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• NextGen NCLEX

Faculty Case Studies

The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine. 

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank  are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items. 

Family  ▾

• Attention Deficit Hyperactivity Disorder - Pediatric
• Ectopic Pregnancy
• Febrile Seizures
• Gestational Diabetes
• Intimate Partner Violence
• Neonatal Jaundice
• Neonatal Respiratory Distress Syndrome
• Pediatric Hypoglycemia
• Pediatric Anaphylaxis
• Pediatric Diarrhea and Dehydration
• Pediatric Intussusception
• Pediatric Sickle Cell
• Postpartum Hemmorhage
• Poststreptococcal Glomerulonephritis Pediatric
• Preeclampsia

Fundamentals and Mental Health  ▾

• Abdominal Surgery Postoperative Care
• Anorexia with Dehydration
• Catheter Related Urinary Tract Infection
• Deep Vein Thrombosis
• Dehydration Alzheimers
• Electroconvulsive Therapy
• Home Safety I
• Home Safety II
• Neuroleptic Maligant Syndrome
• Opioid Overdose
• Post Operative Atelectasis
• Post-traumatic Stress
• Pressure Injury
• Substance Use Withdrawal and Pain Control
• Suicide Prevention
• Tardive Dyskinesia
• Transfusion Reaction
• Urinary Tract infection

Medical Surgical  ▾

• Acute Asthma
• Acute Respiratory Distress
• Breast Cancer
• Chest Pain (MI)
• Compartment Syndrome
• Deep Vein Thrombosis II
• End Stage Renal Disease and Dialysis
• Gastroesphageal Reflux
• Heart Failure
• HIV with Opportunistic Infection
• Ketoacidosis
• Liver Failure
• Prostate Cancer
• Spine Surgery
• Tension Pneumothorax
• Thyroid Storm
• Tuberculosis

Community Based  ▾

Mini Review  ▾

• Comprehensive Review
• Fundamentals
• Maternal Newborn Review
• Medical Surgical Nursing
• Mental Health Review
• Mini Review Faculty Summaries
• Mini Review Training for Website
• Mini Reviews Student Worksheets
• Pediatric Review

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

On March 6th, 2019, Maria Fernandez, a 19-year-old female, presented to the Emergency Department with complaints of nausea, vomiting, abdominal pain, and lethargy. She reveals a recent diagnosis of type 1 diabetes but admits to noncompliance with treatment. At the time of admission, Maria’s vital signs were as follows: BP 87/50, HR 118, RR 28, O2 95% on room air, diffuse abdominal pain at a level of 5, on a verbal numeric 1-10 scale, with non-radiating pain beginning that morning. She was A&O x3, oriented to self, place, and situation, but sluggish. Upon assessment it is revealed that she is experiencing blurry vision, Kussmaul respirations, dry, flushed skin, poor skin turgor, weakness, and a fruity breath smell. Labs were drawn. During the first hour of admission, Maria requested water four times and urinated three times.

Code status:  Full code

Medical hx : Type 1 Diabetes

Insurance : None

Allergies : NKA

Significant Lab Values

• Blood glucose 388
• ABGs: pH 7.25, Bicarb 12 mEq/L, paCO2 30 mm Hg, anion gap 20 mEq/L, paO2 94%
• Urinalysis: Ketones and acetone present, BUN 25 mL/dL, Cr 2.1 ml/dL
• Chemistry: sodium 111 mEq/L, potassium 5.5 mEq/L, chloride 90 mEq/L, phosphorus 2.5 mg/dL, Magnesium 2.0 mg/dL
• CBC: WBC 13,000 mcL, RBC 4.7 mcL, Hgb 12.6 g/dL , Hct 37% (Wolters Kluwer, 2018).

Diagnosis:  Diabetes Ketoacidosis

• Oxygen administration by nasal cannula on 2L and airway management
• Establish IV access
• IV fluid administration with 0.9% NS; prepare to titrate to 0.45% normal saline as needed
• Monitor blood glucose levels
• Administer 0.1-0.15 unit/kg IV bolus of regular insulin
• IV drip infusion at 0.1 unit/kg/hr of regular insulin to hyperglycemia after bolus,
• Addition of Dextrose to 0.9% NS as glucose levels decreases to 250 mg/dL
• Monitor potassium levels
• Potassium replacement via IV when the potassium level is 5.0 mg/dL or less and urine output is adequate
• Assess for signs of hypokalemia or hyperkalemia
• Monitor vital signs and cardiac rhythm
• Q1-2hr fingerstick blood glucose checks initially, then q4-6hr once stabilized
• Monitor blood pH, I&O
• Assess level of consciousness; provide seizure and safety precautions (Henry et al., 2016)
• Notify MD of any critical changes

Maria Fernandez was then transferred to the ICU unit for close observation, maintenance of IV insulin drip, cardiac monitoring, fluid resuscitation, and correction for metabolic acidosis.

Upon discharge, Maria was reeducated on Type 1 Diabetes Mellitus through the use of preferred learning materials.

• What is the priority assessment data that supports DKA diagnosis?
• What education strategies would you consider implementing to improve treatment adherence after discharge?
• What considerations, services, or resources would you anticipate to be offered by case management or social services?

Henry, N.J., McMichael, M., Johnson, J., DiStasi, A., Ball, B.S., Holman, H.C., Elkins, C.B., Janowski, M.J., Hertel, R.A., Barlow, M.S., Leehy, P., & Lemon, T. (2016).  RN adult medical surgical nursing: Review module  (10 th  ed.). Leawood, KS: Assessment Technologies Institute.

Wolters Kluwer. (2018). Lippincott Nursing Advisor (Version 4.1.0) [Mobile application software]. Retrieved from  http://itunes.apple.com

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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MEDSURG Nursing Journal

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MEDSURG Nursing  is a scholarly journal dedicated to advancing evidence-based medical-surgical nursing practice, clinical research, and professional development.

Here's what you get:

• Multiple CEs with each issue
• 6 issues a year
• Evidence-based peer-reviewed articles with the most up-to-date information
• Interprofessional information you need to provide clinically excellent patient care
• Education you need to enhance your nursing practice
• Wherever you practice, MEDSURG Nursing supports your professional practice and enhances your knowledge and skills so you can promote health, prevent and manage disease and improve the health status of patients and families.

You can find all journal CE on the AMSN Online Library. The articles are free for members, and $20 for non-members.

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Core Curriculum for Medical-Surgical Nursing

Prepare for the Exam, Provide Excellent Care, Stay Current Core Curriculum for Medical-Surgical Nursing (5th Edition)...

Med-Surg Talks

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Core Curriculum for Medical-Surgical Nursing

Core curriculum for medical-surgical nursing (6th edition).

The updated 6 th Edition of the Core Curriculum for Medical-Surgical Nursing  provides the latest information in medical-surgical nursing practice, making it an essential tool to stay current on specific practice areas, trends, and topics. Presented in an easy-to-use topic and outline format, this comprehensive resource provides the foundational body of knowledge for medical-surgical nursing practice and providing patient care. 

New chapters in the 6 th edition include:

• LGBTQIA+ Patients
• Care of Victims of Intimate/Domestic Partner Violence and Human Trafficking
• Care of Patients with Stroke
• Healthy Practice Environment

33 chapters, 700+ pages

Purchase the 6th Edition Core Curriculum for Medical-Surgical Nursing

Previous Version

Core curriculum for medical-surgical nursing (5th edition)  .

Are you preparing for the CMSRN exam? Are you a med-surg nurse interested in providing excellent care? Do you want to stay current on trends and topics in medical-surgical nursing?

This comprehensive resource provides the foundational body of knowledge for medical-surgical nursing practice.  This must-have reference book is written by expert medical-surgical nurses who designed it for new and experienced nurses.

Each chapter ends with a Case Study where you will learn to apply your knowledge to real life patient care.

Presented in an easy-to-use topic and outline format, the Core Curriculum for Medical-Surgical Nursing is your go-to guide for medical-surgical nursing, best practices, and exam preparation.

29 chapters, 600+ pages

Sample Pages | Sample Case Study | Table of Contents

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AMSN Blog | November 22, 2021

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Medical-Surgical Nursing Resources

Videos, guides, tips & more to help you master and pass Medical-Surgical

Medical-Surgical Videos & Articles

Med-surg - integumentary system, part 11: sjs and ten.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), including pathophysiology, signs/symptoms, diagnosis, treatment, and nursing care for these life-threatening skin reactions.

Med-Surg - Integumentary System, part 10: Lice & Scabies

Parasitic infestations, including pediculosis (i.e., lice) and scabies. Risk factors, signs/symptoms, treatment and patient teaching for lice and scabies.

Med-Surg - Integumentary System, part 9: Lyme Disease

Lyme disease—the prevention, stages of lyme disease, symptoms of lyme disease, diagnosis and treatment.

