What aged care nurses say they need for end-of-life care

Interviews with 64 residential aged care nurses from 14 residential aged care services in three Australian states offer insight into what these nurses need to consistently deliver quality end-of-life care. The research, led by Flinders University’s Research Centre for Palliative Care, Death and Dying (RePaDD), as part of the ELDAC (End of Life Directions for Aged Care) project, revealed that while deeply attuned to the needs of residents nearing the end of life, nurses are often constrained by limited resources, inefficiencies of care processes and limited training.

“As Australia’s population continues to age, nursing staff within our aged care system are at the frontline, with palliative and end-of-life care a core aspect of their job,” said Dr Priyanka Vandersman, from RePaDD and Flinders’ ELDAC team, and lead author on the study. “Just over one-third of deaths among Australians aged over 65 occur in residential aged care. With sector-wide reforms underway, including mandated care hours and 24/7 registered nurses, there is a strong need to ensure that quality care is not only being delivered, but also understood in practice.”

Part of the study’s findings were that nurses can often detect a prolonged period of irreversible decline through both clinical assessments and intuitive cues developed from long-term relationships with residents, this period lasting six to 12 months before death. Changes in behaviour, mood or social engagement were identified as some of the early signs, and serve as key opportunities for timely person-centred care planning.

“Participants described this pre-terminal phase as requiring a nuanced and proactive approach,” Vandersman said. “But time pressures, documentation demands, and a resource limitation can make it difficult for nurses to act on their insights.” Though what constitutes good end-of-life care is understood by nurses — and includes early planning, open communication, emotional support and comfort-focused practices — a key finding of the study was that nurses reported difficulty delivering this consistently.

Difficulties reported include situations where a limitation in resources led to unnecessary hospital transfers and being unable to remain with dying residents due to staffing shortages. “Good end-of-life care doesn’t begin in the final hours — it begins much earlier — and the system needs to recognise and support this,” said Professor Jennifer Tieman, co-author and RePaDD Director. “Nurses need support and time to identify early decline and respond with care that is aligned with each person’s needs and wishes.”

Dr Priyanka Vandersman and Professor Jennifer Tieman.

Findings from another recent study (doi.org/10.1016/j.jamda.2025.105686) — from the Registry of Senior Australians (ROSA) Research Centre and Flinders — that found no clear link between increased care minutes and improved resident experiences or clinical outcomes, further support the present study’s findings, which point to the value of complementing staffing reforms with broader support for clinical judgment, communication and person-centred care. This nurses’ interviews study was published open access in BMC Nursing in July 2025 — you can read it at doi.org/10.1186/s12912-025-03411-3.

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