How nurses in China navigate end-of-life communication: A qualitative study

End-of-life communication involves navigating diverse beliefs, values and expectations while supporting individuals and families during a highly vulnerable and emotionally charged stage of life. In China, where family-centred decision-making and taboos surrounding death are still common, nurses face distinctive challenges in navigating these conversations.

To explore and describe how experienced registered nurses learned and adapted to engaging in end-of-life communication within the Chinese cultural context, drawing on their retrospective accounts.

A qualitative descriptive study design.

Three large public tertiary hospitals (Grade A) in Jiangsu Province, China.

Twenty-six registered nurses (age range, 26-45 years; 20 [76.9%] female; clinical experience, 6-20 years) were recruited through purposive sampling, supplemented by snowball sampling.

Semi-structured, face-to-face interviews were conducted between June and August 2025, and data were analysed using reflexive thematic analysis supported by NVivo 12 software.

Four themes were developed, including: (1) Hesitant beginnings: early dilemmas in end-of-life communication; (2) Ongoing transformation: learning through accumulated experiences; (3) Mediating practices: reconciling cultural expectations, ethical responsibilities and patient-centred communication; and (4) Empathic realism: balancing emotional engagement and professional boundaries.

Nurses working in tertiary hospitals in eastern China described an evolving, not always linear process of learning to navigate end-of-life communication, shifting from hesitant and culturally constrained interactions towards more balanced approaches. Nurses' cumulative experiences supported their professional growth. However, targeted education, alongside organisational and policy-level support, remains essential to promote effective and culturally sensitive end-of-life communication.