434 Med-Surg topics to know for the NCLEX

This is also an essential list of the A&P background, med-surg diseases/disorders, and critical care topics to know for your Med-Surg exams!

Nursing Tips: Medical-Surgical

Cushing's disease: nutritional guidance, tnm staging criteria for tumors, guillain-barre syndrome (gbs), cataract surgery: patient teaching, medical-surgical nursing flashcards & review games, medical-surgical nursing - flashcards, flashables - digital nursing flashcards - nclex edition, the ultimate nursing school survival kit - flashcards, level up nurse squad - med-surg, the ultimate med-surg bundle, level up nurse squad - great eight, level up nurse squad - fab four, the comprehensive nursing collection.

Level Up RN Membership

Get unlimited access to the most important information you need to know without the fluff – all in one ad-free space. 

• 132 Med-Surg videos
• 184 Med-Surg review questions
• 4-hour Med-Surg Cram Course

Membership Courses: Medical-Surgical

Medical-Surgical Cram Course

Compact review of the most highly testable, must-know facts for medical-surgical nursing.

Medical-Surgical Core Content

Learn the most important Medical-Surgical topics from Level Up's extensive playlists of videos.

Medical-Surgical Review Questions

Test yourself with Medical-Surgical practice questions.

EKG Interpretation

Earn 7.5 contact hours for this interactive course covering EKG components and steps to better understand interpreting any EKG.

NCLEX Review Questions

Test yourself with practice questions.

NCLEX Prep Course

Comprehensive review to prepare for the NCLEX exam.

Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

• The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
• Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
• Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
• Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

Nurse Sarah’s Notes and Merch

Just released is “ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

You can get an eBook version here or a physical copy of the book here.

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Delmar's Case Study Series: Medical-Surgical Nursing 2nd Edition

• ISBN-10 1111138591
• ISBN-13 978-1111138592
• Edition 2nd
• Publisher Delmar Cengage Learning
• Publication date February 16, 2011
• Language English
• Dimensions 5.75 x 0.75 x 8.75 inches
• Print length 320 pages
• See all details

Editorial Reviews

About the author, product details.

• Publisher ‏ : ‎ Delmar Cengage Learning; 2nd edition (February 16, 2011)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 320 pages
• ISBN-10 ‏ : ‎ 1111138591
• ISBN-13 ‏ : ‎ 978-1111138592
• Item Weight ‏ : ‎ 13.3 ounces
• Dimensions ‏ : ‎ 5.75 x 0.75 x 8.75 inches
• #279 in Medical & Surgical Nursing (Books)
• #1,556 in General (Books)

About the author

Gina m. ankner.

Discover more of the author’s books, see similar authors, read author blogs and more

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Customers find the case studies in the book great with a lot of information. They say the book provides the answers and rationale, and is a great teaching tool. Readers also mention it's worth the price.

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Customers find the case studies in the book great. They say the book provides the answers and rationale, making the case study an easy read. Readers also mention the book is helpful in considering what is a priority medicine.

"...Nice situations with backgrounds and excellent questions for critical thinking . Anker gives her suggested answers which is nice...." Read more

"...that "looks like." Well, this book does and it helped me get through 3rd semester ." Read more

"I use this book for my nursing students. It uses a wide variety of case studies with different levels of difficulty...." Read more

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Customers find the book worth the price and a great buy.

"...It also provides the answers and the rationale. Great buy !!" Read more

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How to Get Into Med-Surg Nursing

What is med surg nursing.

• How to Become
• Essential Skills
• A Day in the Life

Med surg nursing stands for medical surgical nursing, and it's the largest nursing specialty in the US. A med surg nurse is a specific type of surgical nurse who cares for patients preparing for or recovering from surgery. But med surg nurses' duties expand beyond surgical patients, as they provide care for a wide range of non-surgery patients in the hospital as well.

Medical surgical nurses provide 24-hour care to patients during their hospital stay. Admitted patients will spend more one-on-one time with their med-surg nurse than any other medical professional while admitted to the hospital.

Med-surg nursing provides a range of specialties for nurses to enter, such as:

• General surgery
• Plastic surgery
• Neurosurgery
• Vascular surgery
• Cardiac care
• Gastrointestinal

Med-surg nurses often work at a hospital or medical center in an acute care or med surg unit at the bedside. However, this nursing specialty may also be found in other areas, such as outpatient clinics or home healthcare facilities. 

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What Does a Med Surg Nurse Do?

Med-surg nurses provide direct bedside nursing care in a med-surg unit, which is a hospital ward for patients who are preparing for or recovering from surgical procedures. On shift, a medical surgical nurse usually manages the care of 4 to seven patients at a time. They also discharge patients and admit new patients into their care throughout their shifts. 

Some critical med surg nursing duties and responsibilities include the following:

• Admitting patients to the med surg unit
• Administering medication and providing pain control
• Ambulating patients
• Providing wound care
• Monitoring and recording vital signs and events in electronic medical records (EMRs)
• Working with ancillary specialties - such as physical therapy, diabetes specialists, or speech therapy - to coordinate care
• Performing or ensuring diagnostic testing is completed
• Providing patient education and discharge instructions
• Discharging patients to outpatient facilities or home

Find Nursing Programs

Med surg nurse salary.

The median pay for nurses is $86,070 annually or $41.38 per hour, according to 2023 reports from the US Bureau of Labor Statistics (BLS). But that’s an average across nurses with different degrees, working in many specialties and living in various locations. RN salary varies depending on several factors and can range widely throughout the country. 

One such factor is your nursing specialty, with med surg nurses achieving higher salaries than general RNs. For example, ZipRecruiter reports med surg nursing salaries at $117,052 a year.

Other factors that may impact your med surg nursing salary include:

• The city and state where you live
• The type of healthcare facility you work in 
• Whether you work 8, 10, or 12 hours shifts
• Whether you work full-time or part-time
• How many shifts you work in a week

Med-surg nurses living in some areas of the country may earn a much higher income than others. However, the salary usually aligns with the cost of living in the area. For example, South Dakota nurses typically earn less than San Francisco nurses. However, it's also much more expensive to live in San Fransisco than in many other states, such as South Dakota.

How to Become a Med Surg Nurse

To become a med-surg nurse, you must meet the following requirements: 

1. Attend an Accredited Nursing Program

There are two pathways to becoming an RN :

Associate's degree in nursing (ADN), or 

Bachelor's degree in nursing (BSN) 

2. Pass the National Licensure Examination

Becoming an RN requires you to pass the National Council Licensure Examination for Registered Nurses ( NCLEX-RN ). Per diem nurses must also maintain a current and active license. Once licensed, you must renew your RN credential every two years by completing and submitting  continuing education units (CEUs) per your state's nursing board requirements.

3. Apply for Med-Surg Nursing Jobs

You can begin working in med-surg nursing right away through new nurse graduate programs in your area. Most new graduate med surg nursing programs last 2-6 months and offer the in-depth training you need to be a successful med surg nurse. Often, facilities pair recent nursing grads with a tenured nurse to help teach them core med surg nursing skills and competencies.

>> See Med-Surg Nursing Jobs Hiring Now

4. Become a Certified Med-Surg RN

After earning a minimum of one year of experience, you can sit for the Medical-Surgical Nursing Certification (MEDSURG-BC™) exam. Certification will let your employer, coworkers, and patients know that you are an expert in your field and can provide the highest level of patient care.

Med Surg Nursing Skills & Competencies

The ability to stay calm.

Caring for surgical patients is not easy because their conditions can rapidly become serious or critical. You also have many responsibilities that you must juggle, making the med-surg nursing environment hectic and stressful. Therefore, Med surg nurses must be able to maintain a calm demeanor and work well under pressure.

Organization & Multitasking

Med-surg nurses often care for 4-7 patients at once, all of whom need specific care. On top of that, they must admit and discharge patients throughout the day and tend to any emergencies. To balance all those duties, med surg nursing requires tons of multitasking and organizational skills. 

Critical Thinking

There are many moments throughout the shift when a med surg nurse must prioritize their duties. Sometimes, they do so under urgent conditions, making critical thinking skills a must. Being able to prioritize tasks and think on your feet can make a huge difference in a med surg unit.

Competencies

To work in med-surg nursing, you must be proficient in hundreds of nursing competencies, a few of which include:

• Assessing neurological status
• Managing different types of catheters, such as urinary or epidural
• Providing care for drains, such as a chest tube or hemovac wound drain
• Providing CPR when needed
• Understanding and educating on medication administration, contraindications, side effects, and dosing calculations
• Providing pulmonary care such as tracheal suctioning, chest drainage symptoms, and assessing breath sounds
• Starting and maintaining IVs and providing IV medication
• Performing complex dressing changes
• Providing care for braces, casts, and traction devices

Zip Recruiter reports that employers are looking for several specific keyword skills when reviewing potential med-surg travel nursing candidate’s resumes, some of which include:

• Inpatient care
• Treatment planning
• Behavioral  analysis
• Medical records

>> Related: How to Become a Circulating Nurse

What Is It Like to Work in Med Surg Nursing?

