Experiences of Hindu Nurses in Providing End-of-Life Care for Pacang Seda Patients in Bali, Indonesia: A Phenomenological Study

Agus Ari Pratama; Shanti Wardaningsih

doi:10.14710/nmjn.v15i3.70740

DOI: https://doi.org/10.14710/nmjn.v15i3.70740

Experiences of Hindu Nurses in Providing End-of-Life Care for Pacang Seda Patients in Bali, Indonesia: A Phenomenological Study

Agus Ari Pratama - Sekolah Tinggi Ilmu Kesehatan (STIKes) Buleleng, Indonesia

*Shanti Wardaningsih

- Master of Nursing Program, Universitas Muhammadiyah Yogyakarta, Indonesia

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{NMJN70740,
    author = {Agus Ari Pratama and Shanti Wardaningsih},
    title = {Experiences of Hindu Nurses in Providing End-of-Life Care for Pacang Seda Patients in Bali, Indonesia: A Phenomenological Study},
    journal = {Nurse Media Journal of Nursing},
  volume = {15},
    number = {3},
    year = {2025},
    keywords = {Dying patients; end-of-life care; nursing experience; Pacang Seda; peaceful death},
    abstract = {  Background:  The quality of nursing care for dying patients is influenced by nurses’ understanding of the signs of dying, which in Balinese Hinduism are contextualized through the concept of  Pacang Seda,  a near-death phase metaphorically described as emphasizing the attainment of a peaceful final moment. Empirical accounts of nurses’ experiences in caring for Pacang Seda patients remain limited, highlighting the need for more comprehensive and culturally informed insights.   Purpose:  This study aimed to explore the experiences of Hindu nurses in providing end-of-life care for  Pacang Seda  patients using a descriptive phenomenological approach.   Methods:  The study employed a qualitative research design with a descriptive-phenomenological approach. Purposeful sampling was conducted by interviewing Hindu nurses (n = 10) with specific experience caring for  Pacang Seda  patients. The interviews took place in their homes without any third party present to avoid bias. Data analysis followed the Colaizzi method, and data validation was conducted through follow-up discussions.   Results:  The analysis revealed four main themes derived from the experiences of Hindu nurses: (a) emotional responses, (b) the relationship between medical treatment and  Pacang Seda , (c) strengthening families, and (d) the integration of spiritual aspects into nursing practice. Nurses displayed emotional responses and facilitated connections between medical treatment and  Pacang Seda . They actively provided information to strengthen patients’ families and engaged in  Pacang Seda  care to facilitate a peaceful journey toward death.  Conclusion:  The study’s outcomes provide valuable insights into the experiences of Hindu nurses delivering end-of-life care in Bali, underscoring the significance of emotional responses, the interconnection between medical treatment and  Pacang Seda , the pivotal role of nurses in supporting families, and the specific practices associated with  Pacang Seda  care. These findings contribute to a broader understanding of cultural influences on nursing care, underscoring the need for tailored approaches to end-of-life care.},
   issn = {2406-8799},   pages = {469--483}  doi = {10.14710/nmjn.v15i3.70740},
    url = {https://ejournal.undip.ac.id/index.php/medianers/article/view/70740}
}

Citation Format:

Abstract

Background: The quality of nursing care for dying patients is influenced by nurses’ understanding of the signs of dying, which in Balinese Hinduism are contextualized through the concept of Pacang Seda, a near-death phase metaphorically described as emphasizing the attainment of a peaceful final moment. Empirical accounts of nurses’ experiences in caring for Pacang Seda patients remain limited, highlighting the need for more comprehensive and culturally informed insights.

Purpose: This study aimed to explore the experiences of Hindu nurses in providing end-of-life care for Pacang Seda patients using a descriptive phenomenological approach.

Methods: The study employed a qualitative research design with a descriptive-phenomenological approach. Purposeful sampling was conducted by interviewing Hindu nurses (n = 10) with specific experience caring for Pacang Seda patients. The interviews took place in their homes without any third party present to avoid bias. Data analysis followed the Colaizzi method, and data validation was conducted through follow-up discussions.

Results: The analysis revealed four main themes derived from the experiences of Hindu nurses: (a) emotional responses, (b) the relationship between medical treatment and Pacang Seda, (c) strengthening families, and (d) the integration of spiritual aspects into nursing practice. Nurses displayed emotional responses and facilitated connections between medical treatment and Pacang Seda. They actively provided information to strengthen patients’ families and engaged in Pacang Seda care to facilitate a peaceful journey toward death.

