Navigating uncertainty and vulnerability: Cardiac nurses' perspectives on providing palliative care for patients with late-stage heart failure

Background: Patients with heart failure often experience debilitating symptoms, including dyspnea, fatigue, and anxiety, symptoms that influence quality of life. Cardiac nurses play an essential role in palliative care for patients with heart failure by providing comprehensive disease management, self-care support, patient education, symptom monitoring, medication management, and psychosocial support. Evidence on cardiac nurses' perspectives on palliative care remains limited. 

Objective: This study examines the experiences of cardiac nurses in providing palliative care to patients with heart failure in the late palliative phase. 

Methods: A qualitative approach based on a phenomenological-hermeneutical methodology was used. Four focus group interviews were conducted with 18 cardiac nurses. The analysis was based on Kirsti Malterud's theory of systematic text condensation. 

Results: The cardiac nurses regarded palliative care as a complex and demanding field, which made it challenging to define their care for patients with heart failure. The analysis identified three themes: 1) Identifying the level of treatment, 2) Finding room for the palliative care, acknowledging the patients’ wishes, and 3) Organisation and support in palliative cardiac care. 

Conclusion: Cardiac nurses perceive palliative care for patients with heart failure as both challenging and frequently overlooked within cardiac care settings. The nurses often struggle to integrate and appropriately frame palliative care while respecting patients’ wishes, which contributes to feelings of uncertainty and vulnerability. They highlight the critical need for systematic interdisciplinary collaboration to effectively support patients and their families throughout the palliative care process.