The nurses’ mean age was 35.8 ± 6.73 years (27–44), their working experience in the PCU ranged from 5 months to 7 years, and their overall work experience ranged from 5 to 23 years. 54.5% of the family caregivers were female, with a mean age of 43.09 ± 10.11 (27–54), while their patients’ hospitalization time ranged from 3 to 92 days. The family caregivers’ educational levels were as follows: primary (54.5%), high school (27.3%), vocational school (9.1%), and college (9.1%).

Theme-1: impacts of being in a palliative care unit

Within the theme “Impacts of being in a Palliative Care Unit,“ four sub-themes were identified namely, “Impacts on physical health”, “Psychological, emotional, and spiritual impacts”, “Economic impacts” and “Impacts on personal development and life”.

Impacts on physical health

Family caregivers expressed feelings of fatigue, struggles in providing care, and sleep deprivation while accompanying their patients in the PCU (Table 1, FC9).

Psychological, emotional, and spiritual impacts

Family caregivers conveyed feelings of sadness due to their patients’ suffering and their own inability to care for their families and/or children during this period. Consequently, they stated that they experienced overwhelming and intense stress, as well as feelings of helplessness, exhaustion, depression, and anger (Table 1, FC2 and FC6).

Also, nurses expressed that their work in the PCU had various effects on them. They highlighted that the predominant emotion they often encountered while working in the PCU was sadness. Nurses stated that witnessing death, especially the death of young patients makes them very sad (Table 1, N1).

Economic impacts

Some family caregivers stated that the treatment process of their patients economically affected them. Furthermore, employed family caregivers mentioned that the care process also affected their work life. Some family caregivers took leave from their jobs to be with their patients; whereas some others tried to continue both caregiving and work responsibilities simultaneously (Table 1, FC5).

Impacts on personal development and life

The majority of the nurses stated that their work in the PCU contributed to their personal development and altered their outlook on life. A majority of the nurses commented that working in a PCU provided them with some positive outcomes such as being sensitive, learning to be grateful, gaining a positive perspective in life, and developing empathy skills (Table 1, N4, N3 and N9).

Theme-2: coping methods

Based on the nurses’ statements, coping methods with the effects of being in the PCU were grouped in two sub-themes namely, “Avoidance” and “Acceptance”. Similarly, in consideration of the family caregiver’s expressions, their coping methods were grouped under two sub-themes: “Religious coping methods” and “Social support and sharing”.

The nurses stated that they often used avoidance and acceptance to cope with the problems being in the PCU. Some of the nurses stated that they abstain from establishing emotional bonds with patients to avoid being affected by working in the PCU. A majority of the nurses said they accepted that death was inevitable and got used to patient deaths (Table 1, N1).

On the other hand, the family caregivers stated that they used religious coping methods frequently and received social support to cope with difficulties. the family caregivers commented that they used some methods including praying, seeking refuge in God, being patient, getting support from relatives, and talking to relatives of other patients (Table 1, FC3 and FC1).

Theme-3: importance of spirituality and spiritual care

The nurses stated that spirituality and spiritual care provide family caregivers with motivation, a feeling of confidence and resilience, as well as help them to relieve, accept, and cope (Table 1, N8 and N1).

Family caregivers emphasized that spirituality and spiritual care help them be patient and bear with, feel relieved and safe (Table 1, FC4 and FC11).

Theme-4: spiritual care

Within the theme of “Spiritual Care,“ spiritual care practices offered by PCU nurses to family caregivers, the spiritual care needs of family caregivers, and the factors hindering nurses from providing spiritual care were identified from the viewpoints of both nurses and family caregivers.

Spiritual care practices

The spiritual care practices provided by nurses for family caregivers were allowing them to spend time with their patients, helping them to pray, showing a friendly approach, and directing them to the spiritual care department (Table 1, N9).

Some of the nurses stated that they direct family caregivers to pray according to their own faith (Table 1, N7 and N8).

On the other hand, family caregivers stated that the spiritual care practices they received in the PCU were the friendly approach of nurses and allowing them for praying (Table 1, FC1 and FC4).

Needs

According to the nurses, the needs of the family caregivers in the PCU are speaking, hoping, and getting informed about their patient’s status (Table 1, N4 and N3).

According to the family caregivers, their needs are a private room in the PCU for praying, continuous presence of Muslim religious officers, friendly attitudes of nurses, dialogue with and being relieved by the nurses, and hopeful speeches of doctors and nurses (Table 1, FC1 and FC9).

Barriers

According to the nurses, barriers to providing spiritual care were workload and large numbers of patients, insufficient number of nurses, lack of time, unsuitable physical conditions, and doctors’ attitudes (Table 1, N6, N9 and N10).

Some of the nurses commented that they feel inadequate in spiritual care, they lack information and want to receive train (Table 1, N1).

Table 1 Themes, sub-themes, and representative quotes