N, et al. (2018) Critical care nurses’ experiences with spiritual care. American Journal of Critical Care 27(3), 212–219. doi:10.4037/ajcc2018300CrossRefGoogle ScholarPubMed
Browall, M, Henoch, I, Melin-Johansson, C, et al. (2014) Existential encounters: Nurses’ descriptions of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing 18(6), 636–644. doi:10.1016/j.ejon.2014.06.001CrossRefGoogle ScholarPubMed
Bush, T and Bruni, N (2008) Spiritual care as a dimension of holistic care. International Journal of Palliative Nursing 14(11), 539–545. doi:10.12968/ijpn.2008.14.11.31758CrossRefGoogle Scholar
Byrne, MK, Sullivan, NL and Elsom, SJ (2006) Clinician optimism: Development and psychometric analysis of a scale for mental health clinicians. Australian Journal of Rehabilitation Counselling 12(1), 11–20. doi:10.1375/jrc.12.1.11CrossRefGoogle Scholar
Cambridge Dictionary (2021) Competence. In Cambridge Dictionary. Available at: https://www.merriam-webster.com/dictionary/self-report (retrieved April 5, 2021).Google Scholar
Cancer Australia (2013) Conceptualisation, Assessment and Interventions to Alleviate Suffering in the Cancer Context: A Systematic Literature Review. Available at: https://www.canceraustralia.gov.au.Google Scholar
Cane, J, O'Connor, D and Michie, S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science 7(1), 37. doi:10.1186/1748-5908-7-37.CrossRefGoogle ScholarPubMed
Carroll, B (2001) A phenomenological exploration of the nature of spirituality and spiritual care. Mortality 6(1), 81–98. doi:10.1080/13576270124229CrossRefGoogle Scholar
Castelfranchi, C (2014) Intentions in the light of goals. Topoi 33(1), 103–116. doi:10.1007/s11245-013-9218-3CrossRefGoogle Scholar
Chan, WC and Tin, AF (2012) Beyond knowledge and skills: Self-competence in working with death, dying, and bereavement. Death Studies 36(10), 899–913. doi:10.1080/07481187.2011.604465CrossRefGoogle ScholarPubMed
Costello, J (2006) Dying well: Nurses’ experiences of ‘good and bad’ deaths in hospital. Journal of Advanced Nursing 54(5), 594–601. doi:10.1111/j.1365-2648.2006.03867.xCrossRefGoogle ScholarPubMed
Craig, LE, McInnes, E, Taylor, N, et al. (2016) Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department. Implementation Science 11(1), 157. doi:10.1186/s13012-016-0524-1.CrossRefGoogle ScholarPubMed
Daaleman, T, Usher, B, Williams, S, et al. (2008) An exploratory study of spiritual care at end of life. Annals of Family Medicine 6(5), 406–411. doi:10.1370/afm.883CrossRefGoogle ScholarPubMed
Dalgaard, KM, Thorsell, G and Delmar, C (2010) Identifying transitions in terminal illness trajectories. International Journal of Palliative Nursing 16(2), 87–92. doi:10.12968/ijpn.2010.16.2.46754CrossRefGoogle ScholarPubMed
Delgado, C, Upton, D, Ranse, K, et al. (2017) Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies 70, 71–88. doi:10.1016/j.ijnurstu.2017.02.008CrossRefGoogle ScholarPubMed
Doorenbos, AZ, Wilson, SA, Coenen, A, et al. (2006) Dignified dying. International Nursing Review 53(1), 28–33. doi:10.1111/j.1466-7657.2006.00458.xCrossRefGoogle ScholarPubMed
Edwards, A, Pang, N, Shiu, V, et al. (2010) The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care. Palliative Medicine 24(8), 753–770. doi:10.1177/0269216310375860CrossRefGoogle ScholarPubMed