Med-surg nurses provide essential and often life-saving care for their patients and families during some of the most challenging times of their lives. Although working in med-surg nursing can be very stressful and exhausting, many say the career gives them a sense of pride in their work. 

A career as a med-surg nurse may not be suitable for everyone. This nursing specialty requires a sense of determination, the ability to manage the complex patient care of multiple patients simultaneously, and a strong stomach. 

But if learning about various surgical procedures while utilizing a wide range of complex nursing skills appeals to you, med surg nursing might be the perfect career for you!

Sarah Jividen , RN, BSN, is a trained neuro/trauma and emergency room nurse turned freelance healthcare writer/editor. As a journalism major, she combined her love for writing with her passion for high-level patient care. Sarah is the creator of Health Writing Solutions , LLC, specializing in writing about healthcare topics, including health journalism, education, and evidence-based health and wellness trends. She lives in Northern California with her husband and two children. 

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What Is Medical-Surgical (Med-Surg) Nursing Like?

As the largest, broadest, and most widely defined branch of nursing, the field of med-surg nursing covers a lot of ground! 

At its most basic level, med-surg nursing involves caring for patients who have a range of medical conditions and surgical needs; this can mean anything from dressing wounds and administering medication to communicating with family members and physicians. 

In this article, we’ll explore the world of med-surg nursing, discussing the responsibilities, challenges, and rewards of this important nursing specialty.

The Role of a Med-Surg Nurse

Med-surg nurses play a crucial role in providing comprehensive care to patients with acute and chronic medical conditions. 

This essentially means that they will be working with patients who have been injured, patients who are recovering from surgery, patients who are dealing with chronic conditions like diabetes , and patients who are recovering from acute illnesses such as pneumonia.

These nurses are responsible for assessing patients, administering medications, monitoring vital signs, coordinating care, and educating patients and their families throughout patients' health journeys. In addition, med-surg nurses collaborate with other healthcare professionals, such as physicians, specialists, and allied health staff, to ensure the best possible outcomes for the patients under their care.

The Diversity of Patient Populations

One unique hallmark of med-surg nursing is the incredibly diverse range of patient populations that nurses encounter. 

In most other cases, a nurse’s specialty will go hand in hand with a specific group of patients. Cardiovascular care, for example, will typically feature older patients; pediatric care, by definition, will see you working with younger patients.

Unlike these other specialties, med-surg nurses care for patients across the lifespan, from infants to older adults. In a given week, they may see patients with respiratory diseases, cardiovascular disorders, gastrointestinal issues, renal conditions, orthopedic injuries, or neurological disorders. They’ll be meeting and interacting with patients from all walks of life and in all stages of life.

Working as a med-surg nurse can be an awesome opportunity to bond with patients and hear their stories. However, the diversity of the conditions and treatments also means that med-surg nurses must have a broad knowledge base and the ability to adapt to a wide range of patient needs.

A Fast-Paced and Dynamic Environment

While not the fastest-paced nursing environment—see emergency room nursing for this one! —  working as a med-surg nurse will definitely expose you to some fast-paced and stressful situations. 

Nurses in this specialty often handle multiple patients simultaneously, prioritizing the needs of their patients and making critical decisions quickly. 

Succeeding in this profession requires the ability to manage your time and stay organized, even during particularly chaotic situations. At any given time, med-surg nurses may find themselves juggling multiple competing responsibilities, such as administering medications, speaking to family members and collaborating physicians, documenting patient information, and responding to emergencies.

Collaboration and Multidisciplinary Teamwork

As a med-surg nurse, you’ll often find yourself working with other members of a patient's healthcare team. 

This team can include physicians and physician assistants, nurse practitioners, pharmacists, respiratory therapists, physical therapists, and a whole host of other healthcare professionals. Each of these professionals has worked (or will work) with the patient at a stage of their healthcare journey, and part of your job is making sure all of this care remains coordinated and informed .

In an ideal world, this collaboration ensures that your patients receive holistic care that is aligned with their specific needs.

Emotional Support and Patient Advocacy

In addition to the hands-on care they provide, med-surg nurses also serve as advocates for their patients, ensuring their needs and rights are respected. 

During challenging moments in the healthcare journey, med-surg nurses can provide a much-needed lifeline to patients who are feeling demoralized and anxious. The healthcare system can be an incredibly complex and intimidating labyrinth for the average patient to navigate. 

As a med-surg nurse, you’ll be acting as a guide for patients, someone who can help them understand where they are in the process and what the next steps will be. 

Whether it's explaining a complex diagnosis, assisting with end-of-life decisions , or offering a compassionate ear, a huge aspect of your job will be providing comfort and reassurance to patients and their loved ones.

Challenges in Med-Surg Nursing

While med-surg nursing can be an unbelievably rewarding profession, it is not for everyone. 

To start, the workload can be demanding. Every patient walking through your door will have a different story, with different needs and preferences. While taking some extra time with a patient can make a world of difference to that patient, it can also cause scheduling difficulties for the next six patients you’ll be seeing that day. 

At times, balancing the needs of your patients with your resources—and the facility’s—can be an enormous challenge. To this end, med-surg nurses must be resilient and adaptable to handle these demands. Shift work, including working nights and weekends, can disrupt personal and social life. 

Beyond being stretched thin for time and energy, you will be working in an environment where patient suffering— and even loss —are common. Working in this sort of environment can make it difficult for some nurses to remain emotionally invested in their patients and can take a toll on their mental health.

The Rewards of Med-Surg Nursing

Despite the challenges, med-surg nursing remains a rewarding and fulfilling career for thousands of nurses. There’s nothing quite like witnessing your favorite patients recover, regain their health, and return home.

Beyond this, the variety of the work that you’ll be handling as a med-surg nurse keeps the job interesting and fresh. After all, no two patients walking through your door are the same; each case will present unique challenges that require you to think critically and work with a variety of collaborating healthcare professionals.

Interested in Becoming a Med-Surg Nurse?

At the end of the day, med-surg nursing has its benefits and drawbacks. And whether you think it’s the right field for you or you’d prefer to take your career in a separate direction, we hope this article has helped outline the hard work and dedication involved in being a med-surg nurse.

If you’re interested in learning more about this specialty, check out our ultimate guide to med-surg nursing . In it, we cover everything from tips for new med-surg nurses to an overview of med-surg units within hospitals.

Beyond that, our per-diem nursing blog is an awesome resource for new and experienced nurses alike. Check it out for content related to all specialties of nursing, as well as other nursing-adjacent topics.

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• Open access
• Published: 16 September 2024

“ You close the door , wipe your sadness and put on a smiling face ”: a qualitative study of the emotional labour of healthcare professionals providing palliative care in nursing homes in France

• Benoite Umubyeyi 1 ,
• Danièle Leboul 1 &
• Emmanuel Bagaragaza 1  

BMC Health Services Research volume  24 , Article number:  1070 ( 2024 ) Cite this article

Metrics details

Palliative care provided to frail and dying older persons in nursing homes results in intense emotions for residents and their relatives as well as for healthcare professionals. In France, scant attention has been given to how nursing home professionals manage their emotions when providing palliative care. This study analysed the emotional demands of providing palliative care in the nursing home context, the emotional strategies used by healthcare professionals to navigate such demands, and how these demands affect their emotional wellbeing.

This qualitative study used a multiple case study approach. We purposively selected nine nursing homes from three geographical provinces in France with diverse ownership statuses (public, private, associative). Individual interviews and focus group discussions were held with 93 healthcare professionals from various occupational groups employed in the participating nursing homes. Data was collected from April 2021 to September 2022 and was analysed using thematic content analysis.

Data revealed that providing palliative care to dying residents within the nursing home context results in intertwined rewarding and exhausting emotional experiences for healthcare professionals. Professionals have to utilize multifaceted emotional strategies to navigate these experiences, including suppressing and modifying emotions and distancing themselves emotionally from residents to protect themselves from emotional suffering. Participants noted a lack of formal space to express emotions. Unrecognized emotional labour undermines the wellbeing of healthcare professionals in nursing homes, whereas acknowledging emotions enhances satisfaction and gives enhanced meaning to their crucial role in resident care.

Acknowledging emotional labour as an inevitable component of providing palliative care in nursing homes is critical to supporting healthcare professional wellbeing, resilience, and retention, which may ultimately improve the quality of care for dying residents. Ensuring quality care and supporting the emotional wellbeing of nursing home professionals requires an organisational culture that considers emotional expression a collective strength-building resource rather than an individual responsibility, in hopes of shaping a new culture that fully acknowledges their humanity alongside their professional skills.

