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Background: With burnout rates highly prevalent in palliative care nurses, it is important to have a holistic understanding of the causes of burnout and strategies both to prevent burnout and to cope with burnout., Aim: To understand the causes of burnout and strategies used to prevent and cope with burnout in palliative care nurses. This would allow the implementation of strategies on a personal level and organisational level to mitigate the effects of burnout., Methods: A thematic analysis to explore palliative care nurses' experiences and their interpretations. In total, 11 in-depth interviews and one focus group discussion with 19 nurses were conducted. The study participants were recruited from three palliative care units within a health cluster in Singapore and had at least 1 year of experience working in palliative care., Results: Five themes were identified: (a) description of burnout and its attributes; (b) factors that contribute to burnout; (c) triggers that initiate burnout; (d) coping with burnout; and (e) resilience to burnout. The nurses were competent in recognising signs of burnout and understood the use of coping strategies to manage burnout. They were also able to develop resilience to burnout through meaning-making and personal experiences., Significance of Results: Helping palliative nurses find a deep purpose in their work builds resilience. Managers, organisation leaders, researchers and peers should look into ways to increase resilience in this group of nurses.

Background: With more frail elderly living and likely to die in nursing homes, advance care planning (ACP) is critical in overall efforts to provide good palliative care. However, it is unclear how willing older, vulnerable residents in nursing homes are to take on an active role in care decisions., Aim: The objective of this pilot study was to examine nursing homes' healthcare professionals' and residents' views on ACP and the extent of similarities and differences in their views., Methods: Our sample of 24 healthcare professionals and 24 residents were identified and recruited through contacts established from existing collaborations with the nursing homes. Surveys were administered to the participants by a trained research assistant between April 2015 and August 2015., Results: Almost all the healthcare professionals (95.8%) would like to make an ACP for themselves in the future, while residents were divided in their choices (P<<0.01). Most residents (79.1%) felt that the most important guide for their surrogate in making decisions for them when they lose decision-making capacity should be based on their best interests. However, most healthcare professionals (75.0%) felt that it should be based on the resident's wishes and values., Conclusions: Healthcare professionals tended to overestimate the importance of patient autonomy compared to the residents. This study demonstrates that as much as advocacy and awareness are ongoing, nursing home residents' motivation to participate in ACP is lacking. The lack of motivation in ACP participation could be due to medical paternalism and familial determination, which have been a cultural norm for older Singaporeans. This study demonstrates there is a lack of cultural sensitivity in this group of healthcare professionals in approaching nursing home residents' end-of-life care decision-making.