BACKGROUND:In primary care (PC), nurses ensure continuity and person-centered care, fostering long-term relationships with patients and caregivers. How mutuality, a relational process closely linked to patient-centered communication, develops in this context remains underexplored. AIMS:To describe the characteristics of mutuality and explore how it develops in the relationships between nurses and care recipients in a PC setting. METHOD:A qualitative descriptive study was conducted in a PC setting. Participants included 14 nurses trained in Family and Community Nursing and 27 care recipients (patients and family caregivers). Data were collected between May and July 2024 through semistructured interviews. A total of 28 interviews were conducted, including both individual and dyadic interviews with patients and caregivers. Data were analyzed using framework analysis, guided by a conceptual framework on mutuality in the nurse-patient relationship. The framework focused on influencing factors, the mutuality process, and outcomes. RESULTS:Findings from 28 interviews revealed that mutuality was influenced by both organizational and personal factors. Nursing care delivery models that ensured continuity of care and nurse autonomy supported trust, stable, and long-term relationships. The process of mutuality unfolded progressively through three dimensions: (1) building and going beyond the formal encounter, (2) being a consistent point of reference, and (3) deciding and sharing care. Mutuality emerged as a co-constructed relationship, shaped by clear communication, trust, and shared responsibilities, with informal caregivers recognized as integral participants. Outcomes included strengthened professional identity and satisfaction for nurses and improved emotional well-being, self-care, and self-efficacy for care recipients. CONCLUSION:In PC, mutuality transforms task-oriented interactions into meaningful, trust-based relationships, enhancing patient-centered communication and shared decision-making. Care continuity and autonomy, combined with investment in relational skills, are essential to sustain mutuality, improve communication, and enhance care quality.

AIM:To estimate the incidence of unplanned transfers to the emergency department among nursing home residents and to identify resident and organizational factors associated with transfer risk. DESIGN:A 12-month prospective multicentre dynamic cohort study. METHODS:The study was conducted in nine nursing homes in a northern Italian region between July 2023 and June 2024. All long-stay residents aged 65 years or older were included and followed for up to 12 months. RESULTS:A total of 643 residents were included; 204 residents experienced at least one unplanned transfer, accounting for 271 events during follow-up. The incidence of first transfers was 4.47 per one hundred resident-months and varied across facilities. At the resident level, recent admission, a higher number of chronic conditions and dependence in eating were associated with a higher likelihood of transfer, whereas female sex was associated with a lower likelihood. At the organizational level, larger bed capacity was associated with a lower risk of transfer. In contrast, the presence of a physician on site and a higher ratio of general practitioners to residents per occupied bed were associated with increased transfer risk. CONCLUSIONS:Unplanned transfers from nursing homes to the emergency department are frequent. Strategies to reduce transfers should address resident vulnerability and organizational characteristics. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:Nurses should recognize the early period after admission as a critical window for risk stratification and advance care planning and consider how resident vulnerability and organizational characteristics influence transfer patterns. IMPACT:Prospective evidence on unplanned transfers from nursing homes in Europe is limited. Nearly one third of residents experienced at least one transfer, highlighting the importance of addressing multimorbidity, functional dependence and organizational features when planning prevention strategies. REPORTING METHOD:The study adheres to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

INTRODUCTION:Historical, geographic, and contextual variation in nursing titles and the multitude of labels for different roles have hindered the creation of a clear map outlining nursing roles in home care settings for older people. OBJECTIVE:This scoping review aimed to explore the literature on nurses' roles in home care for older people. METHODS:A literature search was conducted using Embase, CINAHL, and Medline by two independent reviewers. RESULTS:Out of 1973 references, 14 studies from eight countries were included, primarily from the United Kingdom (n = 6), the United States (n = 2), and Italy (n = 2). Twelve distinct nursing roles were identified, addressing health issues such as cardiovascular disease, mental health disorders, and diabetes. The most frequent nursing activities performed were assessment-related (32%). CONCLUSION:The findings indicate the presence of diverse nursing roles in home care and highlight the significant heterogeneity in nursing activities performed.

This systematic review aims to evaluate the impact of multimedia education compared to standard approaches for people with central venous access devices for long-term use. We systematically searched PubMed, Embase, and CINAHL Complete until January 2025. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment. Ten studies were identified (832 patients), including six randomized controlled trials and four quasi-experimental studies. Seven multimedia educational programs used asynchronous methods (e.g. pre-recorded videos or presentations), while three employed synchronous approaches (e.g. tele-visits or virtual communities). Five studies assessed short-term knowledge, with two showing significant improvements and three reporting no differences. Skill acquisition improved in two studies. Cumulative catheter complications decreased in two studies, though findings on specific issues were mixed. These findings suggest potential benefits of multimedia education in patient care, but methodological limitations and study variability render the evidence inconclusive, underscoring the need for high-quality research.