Trial registration

ClinicalTrials.gov ID: NCT04708002; National registration: ID-RCB number: 2020-A01832-37, Registration date: 2020-12-03.

Peer Review reports

The steady increase in the number of older persons affected by multiple and complex health needs has led to a growing number of nursing home (NH) residents worldwide spending their final moments of life and dying within these settings [ 1 ]. In turn, this trend has generated heightened attention for the necessity of integrating palliative care within the NH, an approach that has not traditionally been an area of focus [ 2 , 3 , 4 ].

The core philosophy and values of the NH are to provide a home-like environment for residents. When residents require palliative and end-of-life care, the focus shifts from supporting quality living to facilitating quality dying [ 5 ]. Such a shift is accompanied by intense emotions for residents, their relatives, and NH professionals who have had intimate interactions with residents and built strong ties and long-lasting relationships with them during the extended caregiving process. The process becomes even more emotionally laden for professionals, as they often see themselves as holding a professional caring role while also taking on the emotional work of a family member role [ 6 ]. When confronted with providing quality living while simultaneously supporting quality dying [ 5 ], NH professionals have to perform significant emotional labour to provide quality care and preserve the professional-resident therapeutic relationship, all the while maintaining their own health and emotional wellbeing [ 7 ].

In France, as in many other countries, the provision of palliative care in NHs relies heavily on a multidisciplinary staff mainly composed of nursing assistants, personal support workers, registered nurses, and other regulated professionals, under the supervision of a medical coordinator. A medical coordinator in the French nursing home context is a physician, generally with geriatric competences, who has an overall coordination and medical advisory role for nursing home and external provider team for enhanced quality care. Moreover, as elsewhere, NHs in France suffer significant staff shortages due to professional fatigue, burnout, and professional turnover [ 8 ]. The recent COVID-19 pandemic has worsened the situation in NHs, with increased COVID-19-related deaths, augmented workloads, expanded isolation, and added psychological burden among care workers [ 9 , 10 ]. There is a pressing need for NH organisations to acknowledge the emotional labour endured by healthcare professionals during the caregiving process, particularly when it involves providing palliative and end-of-life care to residents.

Current evidence has demonstrated a strong link between burnout, job satisfaction, performance, staff retention, and attrition and the emotional labour of caring [ 11 , 12 ]. When healthcare professionals have to suppress or modify their emotions, they experience dissonance between feelings and performance, which in the long term can result in emotional distress, burnout, and intention to leave the profession [ 12 , 13 ]. Other studies have noted that when emotions are freely expressed and supported, they may have a positive impact on professional-patient interpersonal relationships, staff member wellbeing, and the quality of patient care [ 14 ]. However, most studies that have explored the emotional labour involved in providing palliative care have focused on hospital, hospice, or palliative care unit settings. Rarely have these studies been conducted in NH contexts. In fact, the physical labor associated with caring in NHs and the economic aspects of the work, such as wages and scheduling, receive more attention than does emotional labour [ 15 ]. In addition, emotional intelligence is an expected competency of healthcare professionals, particularly an individual’s ability to manage their own emotions to the point that failing to do so is viewed as an individual weakness and professional failure [ 16 ]. Yet, it has been documented that the effectiveness of emotional labour depends on various factors, including the nature of the service and the organisational culture [ 13 ]. This requires situated knowledge to better understand the emotional work performed by healthcare professionals in specific contexts, such as NHs.

Emotional labour in palliative care and in nursing homes

Emotional labour has been defined as the process through which healthcare professionals suppress or change their feelings to align with organisational rules and guidelines while still conveying to others a sense of being cared for [ 17 ]. Emotional labour involves three strategies: surface acting, deep acting, and displaying genuine emotions [ 18 ]. Surface acting entails suppressing or hiding felt emotions or faking unfelt emotions to alter outwards expression. Deep acting entails a conscious attempt to modify inner feelings and felt emotions to match expected emotions [ 18 , 19 ]. Displaying genuine emotions entails the expression of natural emotions that are congruent with felt feelings without any adjustment [ 18 ]. In this study, we conceptualize emotional labour as the efforts deployed by healthcare professionals to manage their emotions when providing palliative care to NH residents.

Nurse scholars have expanded the concept of emotional labour to nursing, emphasizing the emotional component and the demand associated with caring in nursing [ 19 ]. Nurses perform emotional labour when they have to induce or suppress their feelings to align them with what is expected by their institutions to make patients feel cared for and safe, irrespective of their own actual feelings [ 20 , 21 ]. For example, when nurses are confronted with death but feel unable to facilitate a ‘good death’, they may have complex feelings of guilt and anger but may have to suppress these feelings to continue attending to patients and their relatives [ 22 , 23 ].

Emotions are inherently linked to caring, as they are essential to the development of effective and meaningful relationships with patients, their relatives, and other professionals [ 24 ]. Studies that have explored the emotional labour associated with providing palliative care highlight the complexities of the emotionally demanding experiences healthcare professionals encounter in their practice [ 6 , 23 ]. The cumulative emotional effects of grief and sadness experienced by NH professionals attending to dying individuals require them to deploy significant effort to balance the demands of the healthcare organization, the emotional needs of others, and their own wellbeing [ 23 ].

The limited available literature on emotional labour in NHs illuminates the critical influence that the physical and social environments of NHs have on shaping care providers’ emotional experiences of caring for dying residents [ 7 ]. Caring for ill, disoriented residents with aggressive behaviours as well as dying residents in their last stages of life requires NH professionals to regulate their emotions, often masking their true feelings to prioritize the emotional needs of residents and their families above their own [ 6 , 15 ]. Additionally, ethical and moral concerns that professionals face during end-of-life-care provision, such as preserving residents’ dignity, engaging in end-of-life conversations, respecting end-of-life preferences, life-prolonging treatment or treatment withdrawal, likely play a role in emotional regulation and strategies undertaken by professionals [ 23 , 25 ]. All these may affect healthcare professionals’ capacity to interact effectively with residents and co-workers, nurture their sense of self, and provide optimal care [ 7 , 22 ]. However, it is important to note that the regulation of emotions may also produce positive effects, such as facilitating caring and forming the bonds necessary to foster a home-like NH environment [ 5 , 15 ].

Despite the crucial role that emotions play in providing care in NHs, the emotional labour undertaken by NH care professionals remains an invisible aspect of job requirements [ 15 ]. Notwithstanding the critical role that healthcare professionals play in supporting quality living and quality dying for residents in the French NH context, little is known about how they manage their emotions amidst the complex situations they encounter in their practice or how they continue to provide care without jeopardizing their own emotional wellbeing. This study aimed to help fill this gap in the research by (1) analysing the emotional dimensions of providing palliative care in the NH context as well as the strategies used by healthcare professionals to manage the emotional aspects of caring for dying residents and (2) exploring the effects of emotional labour on NH professionals’ wellbeing. To this end, this study sought to answer the following research questions: (1) How do NH professionals manage the emotional demands of caring for residents requiring palliative care? (2) What effects do emotional demands have on professional-resident interactions and the emotional wellbeing of NH professionals? This study’s findings will inform NH management on strategies and interventions to not only reduce the emotional exhaustion and burnout of healthcare professionals but also improve their resilience and wellbeing at work, ensuring that they are best equipped to provide optimal care to residents and their relatives.

Study overview and design

The findings presented in this manuscript originate from a broader implementation study that evaluated the effectiveness of a timely and integrated palliative care approach in 21 NH facilities in France. The initial study used a mixed-method [ 26 ] approach and was segmented into three phases: pre-implementation, implementation, and post-implementation. The current manuscript reports materials from the pre-implementation phase. A detailed methodological description of the broader study has been reported elsewhere [ 27 ]. The qualitative component of the study follows a multiple case study approach [ 28 ]. Among the aims of the qualitative study were to explore NH professionals’ experiences and quality of life at work and to understand how they navigate the emotional demands associated with providing palliative care to residents.

Participants and settings

This manuscript presents qualitative findings from nine out of the 21 NHs that participated in the broader study. The nine NHs were purposively selected to ensure a balanced sample of three NHs per geographical region (Iles de France, Nouvelle Aquitaine, Provence-Alpes-Côte d’Azur) as well as diversity in terms of ownership status (public, private, and private non-profit).

For this study, we purposively included healthcare professionals from various occupational groups employed on a fixed contract in the selected NHs. Participants had to have a minimum of five months of experience and had experience providing palliative care to residents in the same NH. Casual and non-fixed contractual professionals were excluded from the study.

