Palliative care has long been framed as a specialist discipline reserved for hospices and oncology wards, but a growing body of evidence insists it belongs everywhere people approach the end of life, including nursing homes, where a large share of deaths in ageing societies now occur. A new qualitative study from Sweden, published in BMC Nursing, offers an unusually candid look at what happens inside care teams after they receive structured palliative care education, and the central finding is striking: training changes how staff think, but thinking alone does not change care. The researchers, Camilla Ekeblom, Carina Lundh Hagelin and Jane Österlind of Marie Cederschiöld University in Stockholm, found that the value of an educational intervention depends on an intricate alignment between individual emotions, relational dynamics and organisational realities, and that when any one of these dimensions falls out of step, the benefits of education can quietly dissolve.

The study set out to explore how nursing home staff reason about providing palliative care after participating in an interprofessional educational intervention, abbreviated in the literature as IPEI. Rather than measuring outcomes with questionnaires, the team chose a descriptive qualitative design, interviewing eighteen staff members drawn from five Swedish nursing homes. The participants represented the full spectrum of people who actually deliver and manage care: registered nurses, assistant nurses, a physician, first-line managers and designated palliative care champions. This breadth matters, because palliative care in nursing homes is not delivered by any single profession; it emerges, or fails to emerge, from the daily interplay of people with different training levels, responsibilities and emotional exposures to dying residents.

Data were collected through semi-structured individual interviews conducted between March and April 2024, and analysed using inductive qualitative content analysis, a method that allows themes to rise from the material itself rather than being forced into pre-existing theoretical boxes. From this analysis, three main categories emerged, and together they map the terrain on which palliative care is actually practised. The first concerns managing one’s own emotions, thoughts and attitudes. The second addresses the significance of relationships, communication and interactions in care. The third captures how staff navigate norms, assumptions and organisational structures in everyday palliative care. The categories correspond, respectively, to the individual, relational and organisational dimensions of the work, and the authors argue that it is the interplay among all three, not any single factor, that determines whether good palliative care becomes possible.

The individual dimension is perhaps the most human part of the findings. Staff described the ongoing internal work of confronting their own feelings about death, ageing and suffering, and of examining assumptions they carried about what palliative care even means. A recurring tension in the literature, echoed here, is the tendency to equate palliative care narrowly with end-of-life care, the final days and hours, rather than understanding it as an approach that can and should be integrated into everyday care over a longer trajectory. The interviews suggested that the educational intervention gave participants opportunities for personal as well as professional development, creating space to reflect on attitudes that had previously gone unexamined. In this sense, education functioned less like a knowledge transfer and more like a mirror, prompting staff to notice how their own emotional responses shaped their clinical decisions.

The relational dimension proved equally consequential. Palliative care in a nursing home is saturated with communication: conversations with residents about what matters to them, exchanges with distressed relatives, coordination between assistant nurses who know the residents intimately and nurses and physicians who carry clinical responsibility. The participants’ reasoning placed relationships and interactions at the heart of care provision, indicating that no amount of theoretical knowledge substitutes for the ability to build trust, listen and communicate across professional boundaries. This is where the interprofessional design of the intervention appears to have paid off. By bringing different professions into a shared educational space, the programme created a common language and, implicitly, a shared understanding of what the team was trying to achieve together, something that fragmented, profession-specific training often fails to produce.

The third dimension, the organisational, is where the study’s message becomes most uncomfortable for policymakers and care home leadership. Staff described navigating norms and assumptions embedded in their workplaces, along with structural conditions that could either support or obstruct a palliative approach. Staffing levels, routines, leadership priorities and workplace culture all shape what is practically possible on a shift where residents are dying, families are anxious and time is scarce. The authors’ conclusion is explicit on this point: providing palliative care was not solely a matter of enhancing staff knowledge. Knowledge and the conditions for care are shaped through the interplay between staff attitudes, their reasoning about care, relational dynamics and organisational conditions. When these dimensions align and mutually reinforce one another, favourable conditions for palliative care may be supported; when they do not, even well-trained staff may find their intentions frustrated.

