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Suitable support for anxious hospice patients: what do nurses ‘know’, ‘do’ and ‘need’? An explanatory mixed method study
  1. Danielle Zweers1,
  2. Everlien de Graaf2 and
  3. Saskia Teunissen3
  1. 1General Practice - Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care / Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2General Practice -Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3General Practice -Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Danielle Zweers, Room number: 6.125, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; d.zweers{at}


Objective To provide insight into what nurses know, do and need to provide support to anxious patients in hospice care (HC).

Methods A mixed method study consisted of an online survey and focus groups (FGs) about what nurses know, do, and need was conducted. 336 HC nurses were invited to participate. Descriptive statistics were computed using SPSS. The χ2 and t-tests were conducted to compare. The FGs were transcribed verbatim and thematically analysed.

Results The survey was completed by 265 nurses (79%), and five FGs (n=25) were conducted. Most nurses had >10 years working experience; mean age was 52. The majority (59%) felt that they were equipped with sufficient knowledge; however, lack of knowledge (31%) as well as lack of time (50%) were hampering factors. Identification of anxiety was difficult due to the variety of its expression. Tools for identifying were used by 37%. Interventions were generally chosen intuitively. A major responsibility was experienced in caring for patients with panic attacks during late night shifts, making immediate decisions necessary.

Conclusion This study highlights the struggles of nurses caring for anxious patients in HC. Anxiety management is dependent on the competencies and preferences of the individual nurse. One-third of the nurses require additional training. According to HC nurses, the intervention set should include guidelines for applying assessment tools, effective communication strategies and decision models as well as prediction models in order to select tailored interventions. Future research should focus on patients’ perspectives in order to understand crucial measures for anxiety management.

  • anxiety
  • hospice care
  • palliative care
  • symptoms and symptom
  • management

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  • Contributors This manuscript described original work and is not under consideration by any other journal. All authors have verified the references and are responsible for the accuracy of the references cited. All authors have approved the manuscript and agreed with its submission to BMJ Supportive and Palliative Care. The authors declare that no conflicts of interest exist. All authors have made substantial contributions to: (1) the conception and design of the study; (2) drafting the article; and (3) final approval of this article. All authors declared that they have received no funding for conducting this study.

  • Competing interests None declared.

  • Patient consent No patients were included in this study. Nurses who participated in this study have signed informed consent.

  • Ethics approval This study lies outside the scope of the Medical Research Involving Human subjects Act and is therefore only informally reviewed by the ethics committee. They recommend that a formal review was not necessary. However, the study is performed in compliance with the principles of good clinical practice.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.