Keywords
emotional stress
burnout
palliative care
academic hospital
Roy Adaptation Model
How to Cite
Abstract
Introduction
End-of-life care demands a patient-centred, empathetic approach. In academic hospital settings, nurses frequently encounter profound emotional stress and occupational burnout driven by caring for high volumes of terminally ill patients. These psychological burdens, combined with adverse working environments, frequently compromise care delivery, precipitate mental health challenges, and aggravate resource deficits.
Purpose
This qualitative study explored nurses' perceptions and lived experiences regarding end-of-life care delivery at an academic hospital in the Gauteng province of South Africa.
Methods
The study was conducted in specialized inpatient care units within a major academic teaching hospital in northern Pretoria, Gauteng province. A qualitative, descriptive design was utilized. Purposive sampling was employed to recruit twenty-four (n = 24) professional, enrolled, and auxiliary nurses who had direct experience providing end-of-life care. Data were gathered through face-to-face, semi-structured interviews guided by an open-ended interview schedule. All sessions were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis framework. Rigour was maintained through established qualitative criteria, and the analysis was interpreted through the lens of Callista Roy’s Adaptation Model.
Results
Data analysis yielded two primary themes: (1) Emotional turmoil, capturing subthemes of grief and guilt stemming from intense therapeutic bonds and patient mortality; and (2) Institutional challenges, encompassing subthemes of understaffing, lack of psychosocial support systems, poor physical infrastructure, and deficiencies in staff development and training.
Conclusion
Academic hospital nurses are strongly motivated to deliver compassionate palliative care but face significant structural and psychological barriers. Healthcare legislators and hospital management must establish targeted educational curricula, improve staffing ratios, and scale up institutional mental health support services to safeguard nursing well-being and elevate palliative care quality.
References
Alshammari, F., Sim, J., Lapkin, S., & Stephens, M. (2022). Registered nurses' knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review. Nurse Education in Practice, 59, Article 103294. https://doi.org/10.1016/j.nepr.2022.103294
Ayed, A., Sayej, S., Harazneh, L., Fashafsheh, I., & Eqtait, F. (2015). The nurses' knowledge and attitudes towards palliative care. Journal of Education and Practice, 6(4), 91–99.
Barnard, N. B., Rothmann, S., De Beer, L. T., & Lubbe, W. (2023). Burnout of emergency nurses in a South African context: The role of job demands and resources, and capabilities. Frontiers in Psychology, 14, Article 1119063. https://doi.org/10.3389/fpsyg.2023.1119063
Baqutayan, S. M. S. (2015). Stress and coping mechanisms: A historical overview. Mediterranean Journal of Social Sciences, 6(2), 479–488. https://doi.org/10.5901/mjss.2015.v6n2s1p479
Bloomer, M. J., Ranse, K., Adams, L., Brooks, L., & Coventry, A. (2023). “Time and life is fragile”: An integrative review of nurses’ experiences after patient death in adult critical care. Australian Critical Care, 36(5), 872–888. https://doi.org/10.1016/j.aucc.2022.09.008
Brink, H., van der Walt, C., & van Rensburg, G. (2018). Fundamentals of research methodology for health care professionals (4th ed.). Juta.
Clayton, M., & Marczak, M. (2023). Palliative care nurses’ experiences of stress, anxiety, and burnout: A thematic synthesis. Palliative & Supportive Care, 21(3), 498–514. https://doi.org/10.1017/s147895152200058x
Cybulska, A. M., Żołnowska, M. A., Schneider-Matyka, D., Nowak, M., Starczewska, M., Grochans, S., & Cymbaluk-Płoska, A. (2022). Analysis of nurses’ attitudes toward patient death. International Journal of Environmental Research and Public Health, 19(20), Article 13119. https://doi.org/10.3390/ijerph192013119
De Brasi, E. L., Giannetta, N., Ercolani, S., Gandini, E. L. M., Moranda, D., Villa, G., & Manara, D. F. (2021). Nurses' moral distress in end-of-life care: A qualitative study. Nursing Ethics, 28(5), 614–627. https://doi.org/10.1177/0969733020964859
Dixon, E. L. (1999). An application of Roy's Adaptation Model to grief and bereavement. In C. L. Roy & D. A. Andrews (Eds.), The Roy Adaptation Model: A guide for nursing practice (pp. 125–140). Appleton & Lange.
Grove, S. K., Gray, J. R., & Burns, N. (2019). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.
