Nurse's Obstacles In Delivering End Of Life Care

Main Article Content

Reni Sulung Utami
Ayu Karunia Putri


Background: Death can occur in any situation at any time, and each hospital setting has different difficulties in providing high-quality end-of-life care. The hospital's Islamic culture might offer new experiences to nurses when providing EOLC and be related to the challenges they face. This study identified the difficulties nurses encounter when providing end-of-life care in an Islamic-based hospital.

Methods: A descriptive cross-sectional survey was applied to this study. A questionnaire that was adapted from the Nursing Survey Questionnaire Regarding End-of-Life Care on Medical-Surgical Units was used to collect the data. The translation and back-translation processes were carried out in the Indonesian version. All questionnaire items were declared valid with a validity value range of 0.820 to 0.950 (r table = 0.312), and the reliability test results obtained an alpha coefficient value of 0.977 (very reliable). The consecutive sampling method was applied. The data were analyzed using univariate analysis. At an Islamic hospital in Semarang, 97 surgical and medical nurses in total participated in the survey.

Results: The findings indicate that the three main obstacles to nurses delivering end-of-life care are knowledge gaps (x = 2.53), a lack of education or training (x = 2.34), and health professionals’ avoidance of dying patients (x = 2.30). Other major impediments include a lack of family acceptance and uncooperative family attitudes.

Conclusion: Nurses and family factors are the biggest obstacles for nurses in caring for dying patients.

Article Details

How to Cite
Utami, R. S., & Putri, A. K. (2022). Nurse’s Obstacles In Delivering End Of Life Care . (JKG) Jurnal Keperawatan Global, 95–107.


Abate, A. T., Amdie, F. Z., Bayu, N. H., Gebeyehu, D., & G/Mariam, T. (2019). Knowledge, attitude and associated factors towards end of life care among nurses’ working in Amhara Referral Hospitals, Northwest Ethiopia: a cross-sectional study. BMC Research Notes, 12(1).

Anstey, S., Powell, T., Coles, B., Hale, R., & Gould, D. (2016). Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Supportive & Palliative Care, 6(3), 353–361.

Ariyanti, S., Emaliyawati, E., & Mirwanti, R. (2019). Emergency nurses’ perceptions of supportive behaviors and burdens in providing end-of-life care. Journal of Nursing Care, 2(1), 65–71.

Asosiasi Institusi Pendidikan Ners Indonesia. (2016). Kurikulum inti pendidikan ners Indonesia 2015 (F. Haryanti, H. Kamil, K. Ibrahim, & M. Hadi, Eds.). Asosiasi Institusi Pendidikan Ners Indonesia.

Attia, A. K., Abd-Elaziz, W. W., & Kandeel, N. A. (2013). Critical care nurses’ perception of barriers and supportive behaviors in end-of-life care. American Journal of Hospice and Palliative Medicine®, 30(3), 297–304.

Beckstrand, R. L., Isaacson, R. F., Macintosh, J. L. B., Luthy, K. E., & Eden, L. (2019). NICU nurses’ suggestions for improving end-of-life care obstacles. Journal of Neonatal Nursing, 25, 32–36.

Beckstrand, R. L., & Kirchhoff, K. T. (2005). Providing end-of life care to patients: critical care nurses’ perceived obstacles and supportive behaviors. American Journal of Critical Care, 14(5), 395–403.

Beckstrand, R. L., Moore, J., Callister, L., & Bond, A. E. (2009). Oncology nurses’ perceptions of obstacles and supportive behaviors at the end of life. Oncology Nursing Forum, 36(4), 446–453.

Beckstrand, R. L., Rawle, N. L., Callister, L., & Mandleco, B. L. (2010). Pediatric nurses’ perceptions of obstacles and supportive behaviors in end-of-life care. American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses, 19(6), 543–552.

Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency nurses’ perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care. Journal of Emergency Nursing, 34(4), 290–300.

Blaževičienė, A., Newland, J. A., Čivinskienė, V., & Beckstrand, R. L. (2017). Oncology nurses’ perceptions of obstacles and role at the end-of-life care: cross sectional survey. BMC Palliative Care, 16(74).