Data collection

A combination of focus group discussions and individual in-depth interviews was used to collect data. This was to achieve an enhanced understanding of the phenomenon of emotional labour within a NH context by exploring views at individual and social contexts [ 29 ]. Nine focus group discussions were conducted with various healthcare professionals who provide direct care to residents. Each focus group was composed of seven to eleven professionals. Given the purpose of the study which was to explore how different professionals navigate the emotional demands of providing palliative care within a NH context, group composition brought together all professionals involved at varying degrees in providing such a type of care. However, to allow participants to share their experiences freely and to avoid any status distinction or hierarchical influence [ 30 ], professionals in the managerial roles were not included in the focus groups. They were involved in individual interviews.

Prior to data collection, a meeting was organized at each participating NH to introduce the broader interventional study to professionals and invite them to take part in the study. The focus group sessions were held at a predetermined location within the NH at a time convenient to the participants and facility and lasted between 90 and 120 min. Individual in-depth interviews were conducted with the supervisory teams, namely the nurse coordinators and medical coordinators. Each individual interview lasted approximately 45 min and was held at a time and place convenient to participants. We used the interview guide developed by the researchers for the purpose of this study (supplementary material 1). The same interview guide was used for individual and focus group discussions, with slights changes on the phrasing of questions for interviews with the management team. Focus group and individual interview questions inquired about experiences of providing palliative and end-of-life care to residents, the emotional dimensions associated with such a type of care, how professionals navigate those experiences and the perceived consequences on professional wellbeing. Examples of questions included the following: How would you describe your experience of caring for dying residents in NHs? What are the emotional aspects of providing palliative care to residents, and how do you navigate those experiences? The last author conducted most of the individual interviews and some focus group discussions, while a trained research assistant under the supervision of the last author moderated the remaining focus groups. Both hold PhD degrees and have experience in conducting qualitative interviews for health research. All interviews and focus group discussions were conducted from April 2021 to September 2022. The interviews were audio-recorded after the participants granted permission. Regular field notes were written immediately after interviews and focus groups. Data collection continued until we have gained adequate and in-depth understanding [ 31 ] of emotional experiences of providing palliative care in NH.

Data analysis

Thematic content analysis following the analytical approach of Paillé and Mucchielli [ 32 ] guided the analysis. The level of analysis was a NH, with each NH considered a case. After verbatim transcription of all the data from the nine cases, two authors (BU & DL) became acquainted with the data by rereading the transcribed interviews, examining participants’ narratives from each case separately, and then developed a list of codes. From the code list, they created a thematization journal using code subdivision, integration, and hieararchization [ 32 ]. Next, the same two authors grouped related codes from all the cases, with a third team member (BE) resolving any discrepancies between the previous analysts. At the end of this stage, a thematic tree of three themes and eight subthemes was constructed. NVivo 14 software assisted with data management and facilitated the coding process.

To ensure methodological rigor, the authors used the recommended strategies for trustworthiness of qualitative data [ 33 ]. To ensure the reliability of the findings, two analysts completed the coding of transcripts, organized peer debriefing meetings throughout the analysis, and kept a reflexive journal recording all the steps taken and decisions made. A third analyst resolved any disagreements through consensus. To ensure credibility of findings, the authors triangulated methods (individual in-depth interviews and focus groups) and collected participant perspectives from various healthcare professions (nurses, nurse assistants, personal support workers, psychologists, occupational therapists, physiotherapists, medical doctors). The writing of the manuscript followed the “consolidated criteria for reporting qualitative research (COREQ)” [ 34 ] (Supplementary material 2).

Ethical considerations

The French Committee of Protection of Person (CPP) granted ethical approval for this study (Approval number: 2020.09.06 bis_20.07.31.64318). All focus groups and interviews respected the rights of participants to choose to participate in the study through informed consent. To ensure confidentiality and anonymity of the collected data, the reporting used codes instead of names.

Demographic characteristics of participants

All NH professionals who met the inclusion criteria and who were available on the day of the focus group were included in the study. In total, 93 professionals participated, including 79 participants in nine focus groups and 14 participants in individual interviews. Tables  1 and 2 provide the detailed characteristics of the settings and demographic characteristics of participants.

Quotes from individual interviews are followed by an acronym designating the profession of the participant (for example NC for Nurse Coordinator, MedCo for Medical Coordinator) as well as the code number of the NH. Quotes from focus groups are designated by the acronym FG, followed by an acronym for the location of the NH (IDF for Ile de France, NA for Nouvelle Aquitaine, PACA for Provence-Alpes-Côte d’Azur), and the code number of the NH.

Analysis of participants’ narratives revealed three overarching themes related to the emotional dimensions of providing palliative care in NHs: (1) intertwined emotionally rewarding and challenging experiences; (2) multifaceted emotional strategies; and (3) switching between emotional engagement, detachment and exhaustion. Supplementary material 3 illustrates the generation of themes and subthemes with illustrative quotes.

Theme 1. Intertwined emotionally rewarding and challenging experiences

Participants’ narratives revealed two intertwined and simultaneous emotional dimensions of providing palliative care to dying residents in NHs: (1) emotionally rewarding experiences and (2) emotionally challenging experiences. The emotionally rewarding dimension of the experiences was supported by the individual professionals’ intrinsic commitment, devotion, and engagement with older persons under their care and a professional duty to provide them with the “best possible care” they deserve. On the other hand, the NH context as a place of living and of care, with its organisational constraints, rendered the experience of providing palliative care to residents emotionally challenging. Specifically, it hindered the care providers’ ability to facilitate what they perceived to be a “dignified death,” leaving them with feelings of distress, frustration, guilt, and uselessness.

Caring for dying residents: emotionally rewarding experiences

Numerous participants described working in NH as a deliberate professional choice and vocation, stemming from their sense of commitment and engagement to offer dependant older people the care they deserve. The relational dimension associated with caring for NH residents gives meaning to their work and becomes a source of pleasure, satisfaction, and self-worth, as illustrated by the following registered nurse:

“Helping older persons is my passion. I find that there is less invasive care in NHs , and there is a relationship that develops and that I enjoy” (NC , NA , 751).

For the majority of healthcare professionals, this deliberate choice to work in NHs implies that confronting death on an ongoing basis is a professional responsibility. Despite the emotional challenges that come with multiple exposures to death, the participants affirmed their commitment to confront death as part of caring for residents. They held the belief that dying is part of living and that accompanying death is a normal process that comes with caring for the living. The devotion to accompanying residents until the end was perceived by NH professionals as a rewarding experience when they felt they had fulfilled their responsibility of facilitating a dignified death:

“It feels so rewarding to see a resident dying the way they should: with dignity , respect , free of pain and with the best possible comfort. That is what we are here for” (FG , PACA , 935).

Although death is considered an expected life trajectory in NHs, participants recognized that dying older persons are often overlooked as a category of the population requiring adequate palliative care. Their perceived duty to accompany residents until the end demonstrates their commitment to ensuring that dying residents experience comfort and dignity equal to that experienced by individuals dying in settings outside the NH.

Similarly, for some residents, NH professionals are the sole individuals they can bond with at a human level and who can meet their diverse emotional needs. Participants believed their role goes beyond that of care providers. Their drive to go above and beyond and make a difference in the end-of-life trajectory of residents becomes a rewarding experience that provides a sense of pride and self-worth. The NH professionals expressed feeling honoured to be the ones to accompany residents in that ultimate moment, even if it means forgetting themselves:

“Aging comes with many losses and emotional needs: most of them do not want to be here [in the NH]; they feel abandoned by their families , they lose their autonomy over things they used to do , they need to feel cared for. Being there for them through the most important moments of their stay here is very rewarding to us. Basically , in the first place , if they are put here , it is so they do not die alone” (FG , PACA , 931). “It’s truly a phase full of emotions where everything comes out: their past traumas , their anxiety , their worries. We try to hold it together , to forget ourselves a little so we can give them what they deserve…” (FG , NA , 755).

Participants’ accounts bring to the forefront that despite the emotionally laden experience of providing palliative care in an NH context, their commitment and determination to accompany residents in their last living moments make this experience emotionally rewarding.

A living and dying space: emotionally challenging experience

Narratives from healthcare professionals emphasized the context of the NH as being initially designed to serve as a living space. Such a home-like living environment that progressively becomes a place of care and ultimately a place of dying leads to the development of close bonds between NH professionals and residents for an extended period. The emotional and physical closeness formed with residents during their stay transcends the caregiver-resident therapeutic relationship. Healthcare professionals have to navigate these different aspects of the NH and remain professional caregivers, all the while providing a home-like environment. One participant explained:

“I’m here from 8am to 8 pm; we live with them [residents]. I do not call some of them by their names anymore. I call them grandpa , grandma. By living with and caring for them for an extended period , they end up becoming like family. When they die , it breaks our hearts” (FG , PACA , 931).

