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Policy Frameworks for Nursing Practice in Community-Based Palliative Care: A Four-Country Comparative Documentary
Ana Gonçalves1,2, Barbara Gomes3,4, Sara Pinto5,6
1School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal.
Policy, Politics & Nursing Practice
|July 15, 2026
Summary
Nursing autonomy in community palliative care varies across Europe. Policies must formalize specialized roles to ensure quality end-of-life care and support the nursing workforce.
Area of Science:
- Palliative Care
- Nursing Studies
- Health Policy Analysis
Background:
- Nurses are crucial in community palliative care, but their autonomy and contributions are often underestimated.
- Understanding how nursing autonomy is conceptualized in policy documents is vital for improving care delivery.
Purpose of the Study:
- To analyze political and professional documents concerning nursing autonomy in community palliative care across four European countries.
- To identify factors influencing the recognition and formalization of specialized nursing roles in end-of-life care.
Main Methods:
- Comparative documentary analysis using the READ methodology (Reading materials, Extracting data, Analyzing data, Distilling findings).
- Qualitative content analysis of 68 strategic documents from the Netherlands, Portugal, Spain, and the United Kingdom.
- Combined deductive coding with inductive theme generation to identify multilevel frameworks (micro, meso, macro).
Main Results:
- A multilevel framework emerged, highlighting tensions between technical visibility and formal authority in nursing roles.
- Portugal and Spain show high clinical visibility but limited legal recognition of specialized nursing roles.
- The UK and Netherlands leverage specialty recognition and advanced education for greater nursing agency and nurse-led care.
Conclusions:
- Differences in policy approaches to nursing autonomy can impact workforce sustainability and migration.
- Formalizing specialized nursing roles is essential to avoid 'gray zones' of responsibility and ensure timely care.
- Strengthening structural support for nursing autonomy is key for viable community-based palliative care models.
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