Why does this matter on a societal scale? Nursing homes accommodate older people with complex needs and account for a large proportion of deaths, which makes palliative care a central component of care in these settings rather than an occasional emergency. Yet access to palliative care remains unequal, particularly for older people, and staff in long-term care often lack sufficient training. The demographic arithmetic is unforgiving: as populations age, the number of people who will die in nursing homes rises, and the quality of their final months depends heavily on the competence and confidence of the workforce that cares for them. Studies like this one move the conversation beyond the simplistic assumption that a training course fixes the problem, and toward a systems view in which education is necessary but insufficient on its own.

The study also carries a methodological lesson for how we evaluate educational interventions in care settings. Much of the existing research measures knowledge gains or self-reported confidence before and after training. Those metrics are useful, but they cannot reveal how staff actually reason about applying what they have learned in the messy reality of daily care. By using inductive content analysis of interviews, the Swedish team surfaced the texture of that reasoning: the hesitations, the emotional labour, the negotiations with colleagues and managers, the quiet adjustments between ideal practice and what the shift allows. The findings suggest that interprofessional educational initiatives work best when they combine theoretical knowledge with opportunities for reflection and practical application, allowing staff to translate concepts into their own working context rather than leaving translation to chance.

There are limits worth noting. The study involved eighteen participants in five Swedish nursing homes, interviewed at a single point in time after the intervention, and qualitative findings are not designed to be statistically generalised. The researchers themselves submitted the work for ethical review, receiving approval from the Swedish Ethical Review Authority, and obtained written informed consent from all participants, but the transferability of the results to other health systems will depend on how similar those systems’ nursing homes and educational programmes are to the Swedish context. Still, the three-dimensional framework that emerged, individual, relational and organisational, offers a portable lens that other teams can use to examine their own settings, and it aligns with a broader international consensus that palliative care competence must be built at every level of an organisation simultaneously.

The most durable insight from this research may be its refusal to locate the solution in any single place. Staff who completed the intervention perceived it as an opportunity for growth, and their reasoning showed genuine movement in how they understood palliative care as an ongoing approach rather than a final act. But their accounts also made clear that attitudes, relationships and structures must pull in the same direction for that understanding to reach residents’ bedsides. For nursing homes everywhere, the implication is a practical checklist of a different kind: train your staff together, give them room to reflect, examine the norms your workplace quietly enforces, and make sure the organisation’s daily conditions match what the education teaches. Where those elements align, palliative care stops being an aspiration and becomes, simply, the way care is done.

Subject of Research: Nursing home staff's reasoning about providing palliative care after an interprofessional educational intervention

Article Title: “Nursing home staff’s reasoning about providing palliative care following an educational intervention – a qualitative interview study”

Article References: Ekeblom, C., Lundh Hagelin, C., & Österlind, J. (2026). “Nursing home staff’s reasoning about providing palliative care following an educational intervention – a qualitative interview study”. BMC Nursing, 25(1), Article 956. https://doi.org/10.1186/s12912-026-05480-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05480-4

Keywords: palliative care, nursing homes, older people, interprofessional education, qualitative research, nursing education, end-of-life care, care staff attitudes, organisational conditions, Sweden, BMC Nursing, healthcare workforce

Wildfire scientists have unveiled a new rapid risk-assessment tool that shows substantial wildfire danger to homes and buildings in three major Arctic communities, revealing that between 14% and 26% of structures in Anchorage, Fairbanks, and Whitehorse face high or very high risk from approaching flames. The study, led by Jennifer I. Schmidt of the University of Alaska Anchorage together with Robert H. Ziel, Monika P. Calef, Anna Varvak, and Julio C. Postigo, was published in the International Journal of Disaster Risk Science. Rather than relying on complex fire-behavior simulations that demand specialist analysts and expensive software, the approach combines datasets that most local governments already possess: building footprints, zoning maps, and readily available vegetation layers. The result is an updatable, affordable portrait of which buildings face the greatest threat and where mitigation dollars can do the most good.