Brooks, L. A., Manias, E., & Nicholson, P. (2016). Barriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context. Australian Critical Care.

Caton, A. P., & Klemm, P. (2006). Introduction of novice oncology nurses to end-of-life care. Clinical Journal of Oncology Nursing, 10(5), 604–608.

Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., & Hashmi, S. K. (2017). A systematic review of religious beliefs about major end-of-life issues in the five major world religions. In Palliative and Supportive Care (Vol. 15, Issue 5, pp. 609–622). Cambridge University Press.

Cheng, S.-Y., Suh, S.-Y., Morita, T., Oyama, Y., Chiu, T.-Y., Koh, S. J., Kim, H. S., Hwang, S.-J., Yoshie, T., & Tsuneto, S. (2015). A cross-cultural study on behaviors when death is approaching in East Asian countries: what are the physician-perceived common beliefs and practices? Medicine, 94(39), e1573.

Choi, M., Lee, J., Kim, S.-S., Kim, D., & Kim, H. (2012). Nurses’ knowledge about end-of-life care: where are we? Journal of Continuing Education in Nursing, 43(8), 379–384.

Crump, S. K., Schaffer, M. A., & Schulte, E. (2010). Critical care nurses’ perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimensions of Critical Care Nursing, 29(6), 297–306.

Deffner, J. M., & Bell, S. K. (2005). Nurses’ death anxiety, comfort level during communication with patients and families regarding death, and exposure to communication education: a quantitative study. J Nurses Staff Dev, 21(1), 19–23.

Diana, D. L. (2020). Keperawatan menjelang ajal (end-of-life care): kajian literatur mengenai pengetahuan dan sikap pada perawat rumah sakit di Asia.

Dinas Kesehatan Provinsi Jawa Tengah. (2020). Profil kesehatan provinsi Jawa Tengah tahun 2019.

Dufour, B. (2018). Barriers Faced by Nurses Caring For End-of-Life Patients on a Barriers Faced by Nurses Caring For End-of-Life Patients on a Medical Surgical Unit Medical Surgical Unit.

Dunning, T., & Martin, P. (2018). Palliative and end of life care of people with diabetes: Issues, challenges and strategies. Diabetes Research and Clinical Practice, 143, 454–463.

Enggune, M., Ibrahim, K., & Agustina, H. R. (2014). Persepsi perawat neurosurgical critical care unit terhadap perawatan pasien menjelang ajal. Jurnal Keperawatan Padjadjaran, 2(1).

Feudtner, C., Santucci, G., Feinstein, J. A., Snyder, C. R., Rourke, M. T., & Kang, T. I. (2007). Hopeful thinking and level of comfort regarding providing pediatric palliative care: a survey of hospital nurses. Pediatrics, 119(1).

Gedamu, S., Berhane, E., Dires, A., Anteneh, S., Goshiye, D., & Tilahun, L. (2019). Knowledge and attitude of nurses towards palliative care in government hospitals of Addis Ababa, Ethiopia. Journal of Nursing and Care, 8(2).

Harasym, P., Brisbin, S., Afzaal, M., Sinnarajah, A., Venturato, L., Quail, P., Kaasalainen, S., Straus, S. E., Sussman, T., Virk, N., & Holroyd-Leduc, J. (2020). Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives. BMJ Open, 10(8), e037466.

Hasheesh, M. O. A., AboZeid, S. A.-S., El-Said, S. G., & Alhujaili, A. D. (2013). Nurses’ characteristics and their attitudes toward death and caring for dying patients in a public hospital in Jordan. Health Science Journal, 7(4).

Iglesias, M. E. L., Pascual, C., & Vallejo, R. B. de B. (2013). Obstacles and helpful behaviors in providing end-of-life care to dying patients in intensive care units. Dimensions of Critical Care Nursing, 32(2).

Ka, J., & Ho, M. (2016). Resuscitation versus end-of-life care: Exploring the obstacles and supportive behaviors to providing end-of-life care as perceived by emergency nurses after implementing the end-of-life care pathway. Applied Nursing Research, 29, e7–e13.

