Improving the Quality of Nursing: Focus on Palliative Care and End-of-Life Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nursing".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 13100

Special Issue Editor


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Guest Editor
Statistics Unit, SOS Clinical Trial Center, SOC Infrastructure, Research and Statistics, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
Interests: biostatistics; palliative care; end-of-life; near death experiences (NDE); end-of-life dreams and visions (ELDV); psychedelic medicine

Special Issue Information

Dear Colleagues,

I am delighted to extend this invitation to you to contribute original articles to a forthcoming Special Issue of our esteemed scientific journal, entitled “Improving the Quality of Nursing: Focus on Palliative Care and End-of-Life Care”. The aim of this Special Issue is to bring together cutting-edge research and insights that will advance our understanding of, and interventions in, the crucial field of palliative care and end-of-life care within the nursing domain.

The provision of high-quality palliative care and end-of-life care is a cornerstone of healthcare worldwide, reflecting the ethical commitment to ensuring a dignified and comfortable transition for individuals facing life-limiting illnesses. Nursing professionals play a pivotal role in delivering these services, offering compassionate care and support to patients and their families during this challenging phase of life.

However, as the demand for palliative and end-of-life care continues to rise, the nursing community faces complex and evolving challenges. These challenges include the need for improved symptom management, enhanced communication skills, cultural competence, and the integration of new technologies into care delivery, all while adhering to the core principles of patient-centered, evidence-based care. Consequently, this Special Issue seeks to gather innovative research and practical insights that can empower nurses and healthcare teams to provide the highest quality palliative and end-of-life care.

We believe that your valuable contributions will make this Special Issue a comprehensive and informative resource for the global nursing community. Your research and insights have the potential to drive improvements in the quality of palliative care and end-of-life care, ultimately enhancing the lives of those facing life-limiting illnesses.

This Special Issue aims to provide cutting-edge information in order to achieve the following:

  • Enhancements in patient-centered care;
  • Advancements in evidence-based practices;
  • The fostering of multidisciplinary collaboration;
  • Addressing ethical challenges;
  • The promotion of education and training;
  • The promotion of quality-improvement initiatives;
  • Providing data, information, and directions that are useful in suggesting policy changes in this field of healthcare.

I encourage researchers, practitioners, and educators in the field of nursing to submit their original research articles, reviews, case studies, or empirical studies for consideration in this Special Issue. All submissions should follow the journal's guidelines and will undergo rigorous peer review.

Research areas may include (but are not limited to) the following:

  • Symptom management and pain control;
  • Communication and ethical decision making;
  • Cultural competence and diversity;
  • Integrating technology:
  • Education and training;
  • Quality assurance and measurement;
  • Methodological issues concerning the research in question.

I look forward to receiving your contributions.

Dr. Silvio Cavuto
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nursing
  • palliative
  • end-of-life
  • pain
  • hospice
  • dying
  • terminal

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Published Papers (7 papers)

