Psychological Well-Being, Depressive Symptoms, and Death-Related Meaning Among Palliative Care Nurse Practitioners in Israel: A Mixed-Methods Study.

Abstract

Introduction: Palliative care nurse practitioners work in sustained proximity to death, grief, and end-of-life decision, yet relatively little is known about how this role relates to psychological well-being and depressive symptoms.

Objectives: To examine subjective happiness, mental well-being, and depressive symptoms among palliative care nurse practitioners in Israel, and to explore how clinicians interpret repeated exposure to death in relation to these experiences.

Methods: An explanatory sequential mixed-methods study was conducted among certified palliative care nurse practitioners in Israel. In the quantitative phase, participants completed the Subjective Happiness Scale, the Mental Health Continuum-Short Form, and the Center for Epidemiologic Studies Depression Scale. In the qualitative phase, a focus group was conducted with survey respondents to explore meaning, coping, and death-related experiences. Descriptive statistics, internal consistency estimates, and Pearson correlations were used for the quantitative analysis. Qualitative data were analyzed using reflexive thematic analysis.

Results: Thirty-six nurse practitioners completed the survey and ten participated in the focus group. Participants reported moderate subjective happiness and mental well-being, while 44.4% scored above the threshold for elevated depressive symptoms on the depression screening measure. Qualitative analysis generated four themes: temporal reflections on death, cultural and societal meaning, existential struggle, and professional-personal identity intersections.

Conclusion: Palliative care nurse practitioners may sustain professional meaning while also carrying substantial depressive symptom burden. Institutional responses should move beyond informal self-care and include structured reflective support, mental health monitoring, and workforce policies that acknowledge the emotional consequences of repeated exposure to dying.