Nurse Perceptions of End-of-Life Care Quality Across Long-Term Care, Home, and Social Model Hospice Home Settings: A Qualitative Descriptive Study

This qualitative descriptive study explored nursing perspectives on end-of-life care quality across 3 distinct community settings: long-term care facilities, patients' homes, and social model hospice homes. Nurses provide most of the direct end-of-life care in these settings, yet their perspectives remain understudied. Their perspective is essential for improving end-of-life care quality and supporting patients and families during this critical time. Semi-structured interviews were conducted with 11 licensed nurses who had provided end-of-life care across all 3 settings. Participants were recruited through the Omega Home Network and professional nursing networks. Thematic analysis using constant comparative methods was employed. Member checking and independent secondary analysis ensured trustworthiness. Analysis revealed 4 major themes: (1) setting-based care disparities, (2) nurses as educators and translators, (3) mediation of caregiver burden across settings, and (4) relationship-based care as foundational for peaceful deaths. Care setting profoundly influenced these nurses' ability to deliver quality end-of-life care. Findings may have global relevance for hospice and palliative care practice, highlighting the need for systemic changes in institutional long-term care, enhanced support for family caregivers and staff caregivers across settings and recognition of social model hospice homes as a viable alternative for patients lacking adequate home resources.