Boundary-setting issues such as these make the relational dimension of care especially difficult, as NH professionals can become too close to residents, which naturally complicates the transition to end-of-life care. Accompanying death for older persons who they have accompanied for living represented a challenging transition for participants who considered residents like their own relatives, as expressed by the following medical coordinator:

“They’re not just people we care for; we live with them. These are the people for whom we’ve fought for every minute to make life worth living. Professionals look after them almost as if they were their parents. Accompanying someone who is going to die , while you have accompanied them so they can live , is in itself emotionally hard” (MedCo , IDF , 116).

Their strong emotional bond with residents became a challenge for NH professionals when discussing the residents’ end-of-life preferences and the palliative decisions that needed to be made in preparation for the end-of-life care plan. Many shared avoiding these discussions, even when residents prompted them, as they did not feel ready to engage in such emotionally charged conversations.

“Palliative care supposes that we should help them think about their death , but we are unable to do that. We are primarily a place of life , and at the end , there is always death. That’s the complexity of [providing] palliative care in NHs” (NC , NA , 753).

The experience of providing palliative care in NHs was also challenged by structural and organisational constraints such as heavy workloads, a lack of time, and unmanaged pain. As a result, some participants reported that they were unable to provide dying residents with the required relief, which caused NH professionals lingering regret even after the death of the resident.

“That resident who died last week , I would have wished to have been able to stay with them a little longer , hold their hand , put on some music , so that there is a presence , like putting life into the end of life. Unfortunately , I was not able to free myself. And it is difficult to live with such a feeling” (FG , IDF , 116).

Theme 2. Multifaceted emotional strategies

When asked how they cope with the emotional demands of providing palliative care to residents, participants highlighted a diversity of emotional strategies they deployed to protect themselves and to continue fulfilling their caring roles. These ranged from genuinely expressing their emotions to modifying and suppressing their emotions to fit the moment. Modification and suppression of emotions were cited as the most commonly used strategies as opposed to the authentic expression of emotions.

“We shed tears”, “We’ve laughed with” : genuine display of emotions

Participants used expressions such as “We cry with” , “We’ve shed tears” , “We’ve laughed with” to convey the authentic emotional strategies put in place. They genuinely expressed their emotions in situations when they felt a deep connection with residents. Most of these genuine emotional strategies occurred in the moments approaching death or following death.

“All the residents on the floor are like my family. Last time I went to see Mrs. B , when my colleague told me she was dead , I was shocked , truly shocked. It was quick. I cried all my tears. I was so sad. I was unable to continue work because I was crying” (FG , IDF , 111).

In some situations, the NH professional’s personal history prompted the authentic expression of feelings. For example, if a resident’s death mirrored the death of their own loved ones, it made it difficult for them to conceal their true feelings as they usually do. Some referred to it as not being able to pretend to have no feelings.

“I accompanied my dying father in palliative care. Every time there is a death of a resident , it echoes my father’s. We had a resident death not long ago. When I saw him , I completely broke down. I cannot pretend anymore” (FG , IDF , 117).

The authenticity of emotions also manifested through allowing oneself time to grieve the death of a resident. A participant discussed requesting a day off to grieve, but some NHs also provided space for grieving the deceased residents.

“I was truly attached to Mr G. When he died , I took a day off. Everyone else [colleagues] continued living their life… laughing. For me , I could not come to work because I was grieving his death” (FG , IDF , 116).

Other participants also recognized a need for the authentic expression of emotions and requested emotional management support for the team.

“For a resident we’d known for a long time to whom we were very attached , we felt helpless with her end-of-life care , and so we genuinely asked for help. We held a round table… , and we asked for help from an external person” (FG , NA , 751).

While some participants expressed their genuine feelings, many participants across focus groups were in favour of emotions being unnoticed and noted a lack of formalized organisational strategies to deal with emotions. Many NH professionals admitted to frequently modifying their feelings to display emotions that are “acceptable.”

“ You wipe your sadness and put a smile on your face ”: modification of displayed emotions

Some NH professionals described their emotional work as involving frequent switching between sadness and joy to respond to the needs of the moment. Many shared trying to display emotions that were not what they truly felt because the situation at hand required them to convey different, often contradictory emotions; for the participants, this constituted difficult emotional labour.

“On one hand , you’ve got one person who is dying and next to them residents who are living. It is very difficult because you have to go into the room [and] take care of someone who is dying. You are sad because you know you will not see that person again. Nevertheless , the moment you see this person for a few minutes , you have to close the door , wipe your sadness , and put a smile on your face to accompany the next-door resident with a serene face. It is difficult to manage all these emotions at the same time. In one day , you have to give contradictory feelings. You are sad for one person , but at the same time , you have to bring joy to the other resident. You have to show them a different face , and that is not easy” (FG , IDF , 117).

The modification of emotions was compounded in the NH environment for some participants who not only adopted an expression in accordance with what was expected but also tried to set limits and find the appropriate time and space for revealing their true feelings when out of the NH. Participants described this ability to emotionally detach as protective:

“The moment I remove my uniform , I immediately put a different face…. When I reach home , if I have situations that have been painful , I allow myself to be restless and sad; I vent my true feelings…” (FG , PACA , 933).

“ You become numb and move on ”: suppression of feelings

Participants discussed the organisational expectation to suppress emotions in order to continue providing effective care. In a quest to fit into institutional norms, many NH professionals who describe themselves as normally prone to showing their emotions had to learn to suppress them.

“By nature , I am a very sensitive person , but now I keep all my emotions inside of me , and at the end , it becomes difficult to unload. Here , it is not common to open up and show emotions or talk about them. We are expected to keep it to ourselves and move on” (FG , PACA , 933).

Multiple exposures to death and a lack of time and a safe space to grieve deceased residents forced NH professionals to suppress their feelings in an attempt to cope with the distress and to continue providing care to residents.

“How can you display feelings when you have four successive deaths? You become numb and move on. Tomorrow you will have another one. You pretend as if everything is fine but there is a problem…” (FG , IDF , 117).

Theme 3. Switching between emotional engagement, detachment and exhaustion

Participants reported that the emotional labour of providing palliative care in NHs results in both negative and positive consequences. The majority of NH professionals noted that the negative consequences of emotional labour resulted in an inability to provide effective care, and the lack of supportive space to express their feelings caused emotional distress, feelings of guilt, and a sense of failure and powerlessness. Some participants accepted emotions as essential to their caring role and mentioned that they give meaning to their work.

“ Everyone was satisfied ”: enhanced satisfaction and meaning of work

Only a few NHs involved in the study had formalized procedures in place to support the emotional wellbeing of their healthcare professionals. These procedures included formal debriefs, a consultation with a psychologist, and massage therapy. In the majority of the NHs, informal peer-to-peer support was mentioned. In settings where emotions are acknowledged and supported, both professionals and managers reported increased satisfaction when accompanying dying residents.

“We had a resident to whom the team was so emotionally involved. When the end was approaching , emotions were high for both professionals and the resident. We [the supervisory team] requested the intervention of the external palliative care team to introduce a third party in the relationship and gently distance the team without completely disengaging them. At the end , everyone was satisfied , and the resident was properly accompanied. It ended up being one of the memorable end-of-life care for the staff” (NC , NA , 751).

When participants believed that they gave their best up to the end and that the outcome was a peaceful death, they gained a sense of pride and accomplishment. They felt they had attained their mission, which, for many, was one of the reasons they remained working in the NH despite the stressful environment.

“On his passing , the resident was so peaceful , so were relatives. It was a real sense of satisfaction. It is the kind of end-of-life care where you feel you have done the right care and that gives you motivation to stay” (FG , NA , 753).

“ It is heart-breaking ”: a sense of guilt and powerlessness

Suppression or modification of emotions affected the wellbeing of participants as well as the care they provided to residents. Different constraints such as time pressure and competing tasks added to their frustration. Their emotional distress manifested itself as constant feelings of guilt, powerlessness, and a sense of failure for not providing adequate care to residents. One of the most common sources of guilty feelings was when the NH professionals believed that they were unable to offer a peaceful, quality presence during end-of-life moments and that the resident died alone. Dying alone was considered inhumane by participants, as they believed that residents were placed in NHs mainly to ensure they do not die alone.

“Very often you tell yourself , ‘Well , I could have been by her side , tell her a comforting word , play the music she loved , rub her forehands , make sure she had a presence… , but no , she is gone and all alone’. It is not human at all , and you carry this with you for long” (FG , PACA , 933).

Participants also expressed feeling powerless when they saw residents in pain and discomfort, and their inability to provide the required comfort to the dying residents left them with an immense sense of failure and uselessness, which negatively affected their wellbeing and their satisfaction with the work done.

“It breaks your heart to see people suffering like this and little is done about it. It’s heart-breaking to think , ‘We are here to help them , but in fact we’re not even doing that’. We are useless” (FG , NA , 755).