Objective:The objective of this review is to identify and map the available evidence on interventions for heart failure dyads through telemedicine.Introduction:Heart failure is a chronic and progressive condition that requires significant lifestyle changes and daily support from informal caregivers. Due to the shared burden of care, the patient-caregiver dyad should be treated as a single unit in the management of the disease. Although telemedicine interventions for dyads are increasing, their application for dyads with heart failure remains largely unexplored, revealing a critical gap in the field.Eligibility criteria:We will include all quantitative, qualitative, and mixed methods studies focusing on adult dyadic interventions for heart failure delivered via telemedicine. Studies involving dyads who do not share the same household will also be considered. Dyadic interventions aim to reduce discrepancies between patients and caregivers in their approach to the disease (dyadic appraisal), foster greater collaboration in planning appropriate responses to the disease (dyadic behavior), and improve the overall health status of both individuals (dyadic health). These interventions can be provided by various health care professionals using any device.Methods:The scoping review will be conducted according to JBI methodology for scoping reviews. We will comprehensively search electronic databases, including PubMed, CINAHL, Web of Science, and Embase. Gray literature will also be considered. Two independent reviewers will screen the studies according to predefined criteria. Data extraction will be performed using a customized tool. Review findings will be analyzed and displayed using charting techniques in table format.Review registration:OSF osf.io/nwafp

AIM:To assess and synthesise evidence on short peripheral intravenous catheter (sPVC) management training programmes and evaluate their effectiveness in reducing early sPVC failure in hospitalised patients. BACKGROUND:Modifiable risk factors, including choice of catheter, site of insertion, early recognition of complications and provider expertise, play a critical role in sPVC failure, highlighting the need for targeted educational programmes to improve provider skills and adherence to evidence-based practices. DESIGN:A systematic review was employed following the PRISMA guidelines. METHODS:A systematic search was conducted across four databases-PubMed, Embase, CINAHL and the Cochrane CENTRAL. Only randomized controlled trials (RCTs) evaluating training programmes for sPVC management in healthcare professionals, with outcomes related to sPVC failure, were included. Risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs. The protocol was registered in PROSPERO (CRD42023444364) and the search covered studies published up to June 20, 2024. RESULTS:The search strategy retrieved 12,253 articles, of which three were included. These reported a significant reduction in sPVC failure in the intervention groups, with reductions ranging from 8 % to 29 %. However, no improvements were found in individual outcomes (occlusion, dislodgment, infiltration, infection). The included studies exhibited substantial heterogeneity in training programme characteristics, including duration, content and delivery methods. CONCLUSION:Structured training programmes can help reduce sPVC failure rates, despite variations in programme implementation. Short- and long-term programmes showed benefits, with long-term training supporting sustained adherence to evidence-based practice despite requiring more resources. A small number of studies prevent definitive conclusions about overall effectiveness.

The COVID-19 pandemic significantly impacted emergency department (ED) visits by nursing home (NH) residents, leading to notable shifts in visit rates, characteristics, and outcomes over time. This retrospective study analyzed all-cause ED visits among NH residents aged over 65 at a large Italian hospital from 2019 to 2022. Non-COVID-19 visits declined sharply by 63.8% in 2020 and continued to remain below pre-pandemic levels in the following years. Compared to 2019, the risk of respiratory disease-related visits decreased significantly in 2021 and 2022. Conversely, the risk of mental health-related visits, particularly for neurotic disorders, increased significantly, with a threefold rise in 2021 and a fourfold rise in 2022. Similarly, fracture-related visits nearly doubled in 2021 and remained high in 2022. These findings underscore the pandemic's enduring effects on the health of NH residents and highlight the critical need to strengthen healthcare systems to effectively manage future health crises.