Jung, M. Y., & Matthews, A. K. (2021). A systematic review of clinical interventions facilitating end-of-life communication between patients and family caregivers. American Journal of Hospice and Palliative Medicine, 38(2), 180–190. https://doi.org/10.1177/1049909120929323
Kim, L. H., Kim, S. Y., Kim, S., Kim, H. A., Yang, H. J., Lee, K. M., Lee, S. Y., Lee, K. H., & Kim, J. H. (2021). A mixed method study for exploring the difficulties in end-of-life care and end-of-life care competency in nurses who take care of cancer patients. Asian Oncology Nursing, 21(2), 98–109. https://doi.org/10.5388/aon.2021.21.2.98
Kostka, K., Tomczyk, M., & Kus, K. (2021). Professional burnout and moral distress among nurses providing palliative care. Frontiers in Psychology, 12, Article 645123.
Limbu, T., & Taylor, P. M. (2021). Experiences of surgical nurses in providing end-of-life care in an acute care setting: A qualitative study. British Journal of Nursing, 30(18), 1084–1089. https://doi.org/10.12968/bjon.2021.30.18.1084
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE.
Molefe, L. (2024). R425 first-year student nurses' experience of encounters with the death of a patient during clinical placement. BMC Nursing, 23(1), Article 246. https://doi.org/10.1186/s12912-024-01922-z
Moses, A. C., Dreyer, A. R., & Robertson, L. (2024). Factors associated with burnout among healthcare providers in a rural context, South Africa. African Journal of Primary Health Care & Family Medicine, 16(1), Article 4163. https://doi.org/10.4102/phcfm.v16i1.4163
Nacak, U. A., & Erden, Y. (2022). End-of-life care and nurses’ roles. The Eurasian Journal of Medicine, 54(Suppl. 1), S141–S145. https://doi.org/10.5152/eurasianjmed.2022.22324
Onah, S. I., & Oriekwo, C. (2024). Effect of patient death on nurses [Unpublished bachelor's thesis]. LABLAND University of Applied Sciences.
Owuor, R. A., Mutungi, K., Anyango, R., & Mwita, C. C. (2020). Prevalence of burnout among nurses in sub-Saharan Africa: A systematic review. JBI Evidence Synthesis, 18(6), 1189–1207. https://doi.org/10.11124/JBISRIR-D-19-00170
Paterson, L. A., & Maritz, J. E. (2024). Nurses’ experiences of the family’s role in end-of-life care. Health SA Gesondheid, 29, Article 2565. https://doi.org/10.4102/hsag.v29i0.2565
Qutishat, M. (2025). Relationship between death anxiety and resilience among critical care nurses in Oman. Nursing in Critical Care, 30(3), Article e13177. https://doi.org/10.1111/nicc.13177
Roy, C. (2009). The Roy Adaptation Model (3rd ed.). Pearson.
Roy, C., & Andrews, H. A. (1999). The Roy Adaptation Model: A guide for nursing practice (2nd ed.). Appleton & Lange.
Roy, C., & Roberts, S. L. (1981). Theory construction in nursing: An adaptation model. Prentice-Hall.
Shepherd, J. (2025). The provision of end-of-life care in hospitals: Nurses' perceptions (Doctoral dissertation, Open Research Newcastle). Newcastle University.
Üstükuş, A., & Eskimez, Z. (2021). The effect of death anxiety in nurses on their approach to dying patients: A cross-sectional study. Perspectives in Psychiatric Care, 57(4), 1845–1852. https://doi.org/10.1111/ppc.12768
Xu, D. D., Luo, D., Chen, J., Zeng, J. L., Cheng, X. L., Li, J., & Hu, F. (2022). Nurses’ perceptions of barriers and supportive behaviours in end-of-life care in the intensive care unit: A cross-sectional study. BMC Palliative Care, 21(1), Article 130. https://doi.org/10.1186/s12904-022-01020-4
Young, C., & Roos, J. H. (2024). Factors that influence the quality of work life in nursing departments: A management perspective. International Journal of Africa Nursing Sciences, 20, Article 100672. https://doi.org/10.1016/j.ijans.2024.100672
Zhang, X., Zhang, C., Gou, J., & Lee, S. Y. (2024). The influence of psychosocial work environment, personal perceived health and job crafting on nurses’ well-being: A cross-sectional survey study. BMC Nursing, 23(1), Article 373. https://doi.org/10.1186/s12912-024-02041-5
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