Registered Nurses' Association of Ontario

Practice Recommendations for Care and Management at the End of Life

Receomendation   *Type of Evidence


Nurses are knowledgeable about pain and symptom management interventions to enable individualized care planning. III - IV


Nurses support individuals and families to make informed decisions that are consistent with their beliefs, values and preferences in the last days and hours of life. Ia - IV

Nurses educate and share information with individuals and their families regarding:

  • reconciliation of medications to meet the individual’s current needs and goals of care;
  • routes and administration of medications;
  • potential symptoms;
  • physical signs of impending death;
  • vigil practices;
  • self care strategies;
  • identification of a contact plan for family when death has occurred; and
  • care of the body after death.
Ib - III

Nurses use effective communication to facilitate end of life discussions related to:

  • cultural and spiritual values, beliefs and practices;
  • emotions and fears;
  • past experiences with death and loss;
  • clarifying goals of care;
  • family preference related to direct care involvement;
  • practical needs;
  • informational needs;
  • supportive care needs;
  • loss and grief; and
  • bereavement planning.


Clinical Management
End-of-Life Care During the Last Days and Hours
Practice Recommendations