The urgency behind the work is hard to overstate. Wildfire costs and damages in the United States alone are now estimated at between USD 394 billion and 893 billion annually, and the 2019 to 2020 Australian fire disasters cost nearly USD 100 billion. The Arctic, often imagined as too cold and wet to burn, is not immune: since 1980, wildfires have cost Alaska between USD 2 billion and 5 billion, with projections suggesting costs could rise 68% by the end of the century. Canadian suppression expenses are expected to climb by 60 to 110% relative to the 1980 to 2009 baseline. Meanwhile, structure loss from wildfire has doubled over the past two decades in the western United States, and western Canada has suffered major structure-loss events in four of the last eight fire seasons. Nearly half the global population now lives within the wildland-urban interface, the zone where people and forests meet or intermingle, making tools that translate fire science into actionable local maps increasingly vital.

The researchers’ central premise is conceptually simple but technically consequential: for a structure to be at high risk, a flammable hazard must exist nearby, within roughly 500 meters, and the surrounding landscape must exhibit high wildfire exposure. The method begins with a flammability hazard layer at 30-meter resolution, built from a modified version of NASA’s ABoVE Landcover dataset in which generic evergreen classes were refined to reflect locally flammable species such as black spruce, white spruce, lodgepole pine, and subalpine fir, each assigned hazard ratings from 0 to 100. Critically, the team treated structures themselves as fuel. Each building contributes three fuel units to the surrounding flammability score, a value chosen after systematic testing of one through ten fuel units; three proved optimal, nudging densely built environments up a hazard category without causing wholesale reclassification. Structure density was computed at 90-meter resolution, multiplied by three, and added to the vegetation-based hazard to produce an enhanced flammability hazard layer.

Wildfire exposure, the second pillar of the assessment, captures the potential for hazard to travel. It is calculated as the average flammability hazard within a 100-meter or 500-meter radius, representing the likelihood that fire can reach and burn a given location even if the local fuels themselves are sparse. Exposure values, also ranging from 0 to 100, are classified into five tiers from very low to extreme, and concentrated pockets of flammable vegetation drive scores upward. The third ingredient is structure vulnerability, produced by multiplying the enhanced flammability hazard by a structure importance factor derived from zoning data: residential buildings and critical infrastructure such as hospitals, schools, and nursing homes receive the highest weight, followed by commercial and other structures. Where zoning was unavailable, as on military installations like Joint Base Elmendorf-Richardson in Anchorage and Fort Wainwright and Eielson Air Force Base in Fairbanks, the team collaborated with base personnel or interpreted aerial imagery to classify neighborhoods. The final risk score synthesizes hazard, exposure, and vulnerability into six categories, from extremely low to very high.

The results paint a nuanced picture of Arctic fire danger. Fairbanks showed the greatest proportion of structures in the top two risk categories at 26%, followed by Whitehorse at 22% and Anchorage at 14%. Anchorage, paradoxically, had the highest share of buildings in the top vulnerability tiers, 42%, yet the lowest risk, a consequence of its large urban footprint where dense housing raises vulnerability but fragmented, less-flammable vegetation and abundant developed ground suppress exposure. Fairbanks and Whitehorse, with structures woven into spruce- and pine-dominated boreal landscapes, showed closer alignment between vulnerability and risk. Anchorage was also the only study area where more than 1% of cells jumped two or more flammability categories when buildings were counted as fuel, at 7%, reflecting its 27% share of structure area containing seven or more buildings per cell. The analysis also confirmed the primacy of exposure: when a structure’s wildfire exposure was extreme, at least 87% of such buildings landed in the highest risk category across all three communities.