Ellington, L, Reblin, M, Ferrell, B, et al. (2015) Naturalistic pilot observations of spiritual conversations. Omega 72(1), 3–19. doi:10.1177/0030222815574689CrossRefGoogle Scholar
Elo, S and Kyngäs, H (2008) The qualitative content analysis process. Journal of Advanced Nursing 62(1), 107–115. doi:10.1111/j.1365-2648.2007.04569.xCrossRefGoogle ScholarPubMed
Epstein, ZD, Sullivan, AJ, Enzinger, AC, et al. (2015) Examining forms of spiritual care provided in the advanced cancer setting. American Journal of Hospice & Palliative Medicine 32(7), 750–757. doi:10.1177/1049909114540318CrossRefGoogle Scholar
Fay, Z and OBoyle, C (2019) How specialist palliative care nurses identify patients with existential distress and manage their needs. International Journal of Palliative Nursing 25(5), 233–243. doi:10.12968/ijpn.2019.25.5.233CrossRefGoogle ScholarPubMed
Ferrell, B, Otis-Green, S, Baird, R, et al. (2014) Nurses’ responses to requests for forgiveness at the end-of-life. Journal of Pain and Symptom Management 47(3), 631–641. doi:10.1016/j.jpainsymman.2013.05.009CrossRefGoogle ScholarPubMed
Gamondi, C, Larkin, P and Payne, S (2013) Core competencies in palliative care. European Journal of Palliative Care 20(2), 86–91.Google Scholar
Gijsberts, MJ, Liefbroer, AI, Otten, R, et al. (2019) Spiritual care in palliative care: A systematic review of the recent european literature. Medical Sciences 7(2), 1–21. doi:10.3390/medsci7020025CrossRefGoogle ScholarPubMed
Graneheim, UH and Lundman, B (2004) Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24(2), 105–112. doi:10.1016/j.nedt.2003.10.001CrossRefGoogle ScholarPubMed
Gravel, K, Légaré, F and Graham, ID (2006) Barriers and facilitators to implementing shared decision-making. Implementation Science 1(16). doi:10.1186/1748-5908-1-16CrossRefGoogle ScholarPubMed
Grol, R and Grimshaw, J (2003) From best evidence to best practice: Effective implementation of change in patients’ care. Lancet 362, 1225–1230. doi:10.1016/S0140-6736(03)14546-1CrossRefGoogle ScholarPubMed
Guedes-Fontoura, E and de Oliveira Santa, D (2013) Experience of the tragic triad in nursing care for the person in life's finiteness. Ciencia, Cuidado Saude 12(3), 510–516. doi:10.4025/cienccuidsaude.v12i3.18066Google Scholar
Harrington, A (1995) Spiritual care: What does it mean to RNs? Australian Journal of Advanced Nursing 12(4), 5–14.Google ScholarPubMed
Harrington, A (2006) The ‘connection’ health care providers make with dying patients. Journal of Religion, Spirituality & Aging 18(2-3), 169–185. doi:10.1300/J496v18n02_13CrossRefGoogle Scholar
Heslehurst, N, Newham, J, Maniatopoulos, G, et al. (2014) Implementation of pregnancy weight management and obesity guidelines. Obesity Reviews 15(6), 462–486. doi:10.1111/obr.12160CrossRefGoogle ScholarPubMed
Highfield, M, Taylor, E and Amenta, MO (2000) Preparation to care: The spiritual care education of oncology and hospice nurses. Journal of Hospice and Palliative Nursing 2(2), 53–63. doi:10.1097/00129191-200002020-00003CrossRefGoogle Scholar
International Council of Nurses (2012) The ICN Code of Ethics for Nurses. Available at: https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_eng.pdf.Google Scholar
Johansson, K and Lindahl, B (2012) Nurses’ experiences of caring for terminally ill patients in hospitals. Journal of Clinical Nursing 21(13–14), 2034–2043. doi:10.1111/j.1365-2702.2011.03952.xCrossRefGoogle ScholarPubMed