“ You finally give up ”: distancing and exhaustion

To protect themselves from the distress associated with multiple exposures to death and a lack of institutional support, some participants admitted that they banalized death to emotionally distance themselves from dying residents, a strategy that the NH professionals recognized as inadequate.

“We give , we give , one day we can’t take it anymore and we banalize death. We don’t see death anymore. It does not affect us any longer , it becomes a commonplace gesture , mundane. Someone dies today; you attend to the next person who will be gone tomorrow , and so forth and so on. You keep accumulating and one day you explode” (FG , IDF , 117).

Other NH professionals adopted a superficial attitude in an attempt to distance themselves and detach themselves from their true feelings. They chose to involve themselves less in the therapeutic relationship by concentrating more on carrying out instrumental and technical care and less on offering a caring and relational presence.

“I go in [the room] , I give the injection and I get out. Not because I do not want to stay , but because I am thinking of the others. I cannot stay with the one who is dying while I have 70 others who are still alive. I have to look after those who are not dying” (NC , PACA , 935).

Some participants dealt with emotionally challenging situations by refusing to accept the palliative care plan of residents with whom they had strong ties. They would ignore the team’s decisions when it involved withdrawing feeding and restricting movement and instead provide the usual care such as taking blood pressure, providing hydration, and mobilizing residents, irrespective of the futile outcome or the risk of causing more suffering. In this way, they felt more useful towards the residents.

“We had a staff meeting , and they said Mrs X was in end-of-life care…that we should avoid mobilizing her and emphasize comfort care. When I arrived in the room , I did not do anything they said. Rather , I got her up from bed , I washed her , I dressed her , I brought the wheelchair , and I was about to take her out. When the nurse coordinator arrived , she could not understand what I was doing. I was in denial. I could not believe she was dying” (FG , IDF , 116).

Several participants reported feeling emotionally strained, exhausted, and lacking the energy to accomplish their mission. Some of them even resigned or verbalized their intentions to resign from their posts. Their emotional exhaustion reportedly stemmed from an accumulation of frustration, discouragement and a lack of accomplishment, feeling incompetent, and a lack of support, which prompted them to resign rather than form a negative view of the residents and fail to deliver effective care.

“You fight , you try your best to keep going , you get discouraged and finally you give up. That is why I want to do something else. Eventually , I want to take care of people and give them what they deserve. Here , I do not give them what they deserve , which frustrates me , and I accumulate. I resigned. I would rather leave the job to someone who wants to do it the way it is done. As for me , I am going to hold onto something else. I do not want to become a bitter caregiver….” (FG , PACA , 933).

The findings from this study illustrate that providing palliative care to dying residents within the NH context exposes healthcare professionals to intertwined rewarding and exhausting emotional experiences. This emotionally demanding work results in a constant switching between feelings of pride and accomplishment on the one hand and guilt, distress, and grief on the other, and it prompts healthcare professionals to identify and distance themselves from the residents to protect themselves from emotional suffering. These findings lead to greater insights into how NH professionals navigate these emotionally laden situations to meet the needs of the residents and the NH as well as their own needs. Drawing from these important findings, our discussion focuses on three key insights from the study: (1) Caring for dying residents results in both emotionally rewarding and emotionally exhausting experiences, (2) NH professionals have to perform emotional labour to navigate the experiences associated with providing palliative care, and (3) Unrecognized emotional labour undermines the wellbeing of NH professionals.

Caring for dying residents results in both emotionally rewarding and emotionally exhausting experiences

Genuine interest in caring for frail older persons is at the heart of the engagement and commitment demonstrated by the participants in our study. Participants described becoming emotionally attached to residents they care for as “unavoidable and the right thing to do,” especially given the expected “home-like” environment of the NH. In that sense, the affective dimension of working in NH and the internal motivation of the healthcare professionals aligned and helped them navigate the emotional labour of caring for dying residents and added meaning to their work. In line with other studies, the unique characteristics of NH, where care providers and residents engage repeatedly in deep personal and intimate exchanges for an extended time, forged closer and more trusting reciprocal relationships than are typically found within acute care setting nurse-patient interactions [ 35 , 36 ].

A majority of participants recalled the emotionally rewarding experiences associated with caring for frail and dying residents. The NH professionals described accompanying residents as their professional duty and took pride in making their last days as dignified, comfortable, home-like, and respectful as possible. Moreover, accompanying residents in their final moments was considered a moral responsibility by participants. The positive experiences and feelings stemming from close and trusting relationships with residents have been recognized by previous studies as central to the emotional wellbeing of NH professionals [ 15 ]. Direct caregivers for dying residents characterize those particular moments as the rare moments they feel appreciated, noticed, and like they are making a difference in settings where they generally feel unseen [ 36 ]. In particular, our participants expressed positive emotions such as engagement, pride, accomplishment, and self-worth in situations where they felt they had achieved dignity in caring for the dying residents. This is relevant because dignity represents an essential part of caring in NHs and in palliative care [ 37 , 38 ]. These personal characteristics and intrinsic motives constitute the internal resources and resilience attributes that allow healthcare professionals to cope with distressing situations surrounding accompanying death in NHs [ 10 ]. Future interventions and training should aim to reinforce the internal resources of NH professionals with a strong focus on building resilience.

Although participants perceived caring for dying residents as a rewarding experience, when the challenging working conditions within NH hindered them from achieving their moral and professional responsibility, it turned the experience into difficult emotional labour. The current NH working environment fails to provide necessary organisational resources and subsequently creates discrepancies between the ideals held by NH professionals on what constitutes the right comfort care to provide and the current practices. Under severe labour shortages, NHs prioritize technical and task-oriented activities over relational moments [ 39 ]. However, for participants in this study, not being present to hold the hands of the dying resident left them feeling guilty of failing their moral responsibility and their professional duty. Consistent with previous studies, the NH culture was found to prioritize tasks and expect healthcare professionals to be consistently “doing something” for residents versus “being” with residents [ 13 , 40 ]. This dissonance creates the most difficult emotional challenges, moral concerns, and distress for NH professionals [ 25 ]. That perceived inability to facilitate a “good death” due to organisational constraints results in moral distress for NH professionals and complicates their grieving process [ 23 , 41 ]. Echoing this, participants in our study shared how emotionally burdensome it was to constantly feel guilty of devoting less time to the “dying resident” because they were required to attend to the “living residents” instead. NH managers and policymakers should take measures to build a culture that enables healthcare professionals to prioritize the emotional needs of residents alongside their physical care needs, as both are equally important to end-of-life care.

Professionals have to perform emotional labour to navigate the experiences associated with providing palliative care

Participants in the current study used different emotional labour strategies to navigate the rewarding and challenging aspects of caring for dying residents in the NH context. Some adopted distancing strategies, such as focusing on task-based care and mechanical actions as well as avoiding feelings and emotional involvement, while others trivialized death or denied the impending death of residents. This process of strategy switching between engagement and detachment is prevalent among palliative care professionals as a way of coping with emotional demands and preventing grief [ 13 , 23 ].

Numerous participants reported that they tended to modify their feelings by displaying emotions that were different from those they felt. For example, some noted “wiping [their] face and showing a smiley face,” while others suppressed their feelings to “become numb and move on” in an attempt to display composure in the moment and comply with institutional rules. Attempting to modify one’s felt emotions to match displayed emotions is known as deep acting, whereas displaying fake, unfelt emotions and suppressing one’s felt emotions indicates a surface acting strategy [ 18 ]. The emotional strategies used by the participants in our study are similar to those commonly used by healthcare professionals in different care contexts [ 12 ]. Particularly in the NH context, emotional labour is intensified by the long-term therapeutic relationship, as the longer the therapeutic relationship the more complicated the emotional labour [ 7 , 15 ]. Participants in our study shared that the stronger and the closer the bond with the resident, the harder it was to navigate the emotional labour associated with witnessing their suffering and providing them with end-of-life care. Debates persist on the appropriate emotional distance to take when accompanying a resident with whom the healthcare professional has formed a close bond. It is noteworthy, however, that healthcare professionals who try to convey caring while remaining emotionally detached may experience increased emotional dissonance and potentially negative effects [ 23 ]. This phenomenon resonates particularly within the NH care context, where professional boundaries are blurred and difficult to respect [ 6 ].

Some participants in this study identified the importance of safe spaces where they can freely express their emotions without faking and without feeling judged, such as spending time informally with colleagues during breaks or with relatives at home. Researchers classify this as the backstage area of emotional expression, owing to the lack of formal recognition and poor appreciation of emotional labour in practice [ 42 , 43 ]. Given the complexity of emotional labour associated with providing palliative and end-of-life care in NHs, scholars recommend more strengthened, explicit, and structured backstage areas to recognize the emotional needs of healthcare professionals and support their emotional growth and resilience [ 43 ]. Unfortunately, findings from our study reiterate the inadequate support available in the NH context for their mental and emotional wellbeing.