Conclusion: The study’s outcomes provide valuable insights into the experiences of Hindu nurses delivering end-of-life care in Bali, underscoring the significance of emotional responses, the interconnection between medical treatment and Pacang Seda, the pivotal role of nurses in supporting families, and the specific practices associated with Pacang Seda care. These findings contribute to a broader understanding of cultural influences on nursing care, underscoring the need for tailored approaches to end-of-life care.

Fulltext View|Download Email colleagues

Keywords: Dying patients; end-of-life care; nursing experience; Pacang Seda; peaceful death

Funding: Universitas Muhammadiyah Yogyakarta; Sekolah Tinggi Ilmu Kesehatan (STIKes) Buleleng

Article Metrics:

Article Info

Section: Articles

Language : EN

In Vol 15, No 3 (2025): (December 2025)

Most cited articles

Dyspnea Experience and Dyspnea Management in Patients with Chronic Obstructive Pulmonary Disease in Bangladesh Review: Anxiety and Quality of life in Patients with Myocardial Infarction Concept Analysis of Perceived Control Eating Behavior of Autistic Children Correlation between Coping Strategies and Quality of Life among Myocardial Infarction Patients in Nepal More cited articles

Agustina, H. R., Purba, C. I. H., Eriyani, T., Haroen, H., Fitri, S. U. R., Alshammari, M. A., Azwadina, A., & Ramdhani, M. Z. (2025). A scoping review of palliative care education for preregistration student nurses in the Asia Pacific region. Journal of Multidisciplinary Healthcare, 18, 2271–2280. https://doi.org/10.2147/JMDH.S501701
Ahmed, S. K. (2024). The pillars of trustworthiness in qualitative research. Journal of Medicine, Surgery, and Public Health, 2, 100051. https//doi.org/10.1016/j.glmedi.2024.100051ff
Alanazi, M. A., Shaban, M. M., Ramadan, O. M. E., Zaky, M. E., Mohammed, H. H., Amer, F. G. M., & Shaban, M. (2024). Navigating end-of-life decision-making in nursing: A systematic review of ethical challenges and palliative care practices. BMC Nursing, 23, 467. https://doi.org/10.1186/s12912-024-02087-5
Alshammari, F., Sim, J., McErlean, G., & Lapkin, S. (2023). Registered nurses’ beliefs about end-of-life care: A mixed method study. Nursing Open, 10(12), 7796–7810. https://doi.org/10.1002/nop2.2027
Becqué, Y.N., Rietjens, J.A.C., van der Heide, A., & Witkamp, E.A. (2021). How nurses support family caregivers in the complex context of end-of-life home care: A qualitative study. BMC Palliative Care, 20, 162. https://doi.org/10.1186/s12904-021-00854-8
Belak, R.M & Goh, K.H. (2024). Death anxiety and religiosity in a multicultural sample: A pilot study examining curvilinearity, age, and gender in Singapore. Frontier in Psychology, 15, 1398620. https://doi.org/10.3389/fpsyg.2024.1398620
Betriana, F., & Kongsuwan, W. (2019). Lived experiences of grief of Muslim nurses caring for patients who died in an intensive care unit: A phenomenological study. Intensive & Critical Care Nursing, 52, 9-16. https//doi.org/10.1016/j.iccn.2018.09.003
Blackwood, B., Albarran, J. W., & Latour, J. M. (2011). Research priorities of adult intensive care nurses in 20 European countries: A Delphi study. Journal of Advanced Nursing, 67(3), 550–562. https://doi.org/10.1111/j.1365-2648.2010.05512.x
Candrawati, S. A. K., Dwidiyanti, M., & Widyastuti, R. H. (2018). Effects of mindfulness with gayatri mantra on decreasing anxiety in the elderly. Holistic Nursing and Health Science, 1(1), 35–45. https://doi.org/10.14710/hnhs.1.1.2018.35-45
Connor, S. R. (Ed.). (2020). Global atlas of palliative care at the end of life (2nd ed.). Worldwide Hospice Palliative Care Alliance
Eiseman, F. B. (1989). Bali: Sekala and niskala: Essays on religion, ritual, and art. Periplus Editions
Ellina, A. D., Nursalam, N., Yunitasari, E., & Rusmawati, A. (2020). Patient satisfaction about nurse caring behavior based on Swanson’s theory of caring and transcultural nursing theory. International Journal of Psychosocial Rehabilitation, 24(9), 737–743. https://doi.org/10.61841/wvv29s72
Fadlilah N., Muhith, A., & Setiyowati, E. (2024). Nurses’ spiritual competence towards spiritual care and patient satisfaction: A systematic review. Journal of Applied Nursing and Health, 6(2), 545–556. https://doi.org/10.55018/janh.v6i2.256
