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This study aimed to clarify how political and professional documents conceptualize nursing autonomy in community palliative care. Using the READ (Reading materials, Extracting data, Analyzing data, Distilling findings) methodology, a comparative documentary analysis was conducted in the Netherlands, Portugal, Spain, and the United Kingdom. Sixty-eight strategic documents, identified through systematic searches and expert consultation, underwent targeted qualitative content analysis, combining deductive coding with inductive theme generation. Results reveal a multilevel framework of professional representation: (1) micro-level interventions; (2) meso-level contextual determinants; and (3) macro-level systemic dimensions. A critical tension exists between technical visibility and formal authority. In Portugal and Spain, robust taxonomic infrastructures provide high clinical visibility, yet legal frameworks prioritize \u201csystem breadth\u201d over specialized nursing roles. The UK and the Netherlands emphasize \u201cvertical career trajectories,\u201d where specialty recognition and advanced education act as levers for clinical agency and nurse-led care. While all country policies prioritize home-based care, differences in how they improve autonomy may influence workforce sustainability and professional migration. These findings suggest that failing to formalize-specialized roles creates \u201cgray zones\u201d of responsibility. Strengthening the structural conditions that support nursing autonomy, including clear role recognition and aligned policy mechanisms, is essential for ensuring timely access to care and the long-term viability of community-based models. This study provides a roadmap for policymakers to reconcile professional agency with the universal right to high-quality care at the end-of-life.<\/jats:p>","DOI":"10.1177\/15271544261463201","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:44:38Z","timestamp":1784101478000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Policy Frameworks for Nursing Practice in Community-Based Palliative Care: A Four-Country Comparative Documentary Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8529-6540","authenticated-orcid":false,"given":"Ana","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"School of Medicine and Biomedical Sciences (ICBAS), University of Porto"},{"name":"Unidade Local de Sa\u00fade do Nordeste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Gomes","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra"},{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King\u00b4s College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pinto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (FMUP), University of Porto, Porto, Portugal"},{"name":"RISE@Health, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1744987117741667"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.3316\/QRJ0902027"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.70019"},{"key":"e_1_3_3_5_1","first-page":"15","article-title":"Recommendation of the Council Recommendation of 22 May 2017 on the European Qualifications Framework for lifelong learning and repealing the recommendation of the European Parliament and of the Council of 23 April 2008 on the establishment of the European Qualifications Framework for lifelong learning","volume":"189","author":"Council of the European Union","year":"2017","unstructured":"Council of the European Union. 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