A key innovation lies in how the team redrew the wildland-urban interface itself. Traditional WUI maps distinguish urban, interface, and intermix zones; the researchers added a fourth category, the transmission zone, marking areas roughly 2.4 kilometers beyond the WUI boundary where fire could move into a community and where fuel breaks might be sited. Within the 500-meter buffer around structures, urban areas were defined by exposure values of 20 or less, interface zones by 21 to 60, and intermix by values above 60, cross-referenced with Alaska and Yukon wildfire management designations that prioritize suppression from critical down to unplanned or wilderness levels. Fairbanks claimed the largest overall WUI footprint, and the transmission zone proved the largest category in every study area, spanning 23,347 square kilometers around Anchorage, 6,180 square kilometers around Fairbanks, and 665 square kilometers around Whitehorse. Across all sites, most structures fell within interface zones, 52 to 61%, followed by intermix at 20 to 35%. Thousands of buildings sit in the high-risk interface and intermix zones where mitigation should concentrate: 15,537 structures in Anchorage, 16,212 in Fairbanks, and 3,734 in Whitehorse.

The method faced its most demanding test against a real disaster. On 17 August 2019, during southcentral Alaska’s hottest and driest summer on record, the likely human-caused McKinley wildfire was driven by high winds across 13.3 square kilometers in three days, destroying 52 residential structures, 84 outbuildings, and three commercial buildings, affecting 1,028 properties and forcing roughly 350 to 400 people to evacuate. By comparing pre-fire aerial imagery from 2017 with post-fire imagery from 2020 at 0.3-meter resolution and linking vanished buildings to the Matanuska-Susitna Borough structure database, the team identified exactly which structures burned. The verdict was statistically compelling: burned structures had significantly higher wildfire exposure than those that survived, and the proportion of burned structures with exposure values above 60 was significantly larger than among unburned ones. Structure risk scores above 60 were also significantly associated with burning. Notably, the test held even under conditions so extreme that normally resistant, low-flammability fuels were igniting.

The study’s design was shaped by sustained community engagement. Through workshops in 2019, 2021, and 2023, along with 15 to 20 meetings organized by Anchorage community councils and landowner associations and public events ranging from wildfire awareness days to Arbor Day, residents and agency staff reshaped everything from color schemes to model parameters. One consequential example: Anchorage residents and fire managers insisted that the maps reflect the spruce beetle outbreak first detected in 2016 and peaking around 2020, which killed and removed many spruce trees. The team responded with rules derived from aerial detection surveys, reclassifying white spruce cells in areas of beetle intensity of 11% or greater to mixed forest, and shifting mixed forest cells to open shrub, while a succession model updated vegetation on areas burned within the last 30 years. This iterative dialogue ensured outputs that both wildfire practitioners and the general public can interpret, a prerequisite the authors see as central to building fire-adapted communities.

The practical implications for planning are direct. Because mitigation funding is often tied to officially designated WUI areas, the ability to rapidly recalculate boundaries from updated building layers expands funding opportunities and keeps pace with community growth. The framework also points to different interventions in different zones: structures in intermix areas, surrounded by vegetation, benefit most from fuel treatments, while those in interface zones, where flammable vegetation is scarcer, are better served by home hardening measures such as fire-resistant roofs, siding, decks, screens, and unburnable buffers. Given that wildfire activity tends to occur where exposure exceeds 60, the authors recommend concentrating resources on the top two risk categories. Where national products like wildfirerisk.org rely on generalized fuel layers that can overestimate unburnable area in WUI zones and are updated too slowly for annually burning landscapes, this approach trades complexity for transparency, using local data that governments already collect. The underlying wildfire exposure toolbox is publicly available on GitHub, and the team argues that empowered residents, equipped with accurate, current, neighborhood-scale information, are crucial to reducing wildfire risk, particularly where communities may prefer action without government intervention.

Affordable, fast-heating and with a clever air fryer function, this versatile model is a winner for outdoor cooks who are willing to give up the traditional flame

• The best pizza ovens – tested
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An electric pizza oven with no flame and no need to rotate the pizza may seem sacrilegious to purists, but the Ninja Artisan electric outdoor pizza oven solves many of the hassles of outdoor pizza making. There’s no lighting or monitoring a flame, no need to keep adjusting the heat, and no need for a turning peel, bulky gas bottle or constant use of an infrared (IR) thermometer (although you may still want one – read on for details).