Fitriyani, N., Juniarto, A. Z., & Utami, R. S. (2018). Life quality of end of life patient’s family in intensive care units. Indonesian Journal of Nursing and Midwifery, 6(1), 16–24. https://doi.org/10.21927/jnki.2018.6(1).16-24
Funk, L. M., Peters, S., & Roger, K. S. (2018). Caring about dying persons and their families: Interpretation, practice and emotional labour. Health & Social Care in the Community, 26(4), 519–526. https//doi.org/10.1111/hsc.12559
Giles, T. M., Hammad, K., Breaden, K., Drummond, C., Bradley, S. L., Gerace, A., & Muir-Cochrane. (2019). Nurses’ perceptions and experiences of caring for patients who die in the emergency department setting. International Emergency Nursing, 47, 100789. https//doi.org/10.1016/j.ienj.2019.100789
Haroen, H., Maulana, S., Harlasgunawan, A. R., Rahmawati, S., Riansyah, A., Musthofa, F., & Pardosi, J. F. (2024). Barriers and facilitators of early palliative care in the trajectory of people living with chronic condition: A mini review using socio-ecological framework to inform public health strategy. Journal of Multidisciplinary Healthcare, 17, 4189–4197. https://doi.org/10.2147/JMDH.S473457
Hochman, O., & Natan, B. M. (2017). Patient-centered care in healthcare and its implementation in nursing. International Journal of Caring Science, 10(1), 596-600
Im, E. O., & Lee, Y. (2018). Transcultural nursing: Current trends in theoretical works. Asian Nursing Research, 12(3), 157-165. https//doi.org/10.1016/j.anr.2018.08.006
Johnson, J. L., Adkins, D., & Chauvin, S. (2020). A Review of the quality indicators of rigor in qualitative research. American Journal of Pharmaceutical Education, 84, 7120. https://doi.org/10.5688/ajpe7120
Juwita, H., Prihatini, S., & Qasim, M. (2024). Palliative care and end of life interventions based on culture, religion, and belief: Qualitative. Science Midwifery, 12(4), 1616–1625. https://doi.org/10.35335/midwifery.v12i4.1728
Kasimovskaya, N., Geraskina, N., Fomina, E., Ivleva, S., Krivetskaya, M., Ulianova, N., & Zhosan, M. (2023). Russian nurses' readiness for transcultural care of palliative patients. BMC Palliative Care, 22, 87. https://doi.org/10.1186/s12904-023-01198-1
Khalaf, I. A., Al-Dweik, G., Abu-Snieneh, H., Al-Dake, L., Musallam, R. M., BaniYounis, M., Al-Rimawi, R., Khatib, A. H., Allah, A. H., Atoum, M. H., & Masadeh, A. (2018). Nurses’ experiences of grief following patient death: A qualitative approach. Journal of Holistic Nursing, 36(3), 228–240. https//doi.org/10.1177/0898010117720341
Kim, Y., & Kim, D-H. (2024). Interventions for family involvement enhance end-of-life care for hospitalized patients: An integrative review. BMC Nursing, 23, 917. https://doi.org/ 10.1186/s12912-024-02538-z
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications
Long, N. H., Thanasilp, S., Anh, T. T., Minh Chinh, N. T., & others. (2023). Death anxiety and its related factors among advanced nurse practitioner candidates: A cross-sectional study. Nursing Forum, 2023, 6403193. https://doi.org/10.1155/2023/6403193
Morandi, A., Thompson, J. L., Bellelli, G., Lucchi, E., Turco, R., Gentile, S., Trabucchi, M., MacLullich, A., Meagher, D., Ely, E. W., Pandharipande, P., & Smith, H. (2019). Delirium in patients with dementia and in children: Overlap of symptoms profile and possible role for future diagnosis. European Journal of Internal Medicine, 65, 44–50. https//doi.org/10.1016/j.ejim.2019.04.023
Morse, J. M., & Field, P. A. (2013). Nursing research: The application of qualitative approaches. Springer
Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2
Nissen, R. D., Viftrup, D. T., & Hvidt, N. C. (2021). The process of spiritual care. Frontiers in Psychology, 12, 674453. https://doi.org/10.3389/fpsyg.2021.674453
Paterson, L. A. & Maritz, J. E. (2024). Nurses’ experiences of the family’s role in end-of-life care. Health SA Gesondheid, 29, a2565. https://doi. org/10.4102/hsag.v29i0.2565
Perangin-angin, M. A. (2019). Pengetahuan dan sikap mahasiswa keperawatan tentang keperawatan paliatif di Universitas Advent Indonesia [Knowledge and attitudes of nursing students about palliative nursing at Universitas Advent Indonesia]. Klabat Journal of Nursing, 1(1), 88–95. https//doi.org/10.37771/kjn.v1i1.383