Johnston-Taylor, E (2013) New Zealand hospice nurses’ self-rated comfort in conducting spiritual assessment. International Journal of Palliative Nursing 19(4), 178–185. doi:10.12968/ijpn.2013.19.4.178CrossRefGoogle Scholar
Kale, S (2011) Perspectives on spiritual care at hospice Africa Uganda. International Journal of Palliative Nursing 17(4), 177–182. doi:10.12968/ijpn.2011.17.4.177CrossRefGoogle ScholarPubMed
Karlsson, M, Kasén, A and Wärnå-Furu, C (2017) Reflecting on one's own death. Palliative & Supportive Care 15(2), 158–167. doi:10.1017/S1478951516000468CrossRefGoogle ScholarPubMed
Keall, R, Clayton, JM and Butow, P (2014) How do Australian palliative care nurses address existential and spiritual concerns? Journal of Clinical Nursing 23, 3197–3205. doi:10.1111/jocn.12566CrossRefGoogle ScholarPubMed
Kisvetrová, H, Klugar, M and Kabelka, L (2013) Spiritual support interventions in nursing care for patients suffering death anxiety. International Journal of Palliative Nursing 19(12), 599–605. doi:10.12968/ijpn.2013.19.12.599CrossRefGoogle ScholarPubMed
Kisvetrová, H, Školoudík, D, Joanovi, E, et al. (2016) Dying care interventions in the intensive care unit. Journal of Nursing Scholarship 48(2), 139–146. doi:10.1111/jnu.12191CrossRefGoogle ScholarPubMed
Kisvetrová, H, Vévodová, Š and Školoudík, D (2018) Comfort-supporting nursing activities for end-of-life patients. Journal of Nursing Scholarship 50(2), 126–133. doi:10.1111/jnu.12341CrossRefGoogle ScholarPubMed
Kmet, LM, Cook, LS and Lee, RC (2004) Standard Quality Assessment Criteria for Evaluating Primary Research Papers From A Variety of Fields. Edmonton: Alberta Heritage Foundation for Medical Research.Google Scholar
Kociszewski, C (2004) Spiritual care: A phenomenologic study of critical care nurses. Heart & Lung 33(6), 401–411. doi:10.1016/j.hrtlng.2004.06.004CrossRefGoogle ScholarPubMed
Kozlowski, SW and Klein, KJ (2000) A multilevel approach to theory and research in organizations. In Klein, IKJ & Kozlowski, SW (eds.), Multilevel Theory, Research, and Methods in Organizations, San Francisco: Jossey-Bass, pp. 3–90.Google Scholar
Kristeller, JL, SheedyZumbrun, C and Schilling, RF (1999) How oncologists and oncology nurses address spiritual distress in cancer patients. Psycho-Oncology 8(5), 451–458. doi:10.1002/(SICI)1099-1611(199909/10)8:53.0.CO;2-3>CrossRefGoogle ScholarPubMed
Kuuppelomaki, M (2001) Spiritual support for terminally ill patients. Journal of Clinical Nursing 10(5), 660–670. doi:10.1046/j.1365-2702.2001.00534.xCrossRefGoogle ScholarPubMed
Lawton, C, Lawton, A, Stevens, E, et al. (2019) Where do we draw the line? Navigating personal and professional boundary challenges in palliative care. Journal of Pain and Symptom Management 57(2), 417. doi:10.1016/j.jpainsymman.2018.12.135.CrossRefGoogle Scholar
Malik, RF, Hilders, CG and Scheelel, F (2018) Do ‘physicians in the lead’ support a holistic healthcare delivery approach? A qualitative analysis of stakeholders’ perspectives. BMJ Open. doi:10.1136/bmjopen-2017-020739CrossRefGoogle ScholarPubMed
McSherry, W, Ross, L, Attard, J, et al. (2020) Preparing undergraduate nurses and midwives for spiritual care. Journal for the Study of Spirituality 10(1), 55–71. doi:10.1080/20440243.2020.1726053CrossRefGoogle Scholar
