The Lived Experiences of Psychospiritual Care Practices of Indonesian Nurses in Promoting End-of-Life Acceptance Among Patients Undergoing Hemodialysis
Abstract
Patients undergoing long-term hemodialysis frequently experience profound emotional, existential, and spiritual distress, making end-of-life acceptance an important yet often insufficiently addressed dimension of nursing care. Although nurses are uniquely positioned to provide sustained psychospiritual support across repeated dialysis encounters, limited evidence exists regarding how such care is enacted in routine hemodialysis practice. This study aimed to explore psychospiritual care practices among Indonesian nurses to promote patients' acceptance of end-of-life care among those receiving long-term hemodialysis. A qualitative descriptive study, guided by Husserlian phenomenology, was conducted at two referral hospitals in Indonesia. Ten purposively selected hemodialysis nurses participated as primary informants, while five patients were included solely as triangulation informants to corroborate contextual interpretations. Data were collected through semi-structured in-depth interviews between October and December 2025, transcribed verbatim, and analyzed using Colaizzi’s method. Three themes were identified: Facilitating spiritual meaning-making and existential acceptance in end-of-life care; Supporting patients in recognizing, managing, and reflecting on anger; and Strengthening connectedness, contribution, and spiritual purpose. These themes indicate that nurses promoted end-of-life acceptance by helping patients interpret illness within a spiritual-existential framework, transforming their anger into emotional insight, and reconstructing meaning in life through relationships, contributions, and a spiritually grounded purpose. Psychospiritual care thus emerged not as an additional task, but as a meaning-centred, relational, and nursing practice embedded in routine hemodialysis care. The findings highlight the strategic role of nurses in integrating culturally sensitive psychospiritual support into everyday practice to foster dignity, inner peace, and acceptance at the end of life.