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How do Australian palliative care nurses address existential and spiritual concerns? Facilitators, barriers and strategies


  • Robyn Keall MS, RN,

    PhD Candidate and Clinical Nurse Consultant (Palliative Care), Corresponding author
    1. University of Sydney & HammondCare Palliative & Supportive Care Service, Sydney, NSW, Australia
    • Correspondence: Robyn Keall, MS, PhD Candidate, University of Sydney & HammondCare Palliative & Supportive Care Service, The University of Sydney, Rm 164, CeMPED, Transient Building F12, NSW 2006, Australia. Telephone: +61 299038333.


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  • Josephine M Clayton PhD,

    Associate Professor
    1. University of Sydney & HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Greenwich, NSW, Australia
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  • Phyllis Butow PhD

    Professor, Chair of Psychology
    1. The University of Sydney, Sydney, NSW, Australia
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Aims and objectives

To investigate the facilitators, barriers and strategies that Australian palliative care nurses identify in providing existential and spiritual care for patients with life-limiting illnesses.


Palliative care aims to be holistic, incorporating all domains of personhood, but spiritual/existential domain issues are often undertreated. Lack of time and skills and concerns for what you may uncover hamper care provision.


A qualitative study through semistructured interviews.


We interviewed 20 palliative care nurses from a cross section of area of work, place of work, years of experience, spiritual beliefs and importance of those beliefs within their lives. Questions focused on their current practices of existential and spiritual care, identification of facilitators of, barriers to and strategies for provision of that care. Their responses were transcribed and subjected to thematic analysis.


The nurses' interviews yielded several themes including development of the nurse–patient relationship (14/20 nurses), good communication skills and examples of questions they use to ‘create openings’ to facilitate care. Barriers were identified as follows: lack of time (11/20 nurses), skills, privacy and fear of what you may uncover, unresolved symptoms and differences in culture or belief. Novel to our study, the nurses offered strategies that included the following: undertaking further education in this area, being self-aware and ensuring the setting is conducive to in-depth conversations and interactions and documentation and/or interdisciplinary sharing for continuity of care.


Palliative care nurses are well placed to provide existential and spiritual care to patients with the primary facilitator being the nurse–patient relationship, the primary barrier being lack of time and the primary strategy being undertaking further education in this area.

Relevance to clinical practice

These findings could be used for nurse-support programmes, undergraduate or graduate studies or communication workshop for nurses.