{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:00:28Z","timestamp":1790823628301,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the challenges of providing end\u2010of\u2010life nursing care in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifteen participants, including seven nurses, two head nurses, two educational supervisors, two academic staff, one nursing service manager and one critical care physician, were purposively selected from across Iran from October to December 2023. Data were collected through in\u2010depth semi\u2010structured interviews in person and by telephone and analyzed using MAXQDA 2020 software using the inductive content analysis approach of Elo and Kingas. We also examined trustworthiness using Elo et\u00a0al.'s checklist and Lincoln and Guba's criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four main themes emerged: (1) Emotional burden of caring for dying patients (fear and anxiety, compassion fatigue, moral distress and grief responses); (2) Systemic neglect of end\u2010of\u2010life care (educational gaps, lack of national standards and absence of a palliative care organization); (3) Fragmented interdisciplinary care and communication gaps (poor teamwork, physician\u2010centred system, unclear role definitions and cultural and religious barriers); and (4) Absence of supportive infrastructure (economic, social and technological constraints). Participants believed that these themes were related and mutually reinforcing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>End\u2010of\u2010life nursing care in Iran faces serious, interconnected challenges. Therefore, it requires comprehensive institutionalization, planning and educational and clinical interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing Practice<\/jats:title>\n                    <jats:p>To improve care quality, nurses need appropriate policies and specific clinical protocols for end\u2010of\u2010life care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>This study examines an important gap in understanding the challenges of end\u2010of\u2010life care in Iran and provides evidence for policymaking, education and health system management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>The study report was guided by the COREQ checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nop2.70866","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:42:50Z","timestamp":1790822570000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in Providing End\u2010of\u2010Life Nursing Care: A Qualitative Content Analysis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2722-2431","authenticated-orcid":false,"given":"Zahra","family":"Taheri\u2010Ezbarami","sequence":"first","affiliation":[{"name":"Department of Nursing, School of Nursing and Midwifery Guilan University of Medical Sciences  Rasht Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8479-6832","authenticated-orcid":false,"given":"Fateme","family":"Jafaraghaee","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Nursing and Midwifery Guilan University of Medical Sciences  Rasht Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6410-6320","authenticated-orcid":false,"given":"Ali Karimian","family":"Sighlani","sequence":"additional","affiliation":[{"name":"Department of Philosophy University of Guilan  Rasht Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7992-3200","authenticated-orcid":false,"given":"Seyed Kazem","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Nursing and Midwifery Guilan University of Medical Sciences  Rasht Iran"},{"name":"Department of Nursing, Abhar School of Nursing Zanjan University of Medical Sciences  Zanjan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"107","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.29252\/ijn.30.107.74","article-title":"Knowledge and Attitude of Nurses Toward Caring for End\u2010of\u2010Life Patients","volume":"30","author":"Aghaei M.","year":"2017","journal-title":"Iran Journal of Nursing"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010023\u201001305\u20102"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2014.08.036"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare7030083"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijnmr.IJNMR_418_20"},{"issue":"3","key":"e_1_2_14_7_1","first-page":"247","article-title":"Overview of Palliative Care Curriculum's for Nursing Students","volume":"16","author":"Barasteh S.","year":"2023","journal-title":"Educational Strategy in Medical Sciences"},{"issue":"3","key":"e_1_2_14_8_1","first-page":"52","article-title":"Knowledge and Attitudes of Iranian Nursing Students Toward Palliative and End\u2010of\u2010Life Care: A Cross\u2010Sectional Study","volume":"19","author":"Damsaz Hafshejani N.","year":"2026","journal-title":"Journal of Medical Education and Development"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904\u2010021\u201000876\u20102"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/215824401452263"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102648.2007.04569.x"},{"issue":"4","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1086\/JCE200920406","article-title":"Moral Distress, Moral Residue, and the Crescendo Effect","volume":"20","author":"Epstein E. 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