Persson H. Å., Sandgren, A., Fürst, C. J., Ahlström, G., & Behm, L. (2018). Early and late signs that precede dying among older persons in nursing homes: The multidisciplinary team’s perspective. BMC Geriatrics, 18, 134. https://doi.org/10.1186/s12877-018-0825-0
Pratama, A. A., & Wardaningsih, S. (2020). Nurses’ experiences in caring for dying patients: A literature review. JKKI Jurnal Kedokteran dan Kesehatan Indonesia, 11(3), 284-289. https://doi.org/10.20885/JKKI.Vol11.Iss3.art10
Ratnasari, F. R., Maria, J. C., & Sitanggang, Y. F. (2025). Nurses’ experiences of end-of-life care in ICU. NERS Jurnal Keperawatan, 21(1), 125–131. https://doi.org/10.25077/njk.v21i1.244
Rochmawati, E., Wiechula, R., & Cameron, K. (2016). Current status of palliative care services in Indonesia: A literature review. International Nursing Review, 63(2), 180-190. https://doi.org/10.1111/inr.12236
Rochmawati, E., Wiechula, R., & Cameron, K. (2018). Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study. Nursing and Health Sciences, 20(2), 231–237. https://doi.org/10.1111/nhs.12407
Rosser, M., & Walsh, H. (2014). Fundamentals of palliative care for student nurses (1st ed). Wiley-Blackwell
Sarıköse, S., & Çelik, S. Ş. (2024). Structural and psychological empowerment among newly graduated nurses and related factors: A mixed methods study. Journal of Advanced Nursing, 80(7), 2917-2928. https;//doi.org/10.1111/jan.16022
Selman, L. E., Chao, D., Sowden, R., Marshall, S., Chamberlain, C., & Koffman, J. (2020). Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians. Journal of Pain and Symptom Management, 60(2), e81–e86. https://doi.org/10.1016/j.jpainsymman.2020.04.024
Speziale, H. S., Streubert, H. J., & Carpenter, D. R. (2011). Qualitative research in nursing: Advancing the humanistic imperative. Lippincott Williams & Wilkins
Stahl, N. A., & King, J. R. (2020). Expanding approaches for research: Understanding and using trustworthiness in qualitative research. Journal of Developmental Education, 44(1), 26–28. http://www.jstor.org/stable/45381095
Suwendra, D. (2018). Anthology: Model of character education in Hinduism. Nilacakra
Swastika, I. K. (2008). Vrasphati Tattwa. Pustaka Bali Post
Umberger, W. & Wilson, M. (2024). Translating the biopsychosocial-spiritual model into nursing practice. Pain Management Nursing, 25(1), 1–3. https://doi.org/10.1016/j.pmn.2023.12.008
Utami, R. S., Pujianto, A., Setyawan, D., Naviati, E., & Rochana, N. (2020). Critical care nurses’ experiences of end-of-life care: A qualitative study. Nurse Media Journal of Nursing, 10(3), 260–274. https://doi.org/10.14710/nmjn.v10i3.31302
Wessner, P. B. (2018). Last chance to care: An autoethnography of end-of-life care in Indonesia. The Qualitative Report, 23(9), 2238–2250. https://doi.org/10.46743/21603715/2018.3309
Wang, L., Li, C., Zhang, Q., & Li, Y. (2018). Clinical nurses’ attitudes towards death and caring for dying patients in China. International Journal of Palliative Nursing, 24(1), 33-39. https://doi.org/10.12968/ijpn.2018.24.1.33
Widana, I. G. K., & Sriartini, N. M. (2020). Pendidikan agama Hindu bagi pramuwisata dalam rangka meningkatkan kepatuhan terhadap tata tertib kawasan suci Pura Tirta Empul [Education of Hindu religion for tour guides to increase adherence to the regulations of divine area of Pura Tirta Empul]. Widyanatya, 2(02), 1-10. https://doi.org/10.32795/widyanatya.v2i02.1041
Wilson, F., Wardani, E., Ryan, T., Gardiner, C., & Talpur, A. (2024). Barriers and mechanisms to the development of palliative care in Aceh, Indonesia. Progress in Palliative Care, 32(1), 22–28. https://doi.org/10.1080/09699260.2023.2256177
Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature Reviews Disease Primers, 6(1), 90. https://doi.org/10.1038/s41572-020-00223-4
World Health Organization. (2020, August 5). Palliative care (Fact sheet). https://www.who.int/news-room/fact-sheets/detail/palliative-care
Wulandari, M., & Muhith, A. (2024). Islamic spiritual care in supporting emotional stability in high care unit patients: A systematic review. Journal of Applied Nursing and Health, 6(2), 457–467. https://doi.org/10.55018/janh.v6i2.243