The aging population is becoming a growing challenge for health care systems, pushing toward the need for systemic adaptations. In Italy, the role of the Family and Community Nurse (FCN) was introduced as a response to these demographic changes, aimed at ensuring personalized and integrated care for the older adults at the national level. Despite national institutional recognition, the implementation of the FCN role varies considerably across regions, resulting in uneven and fragmented service delivery. To better understand this variability, the present study aimed to describe the perceived barriers and facilitators influencing the delivery of community-based care to older adults. A qualitative descriptive study was conducted, from December 2023 to May 2024, using semi-structured interviews on a purposive sample. Forty-one FCNs from four Italian regions were interviewed. The interviews were transcribed verbatim and analyzed using Qualitative Content Analysis, supported by NVivo software. Under the overarching theme reflecting the barriers and facilitators that influence the delivery of family and community nursing care to older adults, six sub-themes and thirteen categories were identified. The key barriers were the misalignment between strategic leadership level and managerial and operational levels, shortages of instrumental and human resources, heterogeneity and fragmentation of nursing documentation, lack of uniformity of the training pathways and, limited recognition of the FCN role. The most frequent facilitators were current regulations and national policies, the support and collaboration of local organizations and local political institutions, as well as the expansion of interprofessional collaborations. The study emphasizes the need for targeted interventions to strengthen the governance of the FCN role, ensuring greater integration between policy directives, resources, training, and organizational practice. This requires coordinated efforts among health care institutions, universities, and professional organizations to create a system that not only adequately trains FCNs but also ensures their functional and effective placement within community-based care. Not applicable.

Poor treatment adherence and lack of self-care behaviors are significant contributors to hospital readmissions of people with heart failure (HF). A transitional program with non-invasive telemonitoring may help sustain patients and their caregivers to timely recognize signs and symptoms of exacerbation.We will conduct a Randomized Clinical Trial (RCT) to evaluate the feasibility and acceptability of a 6-month supportive intervention for patients discharged home after cardiac decompensation. Forty-five people aged 65 years and over will be randomized to either receive a supportive intervention in addition to standard care, which combines nurse-led telephone coaching and a home-based self-monitoring vital signs program, or standard care alone. Four aspects of the feasibility will be assessed using a mixed-methods approach: process outcomes (e.g., recruitment rate), resources required (e.g., adherence to the intervention), management data (e.g., completeness of data collection), and scientific value (e.g. 90- and 180-day all-cause and HF-related readmissions, self-care capacity, quality of life, psychological well-being, mortality, etc.). Participants will be interviewed to explore preferences and satisfaction with the intervention. The study is expected to provide valuable insight into the design of a definitive RCT.

Maintaining good oral hygiene is essential for preventing and managing oral health problems. This systematic review aimed to identify and assess clinical practice guidelines on oral hygiene, focusing on quality and key areas. A comprehensive search was conducted in PubMed, CINAHL, Scopus, Cochrane, and organizational websites. Guidelines from health organizations that focused on oral health, hygiene education, and disease prevention were included. Guidelines based on expert opinions and those focusing on specific pathologies were excluded. The AGREE II tool was used to evaluate quality, and a narrative synthesis summarized recommendations across pediatric, adult, and senior age groups. Nine studies were reviewed. Results showed that electric toothbrushes do not significantly outperform manual ones in preventing cavities, though they may reduce plaque. Fluoride toothpaste is less effective if followed by rinsing with water. For adults, mouthwashes with chlorhexidine or sodium fluoride are recommended. Checkups every six months are advised for healthy children and adults. Proper denture care is also emphasized. Regular updates to oral care guidelines are necessary, as oral health affects essential functions and social well-being.

In Italy, the Family and Community Nurse (FCN) was officially recognized with Legislative Decree 34/2020 and redefined by Ministerial Decree 77/2022. The introduction of the FCN has been inconsistent across the nation, leading to fragmented experiences and challenges in fully integrating the role into the healthcare system. Based on Cohen’s hermeneutic approach, this phenomenological study explores the lived experiences and meaning of being an FCN in Italy. Semi-structured interviews were conducted from December 2023 to June 2024. Interviews were transcribed, read in-depth and analyzed. Thirty-seven FCNs from four Italian regions were interviewed. Four main themes were identified: (a) Navigating elderly care complexity; (b) Education as a core function; (c) Being a node in the healthcare network; (d) Establishing the FCN identity through role differentiation. Being a FCN means managing complex needs, ensuring continuity of care, and collaborating effectively with the other primary care providers. FCNs distinguish themselves from task-oriented home care nurses by embracing a proactive approach, gaining greater organizational autonomy and actively shaping their professional identity. The implications for practice suggest the need to support FCNs in this consolidation phase through health policies that enhance their contribution to community care.

