Palliative care perceptions and well-being in nurses across healthcare settings: a comparative study from Reggio Emilia, Northern Italy

Background: Nurses play a crucial role in palliative care. They are employed across all settings including home care and hospitals, with potential differences in the perception of care, emotional burden and coping strategies. This study aims to explore the experience of nurses within the palliative care network of an Italian province. Methods: From January to March 2024, we carried out a tailored survey on nurses from three palliative care settings in Reggio Emilia (Northern Italy), namely home care, hospice and hospital ward. We investigated emotional and occupational experience, knowledge of palliative care and organizational challenges. Results: The study included 39 nurses, nearly 90% of whom female. Of these, 20 worked in hospices, 10 in hospital wards and 9 in home care. In relation to occupational issues, most participants believed that newly-graduated nurses need additional training before working independently in both hospital ward and home care. Home care seemed adequate to palliative care demands for most participants, who nonetheless remained skeptical about work in hospice. Major emotional challenges included supporting patients' families and feeling alone during emergencies or during sensitive communication, especially in home care. Emotional support was reported as adequate by 61.5% of nurses. However, 35.9% felt it was insufficient, while two thirds of participants admitted to having cried in front of patients. Almost all nurses frequently witnessed patients' deaths and noted that patients' preferences for their place of death were sometimes overruled by caregivers or doctors. Conclusion: Palliative care nursing requires strong emotional resilience, effective communication and comprehensive clinical training. This is true regardless of the setting. Our findings suggest that nurses in home care may need additional organizational support to manage emergencies and reduce emotional stress. This could improve quality of care for patients as well as caregivers, and reduce burnout risk in healthcare professionals in the palliative care network.