"We Desperately Need More Training": A Qualitative Exploration of Emergency Department Nurses’ Experiences with and Training Needs for End-Of-Life Communication

Abstract Background Approximately 75% of decedents aged ≥ 65 years visited the emergency department in their last six months of life, underscoring the emergency department as a pivotal setting for end-of-life communication. Nurses play a significant role in palliative care, however, little research has been performed on their end-of-life communication experiences and training needs. Methods A qualitative descriptive study reported with reference to the COREQ checklist was conducted. A total of 12 ED nurses from a tertiary hospital in Shenzhen, Guangdong Province, China, were recruited through a purposive sampling method. Semi-structured interviews were conducted from April to June 2026, audio-recorded, and transcribed verbatim. Data were analysed using qualitative content analysis with an inductive coding approach. Results Four overarching themes were identified, including: (1) Complex emotional experiences (Powerless and conflicted; Compassionate and sorrowful; Fear of communication missteps; Compassion fatigue; Sense of mission and achievement) ; (2) Multidimensional barriers (Environment-related; Patient-related; Family-related; Nurse-related barrier ) ; (3) Core knowledge and skills needs (Disease-related knowledge; Psychology-related knowledge; Breaking-bad-news skill; Empathy and emotion regulation skill) ; and (4) Expectations for future training (Specialized teaching content; Practical teaching method; Accessible teaching format) . Conclusions Participants perceived a need for practical and ED-specific EOL communication training. Future programs should adopt blended, simulation-based, and context-specific pedagogical frameworks to address the identified gaps.