Kementerian Kesehatan Republik Indonesia. (2017). Peraturan Menteri Kesehatan Republik Indonesia tentang Pengembangan Jenjang Karir Profesional Perawat Klinis. In Kementerian Kesehatan Republik Indonesia (No. 40; pp. 1–72).

Kim, S., Lee, K., & Kim, S. (2020). Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study. BMC Palliative Care 2020 19:1, 19(1), 1–14.

McCourt, R., Power, J. J., & Glackin, M. (2013). General nurses’ experiences of end-of-life care in the acute hospital setting: A literature review. International Journal of Palliative Nursing, 19(10), 510–516.

National Institute for Health and Care Excellence. (2013). Quality standard for end of life care for adults.

NICE. (2019). End of life care for adults: service delivery.

Ose, M. I., Ratnawati, R., & Lestari, R. (2016). Studi fenomenologi: pengalaman perawat instalasi gawat darurat (IGD) dalam merawat pasien telantar pada fase end of life di RSUD Dr. Saiful Anwar Malang. Jurnal Ilmu Kesehatan, 4(2), 171–183.

O’Shea, E. R., & Mager, D. (2019). End-of-life nursing education: Enhancing nurse knowledge and attitudes. Applied Nursing Research, 50.

Ozga, D., Woźniak, K., & Gurowiec, P. J. (2020). Difficulties perceived by ICU nurses providing end-of-life care: a qualitative study. Global Advances in Health and Medicine, 9, 216495612091617.

Permatasari, E. D., & Utami, R. S. (2018). Persepsi perawat tentang hambatan dan dukungan dalam perawatan end-of-life di intensive care unit.

Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., & Hood, K. (2013). How death anxiety impacts nurses’ caring for patients at the endof life: a review of literature. Open Nurs J, 7, 14–21.

Profile Rumah Sakit Roemani Muhammadiyah. (n.d.). Retrieved July 16, 2021, from

Purnamaningrum, R., & Setyarini, S. (2013). Kualitas perawatan end of life pasien kritis di ICU RSUP Dr. Sardjito Yogyakarta [Universitas Gadjah Mada].

Ranse, K., Yates, P., & Coyer, F. (2014). Factors associated with critical care nurses’ engagement in end-of-life care practices. Australian Critical Care, 27(1), 59.

Reinke, L. F., Shannon, S. E., Engelberg, R. A., Young, J. P., & Curtis, J. R. (2010). Supporting hope and prognostic information: nurses’ perspectives on their role when patients have life-limiting prognoses. Journal of Pain and Symptom Management, 39(6), 982–992.

Robinson, R. (2004). End-of-life education in undergraduate nursing curricula. Dimensions of Critical Care Nursing, 23(2), 89–92.

Rohmah, N. Y., Hartini, S., & Effendy, C. (2019). Hambatan dan dukungan dalam pemberian perawatan akhir hayat pada pasien pediatrik.

Rosseter, R. (2019, April). Fact Sheet: The Impact of Education on Nursing Practice. American Association of Colleges of Nursing.

Sadler, C. (Ed.). (2015). A practical guide to end of life care. McGraw Hill Education.

Searight, H. R. (2019). SPRINGER BRIEFS IN ETHICS: ethical challenges in multi-cultural patient care cross cultural issues at the end of life. Springer.

Shi, H., Shan, B., Zheng, J., Peng, W., Zhang, Y., Zhou, X., Miao, X., & Hu, X. (2019). Knowledge and attitudes toward end-of-life care among community health care providers and its influencing factors in China: A cross-sectional study. Medicine, 98(45), e17683.

Statistics Canada. (2020). Table 13-10-0715-01 Deaths, by place of death (hospital or non-hospital).

Utami, R. S., Pujianto, A., Setyawan, D., Naviati, E., & Rochana, N. (2021). Critical care nurses’ experiences of end-of-life care: A qualitative study. Nurse Media Journal of Nursing, 10(3).

Woo, J. A., Maytal, G., & Stern, T. A. (2006). Clinical challenges to the delivery of end-of-life care. Primary Care Companion to the Journal of Clinical Psychiatry, 8(6), 367–372.