Objective To synthesize evidence assessing the effectiveness of quality improvement (QI) interventions in reducing hospital service use from nursing homes (NHs). Design Systematic review and meta-analysis of randomized controlled trials (RCTs), controlled before-after (CBA), uncontrolled before-after (UBA), and interrupted time series studies. Searches were conducted in MEDLINE, CINAHL, The Cochrane Library, Embase, and Web of Science from 2000 to August 2023 (PROSPERO: CRD42022364195). Setting and Participants Long-stay NH residents (>30 days). Methods Included QI interventions using a continuous and data-driven approach to assess solutions aimed at reducing hospital service use. Risk of bias was assessed using JBI tools. Delivery arrangements and implementation strategies were categorized through EPOC taxonomy. Results Screening of 14,076 records led to the inclusion of 22 studies describing 29 QI interventions from 6 countries across 964 NHs. Ten studies, comprising 4 of 5 RCTs, 3 of 4 CBAs, and 1 of 12 UBAs were deemed to have a low risk of bias. All but 3 QI interventions used multiple component delivery arrangements (median 6; IQR 3-8), focusing on the “coordination of care and management of care processes” alone or combined with “changes in how, when, where, and by whom health care is delivered.” The most frequently used implementation strategies were educational meetings (n = 25) and materials (n = 20). The meta-analysis of 11 studies showed a significant reduction in “all-cause hospital admissions” for QI interventions compared with standard care (rate ratio, 0.60; 95% CI, 0.41-0.87; I2 = 99.3%), with heterogeneity due to study design, QI intervention duration, type of delivery arrangements, and number of implementation strategies. No significant effects were found for emergency department (ED) visits or potentially avoidable hospitalizations. Conclusions and Implications The study provides preliminary evidence supporting the implementation of QI interventions seeking to reduce hospital admissions from NHs. However, these findings require confirmation through future experimental research.

OBJECTIVE:The objective of this scoping review is to explore how wearable technology is being used to care for older adults in long-term care facilities. INTRODUCTION:The use of digital health technologies to support care delivery in long-term care facilities for older adults has grown significantly in recent years, especially since the COVID-19 pandemic. Wearable technology refers to devices worn or attached to the body that can track a variety of health-related data, such as vital signs, falls, and sleep patterns. Despite the evidence that wearable devices are playing an increasing role in older adults' care, no review has been conducted on how wearable technology is being used in long-term care facilities. INCLUSION CRITERIA:This review will consider studies that include people aged over 65, with any health condition or level of disability, who live in long-term care facilities. Primary and secondary studies using quantitative, qualitative, and mixed methods study designs will be included. Dissertations and policy documents will also be considered. METHODS:Data sources will include comprehensive searches of electronic databases (MEDLINE, Embase, CINAHL, and Scopus), gray literature, and reference scanning of relevant studies. Two independent reviewers will screen titles, abstracts, and full texts of the selected studies. Data extraction will be performed using a tool developed by the researchers. Data will be mapped and analyzed. Descriptive frequencies and content analysis will be included, along with the tabulated results, which will be used to present the findings with regard to the review objectives. REVIEW REGISTRATION:Open Science Framework https://osf.io/r9qtd.

Background: The Fundamentals of Care framework emphasizes a patient-centered approach that prioritizes the nurse–patient relationship and care environment to meet patients’ basic needs, including oral hygiene. Recognized as crucial for preventing systemic health problems, oral care neglect is a global concern. Studies identify missed oral care as a widespread issue, contributing to significant patient safety risks. This study aimed at measuring missed nursing care occurrence in a Northern Italian university hospital, exploring the association between missed oral care with nursing staff characteristics and oral care policies. Methods: A single-center cross-sectional study was conducted according to the STROBE guidelines. Data collection was performed in May 2022 using the MISSCARE survey, a self-administered questionnaire sent by email to 473 nurses from all inpatient units. The degree of implementation of oral care policies was obtained by accessing the Facility Score Sheet data at the department level. Descriptive statistics, chi-square tests, and Fisher tests were conducted using SAS 9.4 and R software. Results: Providing oral care was the third-most missed nursing care after rotating patients every two hours and walking them three times daily. The reasons for missed care included resource shortage and high patient turnover. The Facility Score Sheet data showed a low adoption of oral care policies. No significant associations were found between missed oral care and both nurses’ characteristics and oral care policy at the department level. Conclusions: The study confirms highly missed oral care in acute care settings, emphasizing the urgent need for systemic changes via an evidence-based oral care policy and practice implementation. This study was prospectively registered under protocol 293 CE 050/2022 (8 Aril 2022).

Introduction Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. Methods and analysis The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools. The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I 2 or H 2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. Ethics and dissemination Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. PROSPERO registration number CRD42022364195.