Last update:

No citation recorded.

Last update: 2026-03-09 01:19:39

No citation recorded.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Journal Author(s) Rights

In order for the Department of Nursing, Faculty of Medicine, Universitas Diponegoro to publish and disseminate research articles, we need non-exclusive publishing rights (transferred from the author(s) to the publisher). This is determined by a publishing agreement between the author(s) and the Department of Nursing, Faculty of Medicine, Universitas Diponegoro. This agreement involves the transfer or licensing of the copyright for publishing to the publisher, while authors still retain significant rights to use and share their own published articles. The Department of Nursing, Faculty of Medicine, Universitas Diponegoro supports the need for authors to share, disseminate, and maximize the impact of their research through these rights in any databases.

As the author(s), you have rights to a wide range of uses of your article, including use by your employing institution or company. These author rights can be exercised without the need to obtain specific permission. Authors publishing in the Nurse Media Journal of Nursing have extensive rights to use their works for teaching and scholarly purposes without needing to seek permission, including (but not limited to):

use for classroom teaching by the author or the author’s institution and presentation at a meeting or conference, including distributing copies to attendees;
use for internal training by the author’s company;
distribution to colleagues for their research use;
use in a subsequent compilation of the author’s works;
inclusion in a thesis or dissertation;
reuse of portions or extracts from the article in other works (with full acknowledgment of the final article);
preparation of derivative works (other than for commercial purposes) (with full acknowledgment of the final article);
voluntary posting on open websites operated by the author or the author’s institution for scholarly purposes;

following the open access license of the Creative Commons CC BY-SA License.

Authors, readers, and third parties can copy and redistribute the material in any medium or format, as well as remix, transform, and build upon the material for any purpose, even commercially, but they must give appropriate credit (including the name of the creator and attribution parties, detailed information about the authors, a copyright notice, an open access license notice, a disclaimer notice, and a link to the material), provide a link to the license, and indicate if changes were made. The publisher will indicate any modification of the material (if any) and retain an indication of previous modifications using a CrossMark Policy and information about Erratum-Corrigendum notifications.

Authors, readers, and third parties can read, print, and download, redistribute or republish the article (e.g., display it in a repository), translate the article, download it for text and data mining purposes, reuse portions or extracts from the article in other works, sell or reuse it for commercial purposes, remix, transform, or build upon the material. They must distribute their contributions under the same license as the original Creative Commons Attribution-ShareAlike (CC BY-SA).

Copyright Transfer Agreement for Publishing (Publishing Right)

The Authors submitting a manuscript do so on the understanding that if accepted for publication, non-exclusive right for publishing (publishing right) of the article shall be assigned/transferred to Publisher of the Nurse Media Journal of Nursing (Department of Nursing, Faculty of Medicine, Universitas Diponegoro).

Upon acceptance of an article, authors will be asked to complete a 'Copyright Transfer Agreement for Publishing (CTAP)'. An e-mail will be sent to the Corresponding Author confirming receipt of the manuscript together with a 'Copyright Transfer Agreement for Publishing' form by online version of this agreement.

Nurse Media Journal of Nursing and Department of Nursing, Faculty of Medicine, Universitas Diponegoro, the Editors and the Editorial Board make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in the Nurse Media Journal of Nursing are sole and exclusive responsibility of their respective authors and advertisers.

Please note that even though we ask for a transfer of copyright for publishing (CTAP), our journal Author(s) retain (or are granted back) significant scholarly rights as mentioned before.

The Copyright Transfer Agreement for Publishing (CTAP) Form can be downloaded here: [Copyright Transfer Agreement for Publishing (CTAP) Form NMJN 2024]

The copyright form should be signed electronically and send to the Editorial Office in the form of original e-mail below:

Dr. Sri Padma Sari (Editor-in-Chief)
Editorial Office of Nurse Media Journal of Nursing
Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Jl. Prof. Soedarto, Tembalang, Semarang, Central Java, Indonesia 50275
Telp.: +62-24-76480919; Fax.: +62-24-76486849
E-mail: media_ners@live.undip.ac.id

(This policy statements has been updated at 24th January 2024)

Experiences of Hindu Nurses in Providing End-of-Life Care for Pacang Seda Patients in Bali, Indonesia: A Phenomenological Study

Journal Author(s) Rights

Copyright Transfer Agreement for Publishing (Publishing Right)

OFFICE INFORMATION