Equipped with four presets – Artisan, Thin Crust, New York, Pan – plus a custom setting to enable you to bake your pizza exactly how you like it, the Ninja Artisan is as effortless as can be, even next to the simplest plug-and-play gas oven. As you might expect from Ninja, it’s a multipurpose cooker, too, transforming into an outdoor air fryer with a capacity to turn out up to 1.3kg of french fries, or bake six chicken breasts.

Stick vacuums are a convenient alternative to corded designs, but which model wins for overall cleaning prowess? Our expert reveals all

• The best robot vacuums
• How to make your vacuum last longer

Choosing a cordless vacuum isn’t a decision that should be taken lightly. You’re likely to keep a vacuum cleaner for years, relying heavily on its ability to suck up dust, crumbs, mud, pet hair and any other dry spillages or sheddings that end up on your floor. Choosing the right model can be the difference between an effective cleaner that’s a delight to pull out of the cupboard and a dud that you dread having to unblock, detangle and clean after every use.

In this review, I took 16 of the leading cordless vacuum cleaners from a range of manufacturers and at various prices and inflicted the same cleaning tests on each one. That takes all the guesswork out of picking your next cleaner: I can tell you exactly which ones picked up the most mess.

Best cordless vacuum cleaner overall:
Shark PowerDetect Clean & Empty IP3251

Shark’s cordless vacuum is a whiz at cleaning hard floors and pet hair, but a disarmingly short battery life caught our reviewer off guard

• The best cordless vacuum cleaners – tested

Vacuuming rarely starts with vacuuming. First you have to clear the floor of stray socks and abandoned toys left behind by children, pets or messy partners. Then there’s the irritation of finding the vacuum’s dustbin still full of dirt, or the battery flat because someone forgot to charge it.

The (take a deep breath – long name coming up) Shark PowerDetect Speed Clean and Empty Pet Pro cordless vacuum Ultramarine IA3241UKT certainly won’t pick up the scattered toys for you, but it has been designed to make the job of vacuuming as frictionless as possible.

Whether you’re on PC or a console, level up your setup with our gaming expert’s pick of the best chairs

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Comfort is crucial to the gaming experience. It’s hard to focus on blasting aliens or taking Stoke to the Champions League final if your bum has gone to sleep because you’ve been sitting on an old chair for three hours. We’re spending more time playing games than ever before, so good posture matters. If you have set up a dedicated gaming space, then a rickety seat just won’t cut it.

From luxurious ergonomic thrones to cheap-and-cheerful bucket seats, the options available are bewildering. So I set out on an epic quest: to find the most comfortable, durable and stylish gaming chairs. Here’s what I discovered.

Best gaming chair overall:
Secretlab Titan Evo

Best budget gaming chair:
ThunderX3 Solo 360

Surprisingly easy to manoeuvre and skilled at cleaning carpet and hard floor, Shark’s upright bagless model is one of the best corded vacuums I’ve tested

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Corded vacuum cleaners aren’t as glamorous as their cordless cousins, but swapping battery power for a plug socket has its advantages. The device will never be short of power, so it can keep cleaning for as long as you need it to. Prices also tend to be lower because there’s no expensive battery to factor into the cost.

On the downside, there’s a cable to manage while you clean, and even the longest cords usually need to be switched from one plug socket to another if your home is any larger than a small flat.

As summers become hotter, air conditioner sales are booming. If you’re looking to invest, here’s what to consider

When a heatwave struck the UK this week, Jon Connorton, a software developer, began monitoring temperatures inside his east Hampshire terrace house. With some rooms reaching close to 40C, it was time to deploy the air conditioner. “We just wheel it out in emergencies,” he said. “We were having trouble sleeping.”

Connorton and his wife have a portable air conditioner. These plug-in devices cool interior air by removing heat from it and blowing that heat outside, typically via a large hose slung from a window or door.