Background:The Coronavirus disease 2019 (COVID-19) pandemic negatively impacted nursing students' opportunity to gain experience through clinical placement, potentially threatening their readiness for practice and their clinical competence. The aim of this study was to explore whether and to what extent the third-year undergraduate nursing students perceived that their readiness for practice was impacted by changes to clinical placement and classroom learning implemented in response to the COVID-19 pandemic.Study design:Cross-sectional study.Methods:The study was conducted in a university of North-western Italy that provides nursing education across five sites. All sites stopped in-person classroom learning at the beginning of March 2020, but each site was free to decide whether to continue in-person clinical placement based on the local epidemiological situation. All 228 third-year nursing students who completed their degree by June 2020 were invited to participate. Data were collected via online questionnaire, which included the question "What impact do you think that COVID-19 safety measures employed by your nursing programme had on your readiness for practice?" Answers were given on a 5-point Likert scale (none, minimal, moderate, major, and severe). Explanatory variables were collected at the individual, nursing programme, and university site levels.Results:A total of 126 (response rate 55.3%) nursing students completed the questionnaire. Overall, 84 (66.7%) perceived that COVID-19 safety measures had a moderate to severe impact on their readiness for practice. These students often had lower grade point averages (p=0.037) and received no clinical placement during the pandemic (72.6% vs 90.5% of students who reported no or minimal impact, p=0.022). Average duration of third-year clinical placement was also lower among these students, though it was not statistically significant. No differences emerged at the university site level.Conclusions:Despite important advances in technology-based educational activities, clinical placement remains the best educational strategy to allow nursing students to feel prepared to work effectively during a pandemic.

Background: Most people with dementia transition into nursing homes as their disease progresses. Their family caregivers often continue to be involved in their relative's care and experience high level of strain at the end of life. Aim: To gather and synthesize information on interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes and provide a set of recommendations for practice. Design: Mixed-Methods Systematic Review (PROSPERO no. CRD42020217854) with convergent integrated approach. Data sources: Five electronic databases were searched from inception in November 2020. Published qualitative, quantitative, and mixed-method studies of interventions to support family caregivers of people with advanced dementia at the end of life in nursing home were included. No language or temporal limits were applied. Results: In all, 11 studies met the inclusion criteria. Data synthesis resulted in three integrated findings: (i) healthcare professionals should engage family caregivers in ongoing dialog and provide adequate time and space for sensitive discussions; (ii) end-of-life discussions should be face-to-face and supported by written information whose timing of supply may vary according to family caregivers' preferences and the organizational policies and cultural context; and (iii) family caregivers should be provided structured psychoeducational programs tailored to their specific needs and/or regular family meetings about dementia care at the end of life. Conclusion: The findings provide useful information on which interventions may benefit family caregivers of people with advanced dementia at the end of life and where, when, and how they should be provided.

BACKGROUND:Clear communication about a person's poor prognosis and limited treatment choices improves the quality of end-of-life care.AIMS:To investigate how end-of-life communication may contribute to palliative-oriented care at the end-of-life in nursing homes according to both families' and nurses' perspective. Secondly, to identify the contextual factors internal to the nursing home that may influence the timing and quality of communication. Thirdly, to confirm the foundations for a first theory of end-of-life communication.METHOD:This study is a descriptive two-tailed embedded multiple-case study. A secondary analysis of 23 family carer-nurse paired interviews was performed.FINDINGS:Several contextual factors influenced the timing and quality of communication that, in turn, impacted end-of-life care by promoting family understanding, fostering shared decision-making between healthcare professionals and resident/family carers, and improving the knowledge of residents' and family carers' preferences (ie drivers of transition towards palliative-oriented care). Family carers' preferences had the strongest influence in guiding the care approach, while residents' preferences were poorly known and had a limited impact on the end-of-life care goal. Complex and dynamic interactions within and between drivers and contextual factors emerged, providing preliminary evidence for a first end-of-life communication theory.CONCLUSION:Findings suggest the need to promote a familiar atmosphere and quality relationships, and improve the knowledge of a resident's preferences to ensure that end-of-life care is consistent with their desires.

Background: Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. Methods: In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs’ judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. Results: Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22–44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12–5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10–4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04–5.26; P=.041) were statistically significantly associated with missed nursing care. Conclusion: Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.

BACKGROUND:Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the mechanisms by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.METHODS:A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.RESULTS:Four mechanisms by which end-of-life communication contributed to palliative-oriented care were identified: a) promoting family carers understanding about their relative's health conditions, prognosis, and treatments available; b) fostering shared decision-making between healthcare professionals and residents/family carers; c) improving knowledge of residents' preferences; and d) improving knowledge of family carers' preferences.CONCLUSION:Clear and in-depth communication provides insight into residents' and family carers' preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making.