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Background Death is a part of life. While most often a sombre event, opportunities exist to optimise the experience both for the dying patient and their loved ones. This is especially true in institutionalised settings, such as acute care hospitals where cure and recovery tend to be paramount.Purpose To understand ways to improve end-of-life (EOL) care from the perspective of frontline nursing staff and patient and family advisors (PFAs).Methods We conducted focus groups with frontline nursing staff (n=14) and PFAs (n=5) to understand ways to optimise EOL care. Using a videoconference platform, one researcher used a flexible interview guide while a second researcher took field notes. These focus groups were in follow-up to a comprehensive need assessment survey as part of a programme to enhance EOL care practices on the general internal medicine units at our hospital. We used source data from deidentified audio recordings and researcher field notes.Results Five important categories regarding current EOL care practices emerged: communication among key stakeholders, assessment and management of symptoms, engagement of the palliative care team, engagement of the spiritual care team and ongoing tests and interventions at the EOL. We identified challenges specific to each respondent group as well as common challenges from both the professional and public perspectives.Conclusions Views elicited from patients, families and nurses in this qualitative study have informed the development of strategies to enhance EOL practices in our hospital that may be useful in othercentres.

Objectives Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.Methods We developed an 85-item survey informed by the Theoretical Domains Framework and Capability–Opportunity–Motivation–Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores 5 years).Results Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions.Conclusions Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards.