Professional competencies of nurses in palliative care: a systematic review

Abstract

Palliative care is essential for improving the quality of life for patients with life-limiting illnesses and their families. Nurses, as the primary providers of this care, require comprehensive professional competencies spanning clinical, communication, ethical, psychosocial, spiritual, leadership, and informatics domains. Evidence regarding the current levels of these competencies, the tools used to assess them, and the factors influencing their development remains fragmented. This systematic review aims to synthesize existing evidence, identify gaps in practice, and highlight factors associated with competency development. Following PRISMA 2020 guidelines, six international databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, Cochrane Library) and four regional databases (SID, Magiran, IranMedex, Civilica) were systematically searched for original studies published between January 2015 and December 2025 in English or Persian. Eligibility criteria were defined using the Population–Concept–Context (PCC) framework and restricted to original quantitative, qualitative, and mixed-methods studies. Secondary reviews were excluded. Data were extracted using a standardized form and quality was appraised using JBI checklists and MMAT. A narrative synthesis approach was employed. Twenty-three original studies comprising approximately 11,600 participants from 12 countries were included. The majority were cross-sectional in design, conducted in hospital, ICU, and oncology settings. Most studies reported moderate to high levels of competency in clinical symptom management. However, significant gaps were identified in advance care planning (ACP), spiritual care, ethical decision-making under moral distress, and leadership. Across studies, the most frequently reported barriers were moral distress, high workload, and lack of structured education. Self-reported measures predominated, underscoring the need for objective, standardized assessment tools. While nurses demonstrate adequate foundational competencies in palliative care, critical deficits persist in complex psychosocial, ethical, and spiritual domains. There is a potential need for targeted, competency-based educational interventions integrating ethical reasoning, communication skills, and resilience training. Healthcare organizations must also foster supportive environments to mitigate moral distress. Future research should prioritize longitudinal designs and validation of standardized competency assessment tools.