Cardiovascular Nursing Practices Following the Transition to End-of-Life Care for Patients with Heart Failure in Japan.

Heart failure patients face unique end-of-life challenges due to unpredictable disease trajectories, yet nursing practices in cardiovascular wards' palliative care practices in Japan remain underexplored. This study clarified the palliative care practices implemented by nurses in cardiovascular wards after the transition of heart failure patients to end-of-life care. Six experienced nurses participated in semistructured interviews. Data were analyzed using qualitative inductive analysis, and 4 key characteristics were identified. First, nurses provided early decision support despite prognostic uncertainty. Second, nurses balanced disease management with patient preferences through continuous physical assessment. Third, nurses coordinated complex discharge planning managing medical decisions and family preparation. Fourth, nurses engaged physicians to facilitate timely prognosis discussions. Importantly, these practices were delivered by experienced nurses in cardiovascular wards rather than palliative care specialists, reflecting integration of essential palliative care within routine cardiovascular nursing. Notably, cultural barriers and unpredictable disease trajectories create unique challenges requiring specialized nursing competencies.