Introduction Terminal agitation is a well recognised phenomenon. Unlike other symptoms at the end of life its pathophysiological basis is not well understood. Its presence may be disputed and it is therefore of interest because of its subjective nature.

Aim(s) and method(s) I used auto-ethnography and participant observation to explore how healthcare professionals interpret and manage terminal agitation. The participant observation was conducted on a 17 bedded hospice ward in a large city. The field notes were recorded by hand and the data subsequently coded by theme. Observation stopped when no new themes emerged.

Results 4 themes emerged. Personal feelings: Agitated patients challenge our confidence in symptom management. Causes: While we only document biomedical causes of agitation staff discuss a wide range of existential causes for individual patients. Management: There is a pressure from relatives and within teams to “do something” when a patient is agitated.

Medication may be given for reasons other than undeniable agitation. Discordant narratives:

In situations where relatives and staff disagree about the presence or absence of agitation this can often be explained in the context of discordant narratives.

Conclusion(s) There is a subjective component to the identification, cause and management of terminal agitation. We should embrace and acknowledge this. As well as being key to the concept of individualised care it is the expression of these ideas that enable health care professionals to understand and therefore manage terminal agitation.