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A recent study shows that the greatest fear for many Britons is to die alone. More than half the complaints received by the UK National Health Service (NHS) concern end-of-life care, with an emphasis on spiritual matters. Much has been written on the spiritual needs of the dying, but many doctors and nurses still find this a difficult area to approach. They lack the confidence and/or training to recognize or discuss spiritual aspects of death and dying or to affirm the spiritual needs of the dying person. Our end-of-life experience (ELE) research suggests that deathbed visions (DVs) and deathbed coincidences (DCs) are not uncommon, and that the dying process appears to involve an instinctive need for spiritual connection and meaning, requiring compassionate understanding and respect from those who provide end-of-life care.

This article presents an interim study into the end-of-life experiences of elderly residents in a Gloucestershire nursing home as reported by nurses and care assistants. It draws comparisons between the experiences of an end-of-life experiences pilot study conducted with the Camden Palliative Care Team in the United Kingdom with those of the nursing home staff to consider whether the dying experience of elderly nursing home residents is the same as those whose lives are foreshortened through terminal illness. It draws the conclusion that elderly residents have end-of-life experiences similar to those described in the Camden pilot study. It also examines the effect that end-of-life experiences have on the carers and reflects on possible needs for specialized training and support to deal with such existential issues.

Anecdotal evidence suggests that death may be heralded by deathbed phenomena (DBP) such as visions that comfort the dying and prepare them spiritually for death. Medical practitioners have been slow to recognize DBP, and there has been little research into the spiritual effect that DBP have on caregivers or on how these phenomena influence their work. A pilot study looking into the occurrence of DBP was conducted by the palliative care team at Camden Primary Care Trust. Interviews revealed that patients regularly report these phenomena as an important part of their dying process, and that DBP are far broader than the traditional image of an apparition at the end of the bed. Results of the interviews raise concerns about the lack of education or training to help palliative care teams recognize the wider implications of DBP and deal with difficult questions or situations associated with them. Many DBP may go unreported because of this. Results of this pilot study also suggest that DBP are not drug-induced, and that patients would rather talk to nurses than doctors about their experiences.

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