Michie, S, Johnston, M, Abraham, C, et al. (2005) Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality & Safety in Health Care 14(1), 26–33. doi:10.1136/qshc.2004.011155CrossRefGoogle ScholarPubMed
Michie, S, Johnston, M, Francis, J, et al. (2008) From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology 57(4), 660–680. doi:10.1111/j.1464-0597.2008.00341.xCrossRefGoogle Scholar
Minton, ME, Isaacson, MJ, Varilek, BM, et al. (2018) A willingness to go there: Nurses and spiritual care. Journal of Clinical Nursing 27(1-2), 173–181. doi:10.1111/jocn.13867CrossRefGoogle ScholarPubMed
Morita, TM, Murata, HM, Kishi, E, et al. (2009) Meaninglessness in terminally ill cancer patients. Journal of Pain and Symptom Management 37(4), 649–658. doi:10.1016/j.jpainsymman.2008.04.017CrossRefGoogle ScholarPubMed
Nåden, D (2009) Nurses’ perceptions of the phenomenon of confirmation in a cancer context. International Journal for Human Caring 13(3), 47–55. doi:10.20467/1091-5710.13.3.47CrossRefGoogle Scholar
Neathery, M, Taylor, EJ and He, Z (2020) Perceived barriers to providing spiritual care among psychiatric mental health nurses. Archives of Psychiatric Nursing 34(6), 572–579. doi:10.1016/j.apnu.2020.10.004CrossRefGoogle ScholarPubMed
Nixon, AV, Narayanasamy, A and Penny, V (2013) An investigation into the spiritual needs of neuro-oncology patients from a nurse perspective. BMC Nursing 12(1), 2. doi:10.1186/1472-6955-12-2.CrossRefGoogle ScholarPubMed
Paksaite, P, Watson, M, Crosskey, J, et al. (2020) A systematic review using the theoretical domains framework to identify barriers and facilitators to the adoption of prescribing guidelines. International Journal of Pharmacy Practice 29. doi:10.1111/ijpp.12654Google Scholar
Palmer, EK, Hyer, M, Tsilimigras, DT, et al. (2021) Healthcare provider self-reported observations and behaviors regarding their role in the spiritual care of cancer patients. Supportive Care in Cancer. doi:10.1007/s00520-020-05957-1CrossRefGoogle Scholar
Pittroff, GE (2013) The humbled expert: An exploration of spiritual care expertise. Journal of Christian Nursing 30(3), 164–169. doi:10.1097/CNJ.0b013e318294e8d3CrossRefGoogle ScholarPubMed
Rodin, D, Balboni, M, Mitchell, C, et al. (2015) Whose role? Oncology practitioners’ perceptions of their role in providing spiritual care to advanced cancer patients. Supportive Care in Cancer 23(9), 2543–2550. doi:10.1007/s00520-015-2611-2CrossRefGoogle ScholarPubMed
Ronaldson, S, Hayes, L, Aggar, C, et al. (2012) Spirituality and spiritual caring: Nurses’ perspectives and practice in palliative and acute care environments. Journal of Clinical Nursing 21(15–16), 2126–2135. doi:10.1111/j.1365-2702.2012.04180.xCrossRefGoogle ScholarPubMed
Rosário, F, Santos, MI, Angus, K, et al. (2021) Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices. Implementation Science 16(1), 6. doi:10.1186/s13012-020-01073-0.CrossRefGoogle ScholarPubMed
Schultz, M, Lulav-Grinwald, D and Bar-Sela, G (2014) Cultural differences in spiritual care: Findings of an Israeli oncologic questionnaire examining patient interest in spiritual care. BMC Palliative Care 13(1), 19. doi:10.1186/1472-684X-13-19.CrossRefGoogle ScholarPubMed
Selman, P, Young, TB, Vermandere, MD, et al. (2014) Research priorities in spiritual care. Journal of Pain and Symptom Management 48(4), 518–531. doi:10.1016/j.jpainsymman.2013.10.020CrossRefGoogle ScholarPubMed
