Author Identifier
Date of Award
2026
Keywords
active dying, end-of-life care, nurses, nursing, acute hospital, acute care, recognition of dying, death recognition, qualitative research
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Bachelor of Science (Nursing) Honours
School
School of Nursing and Midwifery
First Supervisor
Davina Porock
Second Supervisor
Deborah Sundin
Abstract
Death is inevitable and may happen in many settings, but in our society, most deaths occur in acute hospital settings. As patients approach the end of life, timely recognition of active dying is essential to ensure a shift from curative interventions to comfort-focused, person-centred care. Nurses, due to their continuous patient contact, are uniquely positioned to identify the signs of imminent death and facilitate this transition. Despite the pivotal nature of their role, nurses face several barriers to accurately and consistently recognising when a patient is in the final stages of life. Delayed recognition of active dying frequently occurs in acute care hospitals where life-sustaining treatments are often administered until the final hours of life, despite the proximity of death, ultimately compromising the quality of care for dying and death.
Methods: This study aimed to explore nurses’ experiences and perceptions of recognising active dying in acute care settings and to evaluate the potential role of the Guide to Recognising Active Dying (GRAD) tool in supporting this process. The study was underpinned by a constructivist philosophical paradigm, which assumes that knowledge and meaning are constructed through social interaction and shaped by individual experiences within specific contexts. A descriptive qualitative design was adopted to provide rich insights into nurses’ experiences and perceptions. Semi-structured interviews were conducted with six registered nurses with 2-20 years of clinical experience, working across acute care settings in Perth, Western Australia. Data were collected through face-to-face audio-recorded interviews, transcribed verbatim, and uploaded to NVivo for analysis. Data analysis was guided by thematic analysis.
Findings: Four key themes were identified: (1) Scared to Name Death, which captured the reluctance to acknowledge dying in acute hospital settings explicitly; (2) Just Stick to the Plan, showing the influence of established treatment plans, hierarchical decision-making, and clinical momentum that delayed transitions to palliative care; (3) What Happened to the Big iii Picture?, highlighting an overreliance on physiological parameters and fragmented clinical assessment, often at the expense of recognising the overall trajectory of decline; (4) Carrying the weight of death in silence which described the emotional labour of nurses, including the suppression of personal feelings to maintain professionalism and provide compassionate care. Finally, the GRAD tool evaluation, where participants identified its potential role in supporting recognition of dying by providing a structured framework that collates all signs and symptoms in one place, making active dying more visible, especially to inexperienced nurses, and aiding communication among healthcare teams by providing evidence of active dying.
Discussion: The findings indicate that delayed recognition of active dying is not simply a matter of individual clinical judgement but is also shaped by organisational practices, hierarchical dynamics, and a persistent curative focus within acute care. These factors contribute to treatment continuation even when death is imminent, limiting opportunities for timely transitions to palliative care. Recognition of dying is further complicated by overreliance on measurable physiological parameters rather than holistic assessment and clinical experience. The study suggests that tools such as the GRAD tool may support earlier recognition by consolidating all symptoms on a single page and facilitating communication among healthcare professionals.
Implications: This study emphasises the need for specific education in recognising dying and end-of-life care in general, greater support for shared decision making within hierarchical systems, and organisational shifts to embed recognition of dying in healthcare systems, which may foster early recognition of dying and promote more dignified, patient-centred end-of-life care in acute settings.
Access Note
Access to this thesis is embargoed until 1st September 2027
Recommended Citation
Kemei, V. J. (2026). The experiences and perceptions of nurses recognising active dying in acute hospital settings in Perth, Western Australia: A descriptive qualitative study. Edith Cowan University. https://ro.ecu.edu.au/theses_hons/1634