End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review

Aim: To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. Background: Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. Design: Qualitative systematic review. Data Sources: Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. Methods: The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. Results: Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. Conclusion: Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.