Poured Out and Given: The Lived Experience of Self-Care Among Hospice Nurses in Rural Appalachia.

Hospice nurses encounter profound challenges that make self-care both essential and deeply complex. This study explored the lived experience of self-care among hospice nurses using an existential-phenomenological approach. Hospice nursing, characterized by its focus on comfort care and end-of-life support, presents unique emotional, physical, and ethical challenges that often lead to burnout and compassion fatigue. Phenomenological analysis revealed 4 central themes: Threads of Trust: Weaving Meaningful Connections; A Full Heart, an Empty Cup; When Caring Hurts: The Emotional Cost of Hospice Nursing (with 2 subthemes-The Cost of Grief and The Stigma and Misunderstood Nature of Hospice Work); and The System Forgot the Caregiver. Participants highlighted the emotional strain of hospice work. The participants shared their lived experiences, emphasizing the emotional demands of their work, sparse self-care practices, and a lack of organizational support. The findings suggest that practicing self-care must be augmented by other actions such as systemic changes, caseload limits, leadership training, and structured emotional support systems. This study highlights the urgent need for health care systems to prioritize hospice nurses' well-being and help sustain compassionate nursing care.