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Research

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11 pages, 191 KiB  
Article
The Perspectives of General Practitioners on the Roles and Competences of Nurses During a Euthanasia Process: A Cross-Sectional Study
by Dennis Demedts, Rosalie-Marianne Mathé and Johan Bilsen
Healthcare 2025, 13(6), 595; https://doi.org/10.3390/healthcare13060595 - 8 Mar 2025
Viewed by 594
Abstract
Background: The legalization of euthanasia in Belgium in 2002 positioned nurses as possible participants in the euthanasia process. However, ethical and legal dilemmas necessitate clear definitions of their roles and competencies in this context. Given that general practitioners (GPs) are the primary medical [...] Read more.
Background: The legalization of euthanasia in Belgium in 2002 positioned nurses as possible participants in the euthanasia process. However, ethical and legal dilemmas necessitate clear definitions of their roles and competencies in this context. Given that general practitioners (GPs) are the primary medical professionals performing euthanasia, understanding their perspectives on the roles of nurses is crucial. Aim: This study aims to describe GPs’ perceptions of the roles and competencies of nurses during the euthanasia process. The research question addressed is as follows: “What are GPs’ views on the roles and competencies of nurses in euthanasia?”. Methods: A quantitative cross-sectional survey was conducted among licensed GPs in Flanders, Belgium. Data were collected via an online survey using Qualtrics and analyzed with SPSS Statistics. Ethical approval was obtained from the Medical Ethics Committee of the university. Results: The study included responses from 237 GPs. GPs value the roles and competencies of nurses, recognizing euthanasia as a multidisciplinary process. They acknowledge the critical support nurses provide to patients and their families. GPs assert that the administration of euthanasia medication should remain the exclusive responsibility of the GP. The analysis further indicated that demographic factors did not significantly influence the results. Discussion/Conclusions: GPs in Belgium generally rated the roles and competencies of nurses positively. Enhancing multidisciplinary collaboration, legislating the roles of nurses, and incorporating practical euthanasia training in nursing curricula, e.g., via simulations, are recommended. Full article
19 pages, 311 KiB  
Article
The Economic Cost of Nursing Care of Palliative Patients in the Emergency Department
by Tânia dos Santos Afonso, Manuel Luís Capelas and Lurdes Martins
Healthcare 2025, 13(4), 421; https://doi.org/10.3390/healthcare13040421 - 15 Feb 2025
Viewed by 407
Abstract
(1) Background: The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown. (2) Methods: An observational, retrospective, and analytical study was used encompassing the economic cost of nursing care in a general hospital emergency department that uses descriptive [...] Read more.
(1) Background: The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown. (2) Methods: An observational, retrospective, and analytical study was used encompassing the economic cost of nursing care in a general hospital emergency department that uses descriptive and inferential statistical analysis. (3) Results: We have a sample of 273 palliative patients in preventable hospital admissions (76.3%, CI 95%: 71.7–80.8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 h of complaints, mainly due to respiratory symptoms. Patients remained for approximately 24 h in the emergency department, totaling a median of EUR 180.98 in nursing care costs per admission. (4) Conclusions: It was evident that with the knowledge obtained about palliative economic nursing costs, we could increase results, manage resources, and consolidate PC integration in health systems, as this study proved. This study was not registered. Full article
18 pages, 1473 KiB  
Article
Impact of Symptom Distress on the Quality of Life of Oncology Palliative Care Patients: A Portuguese Cross-Sectional Study
by Florbela Gonçalves, Margarida Gaudêncio, Ivo Paiva, Valéria Andrade Semedo, Francisca Rego and Rui Nunes
Healthcare 2024, 12(23), 2487; https://doi.org/10.3390/healthcare12232487 - 9 Dec 2024
Viewed by 925
Abstract
Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient’s quality of life. In recent years, there has been a growing use of patient-reported outcome [...] Read more.
Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient’s quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights. Full article
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13 pages, 604 KiB  
Article
Complementary Musical Intervention for Patients in Palliative Care in Spain: A Randomized Controlled Trial
by Inmaculada Valero-Cantero, María Ángeles Vázquez-Sánchez, José Luis Casals-Sánchez, Milagrosa Espinar-Toledo, Juan Corral-Pérez and Cristina Casals
Healthcare 2024, 12(19), 1938; https://doi.org/10.3390/healthcare12191938 - 27 Sep 2024
Viewed by 1609
Abstract
Background: Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can [...] Read more.
Background: Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can be used to establish causal relationships and evaluate interventions; hence, nurses can strengthen evidence-based practices, leading to better patient outcomes and quality of care. Our study aimed to evaluate the impact of a 7-day pre-recorded music intervention on cancer symptoms and satisfaction in advanced-stage cancer patients receiving palliative care at home. Methods: This multicenter, double-blind, randomized, controlled clinical trial involved 80 Spanish cancer patients receiving palliative care at home, and was conducted from July 2020 to November 2021. The intervention group (n = 40) received self-selected pre-recorded music for 30 min daily over 7 days. The control group (n = 40) received pre-recorded basic health education sessions of equal duration and frequency. Symptoms and patient satisfaction were assessed before and after the intervention using the Edmonton Symptom Assessment System and the Client Satisfaction Questionnaire, respectively. Results: Comparing the intervention with the control group, significant improvements were observed in various symptoms: total symptom burden (p < 0.001), pain (p = 0.001), fatigue (p = 0.007), depression (p = 0.001), anxiety (p = 0.005), drowsiness (p = 0.006), appetite (p = 0.047), well-being (p ≤ 0.001), and sleep (p < 0.001); additionally, patient satisfaction was higher in the intervention group (p < 0.001). Conclusions: The 7-day pre-recorded music intervention reduced both physical and psychological symptoms in advanced-stage cancer patients receiving home-based palliative care, demonstrating significant alleviation of overall symptom burden and increased satisfaction with healthcare. Full article
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19 pages, 597 KiB  
Article
Exploring Nurses’ Emotional Resilience and Coping Strategies in Palliative and End-of-Life Care Settings in Saudi Arabia: A Qualitative Study
by Abdulaziz M. Alodhialah, Ashwaq A. Almutairi and Mohammed Almutairi
Healthcare 2024, 12(16), 1647; https://doi.org/10.3390/healthcare12161647 - 19 Aug 2024
Cited by 4 | Viewed by 6611
Abstract
Background: Nurses working in palliative and end-of-life care settings face significant emotional challenges due to the demanding nature of their profession. This study aimed to explore the emotional resilience of these nurses, understanding the factors that contribute to their resilience, the impact on [...] Read more.
Background: Nurses working in palliative and end-of-life care settings face significant emotional challenges due to the demanding nature of their profession. This study aimed to explore the emotional resilience of these nurses, understanding the factors that contribute to their resilience, the impact on their professional well-being and performance, and strategies to enhance resilience. Methods: A qualitative study was conducted involving 15 registered nurses from various healthcare facilities in Riyadh, Saudi Arabia. Data were collected through semi-structured interviews, document analysis, and observational data. Thematic analysis was employed to identify recurring themes. Results: The study identified three key themes: Emotional Challenges and Resilience-Building, Support Systems and Resources for Resilience, and Professional Growth and Fulfillment as Resilience Factors. The findings revealed the emotional toll of patient suffering, highlighting resilience-building strategies, such as peer support, mindfulness, and reflective practices. Support systems, including workplace support, organizational resources, and mentorship, were identified as crucial for fostering resilience. Professional growth, a sense of purpose, and recognition emerged as factors contributing to resilience. Conclusions: This study underscores the importance of emotional resilience for nurses in palliative and end-of-life care settings. Healthcare organizations can enhance resilience by implementing resilience training, providing counseling services, fostering a supportive culture, and offering professional development opportunities. Addressing the emotional needs of nurses is vital for their well-being and the delivery of compassionate care. Full article
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14 pages, 248 KiB  
Article
Proficiency and Practices of Nursing Professionals in Meeting Patients’ Spiritual Needs within Palliative Care Services: A Nationwide, Cross-Sectional Study
by Tina Košanski and Marijana Neuberg
Healthcare 2024, 12(7), 725; https://doi.org/10.3390/healthcare12070725 - 26 Mar 2024
Viewed by 1518
Abstract
Spirituality and spiritual needs are integral parts of the human experience, but they are often particularly important for palliative care patients. Spirituality has numerous positive effects, especially for those dealing with serious illness. Nevertheless, the spiritual dimension is sometimes overlooked in patient care. [...] Read more.
Spirituality and spiritual needs are integral parts of the human experience, but they are often particularly important for palliative care patients. Spirituality has numerous positive effects, especially for those dealing with serious illness. Nevertheless, the spiritual dimension is sometimes overlooked in patient care. This study aims to determine the frequency of addressing the spiritual needs of palliative care patients in Croatia and to investigate the self-perceived confidence of caregivers in this task. A quantitative cross-sectional study was conducted involving 194 nurses in specialised palliative care services across Croatia. A specially developed and validated questionnaire was used for this study. The most common intervention undertaken by respondents was “promoting hope and optimism in patients” (88.4%), while the least common intervention was “reading books and other publications to patients” (13.9%). No statistically significant differences were found in the frequency of spiritual care in relation to the respondent’s level of education, professional experience and nursing environment. Approximately two-thirds of the surveyed nurses stated that they “often” or “always” provided some kind of spiritual care to palliative care patients. However, study participants who indicated that they had received sufficient formal instruction in addressing spiritual needs and spiritual care interventions demonstrated a statistically significant tendency to engage in these practices, as well as greater confidence in their knowledge and skills in this area compared to those who lacked such training. The study suggests that there is a need to identify existing barriers to the provision of spiritual care and to develop strategies to overcome them. By placing emphasis on the spiritual needs and preferences of patients, nursing professionals and other healthcare providers have the opportunity to elevate the standard of holistic care and foster a sense of comfort and dignity among patients. Full article

