• end-of-life care;
  • grounded theory;
  • nurse–patient relationships;
  • nurses;
  • nursing

Aim.  The aim of this study was to generate a grounded theory of nursing practice in end-of-life care.

Background.  Provision of end-of-life care that meets the needs of the dying person and their family is complex. While symptom control, disease management and psychosocial care are well understood, there is less evidence about how nurses manage everyday practicalities in challenging organisational environments.

Design.  Qualitative using Glaser’s method of grounded theory.

Methods.  Data were collected from 30 semi-structured interviews with registered nurses working in end-of-life care in New Zealand. Data were analysed using constant comparative techniques. Theoretical sampling and memo writing furthered theoretical development.

Results.  Nurses used the process of moderated guiding to manage different expectations in end-of-life care. Moderated guiding included checking out, involving and supporting. Guiding was both controlling and non-controlling. Moderation was required, as there were tensions in nursing practice because of patient control issues, resource constraints and the individual nurse’s emotional investment in the nurse–patient relationship.

Conclusions.  Moderated guiding raises questions about the challenges nurses face in a health care environment where responsibilities for care have changed.

Relevance to clinical practice.  Moderated guiding explains the role nurses have as resource managers in health services where wider social and economic issues impact multiple clinical demands and influence nursing practice.