Legacy-oriented communication in routine spiritual care and nurse practitioner notes in long-term care: a qualitative document analysis

Legacy-oriented communication can preserve meaning, dignity, identity, and relational continuity near the end of life, but little is known about how it is recorded in routine clinical documentation. This study examined legacy-oriented communication in spiritual care and nurse practitioner (NP) narrative notes in long-term care palliative practice. It also examined how these notes linked patient meaning to bedside actions, continuity of care, and staff responses. This qualitative descriptive study used retrospective document analysis of de-identified spiritual care and NP narrative notes from a complex care long-term care unit in Jerusalem. Twenty-five notes representing three end-of-life trajectories, documented between January 2025 and December 2025, were purposively selected using a predefined operational definition of legacy-oriented communication. Data were analyzed using team-based thematic analysis with iterative codebook development, reflexive memos, peer debriefing, and an audit trail. Seven themes described legacy-oriented communication in routine documentation: caregiver-directed legacy messages; relational completion under family rupture; sensory and symbolic safe place interventions; identity narratives; emotional and existential disruption; autonomy and independent death; and documented interprofessional coordination and staff bereavement. In this dataset, interprofessional activity referred primarily to communication between the NP and spiritual care provider, with nursing leaders and bedside staff involved when recorded. Legacy appeared not as a single final message but as an evolving expression of what mattered to patients during medical and emotional instability. The notes linked meaning with accompaniment, identity, dignity, predictability, and relational continuity, and showed how clinicians translated these meanings into bedside care and team responses. Routine spiritual care and NP notes can make legacy-oriented communication visible as a clinically meaningful component of whole-person end-of-life care in long-term care. The findings support clearer narrative documentation and deliberate communication among spiritual care, NPs, nursing leaders, and bedside staff. Wider interdisciplinary involvement and formal team debriefing require prospective study because they were not consistently represented in the analyzed notes.