"No Right Place to Die": Nursing Attitudes and Needs in Caring for People With Serious Mental Illness at End-of-Life

Abstract

Background: Approximately 6% of the U.S. population suffer from a serious mental illness (SMI). People with SMI reportedly die 20 to 25 years earlier than the general population.

Objectives: To explore both hospice/palliative care nurses' and psychiatric/mental health nurses' attitudes and needs toward people with SMI at the end-of-life.

Design: A qualitative study following a phenomenological approach was used to interview hospice/palliative care nurses and psychiatric nurses about the experience of caring for people with SMI at the end-of-life; a total of 20 nurses were interviewed. Interviews were analyzed and coded, and themes were identified.

Results: Six themes were identified: stigma of mental illness, effect of SMI symptoms on communication and trust, chaotic family systems, advocacy issues around pain and comfort, need for formal support, no right place to die.

Conclusions: Participants discussed the need for better education and collaboration between psychiatric and palliative care nurses as well as the need for ongoing support.

Keywords: end-of-life care; nursing attitudes; serious mental illness; stigma.