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Communication Vignettes: ‘What if I meet “Old Nick”, Nurse?’
  1. Helen Scott
  1. Helen Scott is Editor, End of Life Journal, and a palliative care nurse. Email:

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Regardless of whether or not older people have a life-limiting illness, they are aware that they are in the final stages of their lives. The very end phase of life can be a significant cause of distress (Lloyd-Williams et al, 2007; Gott et al, 2008). Death remains a mystery and, as it approaches, people may start to feel fearful of the unknown (Saunders, 1987). However, forthcoming death may also engender feelings of peace and acceptance (Lloyd-Williams et al, 2007), with some older people viewing death as an opportunity to be reunited with deceased loved ones (Gott et al, 2008). Whatever the individual outlook, approaching death often causes people to reflect on the meaning of their lives (Frankl, 1987; Saunders, 1987; Grant et al, 2004; Murray et al, 2004).

Although it is generally considered that UK society is becoming increasingly secular, in that the practice of religion is diminishing (King et al, 1994, 2006; Wilkinson and Coleman, 2010), many people still have spiritual convictions and believe in a ‘higher power’ (King et al, 1994, 2006). Therefore, nurses and other practitioners may find that patients, when talking about the meaning of life and forthcoming death, express themselves using religious vocabulary and ideology (Koffman et al, 2008a,b; Scott and Speck, 2010). For example, some patients worry that, following death, they will be judged harshly by a higher power for their actions during their lifetime (Saunders, 1987; Hydén, 1997; Goodhead, 2008; Kelly, 2008). Suffering may be perceived as ‘punishment’ for wrongdoing or failure to follow ‘God’s’ guidance (Grant et al, 2004; Murray et al, 2004; Curlin et al, 2005; Koffman et al, 2008a). Such feelings can cause despair at the end of life, which leads to escalating …

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