In a few instances, some participants in our study allowed themselves to express naturally felt emotions. The close bond they had formed with residents prompted those who adopted the genuine manifestation of feelings to view the resident’s death as a parallel of their own loved one’s death; hence, they allowed themselves to react accordingly. Some took a leave of absence to process the grief, while others requested formal support as they struggled to come to terms with the death of the resident. Studies have shown that adopting naturally felt emotions as an emotional labour strategy can protect healthcare professionals from burnout, as it allows for authenticity and empathy expressions in care [ 12 ]. Genuine emotions have also been found to support nurses in the provision of compassionate care and to inspire cooperation from less-cooperative residents [ 6 ]. In our study, however, the absence of a formal supportive space within the NH to vent emotions discouraged the genuine expression of feelings. Even in the few NHs where opportunities for emotional sharing existed through support groups and psychologist interventions, the participants were reluctant to take advantage of these opportunities. One possible explanation could be that openly expressing emotions might be seen as a sign of weakness, incompetency, and inability to respect professional boundaries. Yet, organisational studies have shown that when grief and emotional suffering are acknowledged and collectively shared as a team, emotional distress is no longer perceived as an individual weakness but rather a collective suffering that requires collective measures to address. However, this cultural shift is only possible when it is supported by the institution through the provision of time, space, and opportunity to debrief and grieve [ 44 ].

Unrecognized emotional labour undermines the wellbeing of nursing home professionals

This study revealed that the emotions experienced by professionals receive relatively little attention within the NH context. This finding supports other studies that have highlighted the invisible nature of the emotional labour endured by healthcare professionals in end-of-life and palliative care within NHs [ 7 , 15 ]. Current institutional rules reinforced by professional norms such as the self-imposed emotional strategies used by healthcare professionals implicitly discourage the open expression of emotions and position genuine displays of emotion as incompetence [ 6 ]. Considering the expression of emotions as weak and a sign of a problem to be addressed leads to emotional labour being unrecognized, professionally undervalued, and even discriminated against [ 24 ]. This is deeply problematic, as unrecognized emotional labour can lead to personal, professional, and organisational negative outcomes.

The effect of emotional labour on a healthcare professional varies depending on the frequency, intensity, diversity, and length of the needed emotional displays as well as the degree of emotional dissonance between the emotions experienced and those anticipated [ 14 ]. Evidence demonstrates that a constant mismatch between felt feelings and displayed emotions leads to emotional dissonance, an internal state of conflict that can cause healthcare professionals to experience difficulty in patient interactions, high levels of stress and burnout [ 12 ], emotional “estrangement” (p.443) [ 13 ], and increased intention to leave [ 45 ]. Consistent with these studies, participants in our study felt drained and worn out by the emotional efforts associated with caring for the dying residents. They experienced guilt and feelings of powerlessness and failure, and a significant number expressed their intention to leave the NH.

At the organisational level, studies have demonstrated that poor patient outcomes and poor quality of care, including missing care opportunities and mistreating residents, are potential negative outcomes of emotional exhaustion and unrecognized emotional labour, as well as lower levels of staff recruitment and retention [ 46 ]. In contrast, emerging evidence suggests that when institutional expectations allow and support authentic emotional expression, positive effects can result for healthcare professionals, care recipients, and the healthcare system [ 12 , 14 ].

Implications for policy, practice, and research

The findings from this study expand our understanding of the complex emotional demands associated with caring for dying residents in NHs. Caring for frail older persons requires extensive time, effort, and mental and physical energy, and it involves the interplay of physical and emotional tasks and skills [ 13 ]. These findings represent a valuable contribution to the NH care system, a system that has been predominated by instrumental-focused care. The data highlights the need for a paradigm shift toward valuing the emotional labour involved in accompanying life and death in contexts that are not palliative-care specialised. Upholding quality care alongside the wellbeing of healthcare professionals requires an organisational culture that does not separate instrumental acts from the emotional labour at the very heart of the caring profession. Instead, it requires organisational changes that result in emotional support seen as a collective routine practice that strengthens the team rather than as an individual responsibility and weakness. This will allow NH professionals to regularly share their feelings and emotions, leading to emotional openness and acceptance [ 40 ].

Regular in-service training initiatives should be put in place in NHs to equip healthcare professionals with effective emotional management skills. In particular, the nursing assistants and personal support workers in our study appeared to be most affected by the negative impact of emotional labour. These categories of professional groups require tailored training to help bridge their skill gap. Capacity building approaches such as critical companionship have been proven to equip healthcare professionals with skills on the effective use of emotions in therapeutic relationships and to allow them to reflect on the use of self in caring [ 19 ]. As a lack of institutional support and peer support discourages emotional expression, NH settings should reinforce work environments in which leadership, supervisor, and co-worker support are an integral part of routine practices.

Structural deficiencies such as inadequate staffing, heavy workloads, and competing tasks leave NH healthcare professionals with inadequate time to provide optimal care. This underpins most of the challenges healthcare professionals experience in the NH context and is a primary factor in the emotional burden they experience when they fail to provide quality palliative care to dying residents. There is a need to adapt resource allocation to the complexity of providing palliative care within NHs. Further studies are needed to design interventions that support emotional regulation while increasing the resilience and emotional intelligence of healthcare professionals in NHs.

A strength of our study was the use of individual and focus groups interviews, which enabled a comprehensive exploration of individual and group views on emotional labour of NH professionals. Including professionals involved in direct care and leaders, i.e. nurse and medical coordinators, enabled to capture a diverse set of experiences and perspectives across professional categories and roles. This study did not intend to establish the levels of influence of factors such as professional category, years of work experience, level of interaction with residents or settings characteristics on emotional labour and strategies used. This may constitute the focus of future research.

This study brought to the forefront the complex emotional labour performed by NH professionals while caring for residents requiring palliative care. The results demonstrated that emotions are an undeniable part of caring for frail and dying older persons in the context of a home-like environment; however, current NH culture discourages genuine emotional sharing and emphasizes emotional suppression. Unrecognized emotions undermine the wellbeing of healthcare professionals, leading to negative individual and organisational outcomes. Understanding and acknowledging the emotional labour of NH professionals is critical to supporting their wellbeing, resilience, and retention, and it ultimately may improve the quality of care for dying residents. The stigma surrounding the emotional labour of caring can be broken by decision makers who design healthy workplace environments that celebrate emotional transparency as a strength as well as by each and every healthcare worker who bravely displays their genuine emotions in hopes to shape a new culture that fully acknowledges their humanity alongside their professional skills.

Data availability

The datasets used in this study are available on a reasonable request from the corresponding author.

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Acknowledgements

The authors of this article sincerely thank the funders of this study cited above and the scientific committee members for their valuable support. We acknowledge the contributions of all members of the Padi-Palli team. We are also grateful to the nursing homes and professionals who participated in the study. The authors thank Professor Margaret Fitch for her valuable insights into the manuscript.

This study was supported by the French Ministry of Health and Solidarity through a call for projects PREPS (Healthcare System Performance Research Program): grant number PREPS 19–0066, by the Association des Dames du Calvaire (ADC) and by the Regional Health Agencies (Agence Régionale de Santé) of Ile de France (ARS IDF) and Provence-Alpes-Côte d’Azur (ARS PACA). The funders had no role or responsibilities in the study design, data collection, data management, analysis and interpretation, or publication of this manuscript.

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EB conceptualized and designed the study, collected and analysed the data, and revised the manuscript. BU analysed the data and drafted and revised the manuscript. DL analysed the data and revised the manuscript. All authors have reviewed and approved the final manuscript.

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Research ethics approval for this study was granted by the French Committee of Protection of Person, approval number 2020.09.06 bis 20.07.31.64318. The study is registered in the National Study Database as ID-RCB 2020-A01832-37. The use of databases and data processing were implemented in accordance with French law (“Informatique et Libertés” dated January 6, 1978 and amended June 20, 2018) and European regulations (General Data Protection Regulation - GDPR dated April 27, 2016). All participants provided their informed consent in writing before their inclusion in the study. Confidentiality was ensured using codes and pseudonyms.

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Umubyeyi, B., Leboul, D. & Bagaragaza, E. “ You close the door , wipe your sadness and put on a smiling face ”: a qualitative study of the emotional labour of healthcare professionals providing palliative care in nursing homes in France. BMC Health Serv Res 24 , 1070 (2024). https://doi.org/10.1186/s12913-024-11550-7

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Received : 28 May 2024

Accepted : 05 September 2024

Published : 16 September 2024

DOI : https://doi.org/10.1186/s12913-024-11550-7

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• Nursing home
• Emotional labour
• Staff wellbeing
• Palliative care
• End-of-life care
• Emotional labour strategies
• Healthy environment
• Healthcare professionals

BMC Health Services Research

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