Analyzing the Concepts of “Good Death” from the Perspective of Nursing: A systematic review and concept analysis

Abstract

Background: Words such as “dying well,” “dying peacefully,” “appropriate death,” “desired death,” “dignified death” and “good death,” are often used interchangeably. However, there is no clear definition of the concept of "good death" and its defining attributes. Further studies seem to be needed to clarify and develop the concept of “good death” and its attributes. This study aimed to analyze and clarify the concept of “good death”. Methods: A systematic literature search was conducted from 1980 to the end of 2020 using Magiran, SID, Scopus, Science Direct, PubMed, CINAHL, Google Scholar, ProQuest, Wiley, and Ovid, databases. The title, abstract, and keywords of the articles were searched using keywords of “death,” “dying,” “good death,” “quality of death,” “end of life preferences,” “quality of dying,” “attitude to death,” “terminal care,” “dignity,” “successful,” and “peaceful”. The Boolean search operators “AND” and “OR” were employed to merge search results. We also reviewed the reference lists of all retrieved articles to find other pertinent documents. Concept analysis was conducted using Walker and Avant’s eight-step method. The attributes, antecedents, consequences, and uses of the concept of “good death” were recognized. Results: A total of 7207 titles were identified; after elimination of duplicates, screening, and final selection, 36 relevant publications remained for analysis. The most common defining attributes of “good death” included compatibility with socio-cultural norms, personal experiences, being an ongoing process, having control and autonomy, and attention to religion and spirituality. Antecedents of a good death might vary for the dying person, the caregivers, and the family. The most important consequences of “good death” were mainly related to the family of the deceased (satisfaction with care providers, access to supports, respect, integrity, socially appropriate behavior, satisfaction with mourning, and reducing family grief), and those related to the care providers (quick passing of the process of mourning, being sure of doing their best for the patient and family, job satisfaction, a sense of self-worth and integration). Conclusion: The concept of “good death” was a dynamic process that its meaning heavily depends on the peoples lived experiences. It entails having control and autonomy, fulfilling the basic human needs, attention to religion and spirituality, and accompanies positive and peaceful lived experiences for the dying person, his/her family, and the caregivers. To provide patients with "good death" and quality end-of-life care, caregivers especially nurses should develop their knowledge and proficiency in end-of-life care.