Shantz, A and Latham, GP (2009) An exploratory field experiment of the effect of subconscious and conscious goals on employee performance. Organizational Behavior and Human Decision Processes 109(1), 9–17. doi:10.1016/j.obhdp.2009.01.001CrossRefGoogle Scholar
Taylor, EJ, Highfield, MF and Amenta, M (1999) Predictors of oncology and hospice nurses’ spiritual care perspectives and practices. Applied Nursing Research 12(1), 30–37. doi:10.1016/S0897-1897(99)80156-6CrossRefGoogle ScholarPubMed
Taylor, EJ, Mamier, I, Bahjri, K, et al. (2009) Efficacy of a self-study programme to teach spiritual care. Journal of Clinical Nursing 18(8), 1131–1140. doi:10.1111/j.1365-2702.2008.02526.xCrossRefGoogle ScholarPubMed
Thomas, DL and Diener, E (1990) Memory accuracy in the recall of emotions. Journal of Personality and Social Psychology 59(2), 291–297. doi:10.1037/0022-3514.59.2.291CrossRefGoogle Scholar
Tornøe, KA, Danbolt, L, Kvigne, K, et al. (2014) Hospice nurses’ lived experience with spiritual and existential care for the dying. BMC Nursing 13(1), 25. doi:10.1186/1472-6955-13-25.CrossRefGoogle ScholarPubMed
Tornøe, KA, Danbolt, L, Kvigne, K, et al. (2015) Nurses’ experiences with spiritual and existential care for the dying. BMC Nursing 14(62), 62. doi:10.1186/s12912-015-0114-6.CrossRefGoogle ScholarPubMed
van Leeuwen, R, Tiesinga, L, Middel, B, et al. (2009) The validity and reliability of an instrument to assess nursing competencies in spiritual care. Journal of Clinical Nursing 18(20), 2857–2869. doi:10.1111/j.1365-2702.2008.02594.xCrossRefGoogle ScholarPubMed
van Meurs, J, Smeets, W, Vissers, K, et al. (2018) Nurses exploring the spirituality of their patients with cancer. Cancer Nursing 41(4), E39–E45. doi:10.1097/NCC.0000000000000526CrossRefGoogle ScholarPubMed
Vosit-Steller, J, White, P, Barron, A-M, et al. (2010) Enhancing end-of-life care with dignity in Romania. International Journal of Palliative Nursing 16(9), 459–464. doi:10.12968/ijpn.2010.16.9.78645CrossRefGoogle ScholarPubMed
Walker, H and Waterworth, S (2017) New Zealand palliative care nurses experiences of providing spiritual care to patients with life-limiting illness. International Journal of Palliative Nursing 23(1), 18–26. doi:10.12968/ijpn.2017.23.1.18CrossRefGoogle ScholarPubMed
Wittenberg, E, Ragan, SL and Ferrell, B (2017) Exploring nurse communication about spirituality. American Journal of Hospice & Palliative Medicine 34(6), 566–571. doi:10.1177/1049909116641630CrossRefGoogle ScholarPubMed
Wright, M (2002) The essence of spiritual care: A phenomenological enquiry. Palliative Medicine 16(2), 125–132. doi:10.1191/0269216302pm518oaCrossRefGoogle ScholarPubMed
Yingting, Z, Pal, RP, Wilson, T, et al. (2018) Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study. International Emergency Nursing 37, 13–22. doi:10.1016/j.ienj.2017.07.001Google Scholar
Zerwekh, J (1993) Transcending life: The practice wisdom of nursing hospice experts. American Journal of Hospice & Palliative Medicine 10(5), 26–31. doi:10.1177/104990919301000509CrossRefGoogle ScholarPubMed
Supplementary material: File

Mascio et al. supplementary material

Mascio et al. supplementary material 1

Download Mascio et al. supplementary material(File)
File 97.8 KB
Supplementary material: File

Mascio et al. supplementary material

Mascio et al. supplementary material 2

Download Mascio et al. supplementary material(File)
File 53.7 KB