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8 pages, 175 KiB  
Brief Report
Can ChatGPT Help General Practitioners Become Acquainted with Conversations About Dying? A Simulated Single-Case Study
by Filipe Prazeres
Healthcare 2025, 13(7), 835; https://doi.org/10.3390/healthcare13070835 - 6 Apr 2025
Viewed by 324
Abstract
Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors’ training, particularly with the use of artificial [...] Read more.
Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors’ training, particularly with the use of artificial intelligence (AI). This study aimed to evaluate whether OpenAI’s ChatGPT can simulate a medical communication scenario involving a GP consulting a patient who is dying at home. Methods: ChatGPT-4o was prompted to generate a medical communication scenario in which a GP consults with a patient dying at home. ChatGPT-4o was instructed to follow seven predefined steps from an evidence-based model for discussing dying with patients and their family caregivers. The output was assessed by comparing each step of the conversation to the model’s recommendations. Results: ChatGPT-4o created a seven-step scenario based on the initial prompt and addressed almost all intended recommendations. However, two points were not addressed: ChatGPT-4o did not use terms like “dying”, “passing away”, or “death”, although the concept was present from the beginning of the conversation with the patient. Additionally, cultural and religious backgrounds related to dying and death were not discussed. Conclusions: ChatGPT-4o can be used as a supportive tool for introducing GPs to the language and sequencing of speech acts that form a successful foundation for meaningful, sensitive conversations about dying, without requiring advanced technical resources and without placing any burden on real patients. Full article
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