Making the invisible visible: Revealing the nurse's role in transitions to palliative care
An article written by Geya George (Lecturer), Professor Deborah L. Kirk (Associate Dean), La Trobe University and Professor Davina Porock (Professional Research Fellow) Edith Cowan University
When someone living with advanced cancer begins the shift from active treatment to palliative care, it marks more than just a change in clinical goals—it’s a deeply human moment. For patients and families, this transition is often filled with a complex mix of uncertainty, hope, and grief. For nurses, it is a time when their roles become both intensely visible and quietly invisible. That’s what led us to ask: Do we truly understand what nurses do during these moments, and how can we better articulate their contribution?
Our research team undertook a theory synthesis using Jonathan Turner’s nine-step method to develop a new mid-range nursing theory—Orchestrating Transitions—that seeks to answer this very question. [1] We reviewed grounded theories and qualitative studies exploring the nurse’s role in curative to palliative transitions in advanced cancer care. What emerged was a powerful but often under-recognised duality in practice: nurses engage in work that is both clearly defined (like coordinating care or educating families) and deeply relational (like holding space for emotion, instilling hope, and protecting cultural rituals).
We grouped these into visible roles—advocate, organiser, communicator—and invisible roles—hope instiller, emotion juggler, protector of cultural obligations, and informal communicator. These roles rarely stand alone; they intertwine fluidly in practice. For example, when a nurse facilitates a family meeting to discuss future care, they are coordinating logistics, clarifying medical information, and simultaneously reading the emotional tone of the room. All these aspects are essential—and all too often, only the most measurable parts are acknowledged.
To help visualise this complexity, we used the Boab tree—an iconic Australian symbol known for its deep roots and resource-storing trunk. The visible roles are represented by the tree’s sturdy trunk and canopy; the invisible roles are its expansive underground roots, essential but unseen. Together, they sustain the patient and family through one of life’s most difficult transitions.
What surprised us most was how consistently nurses described this invisible labour across different settings and studies, yet how rarely it is named in policy, documentation, or evaluation. This silence risks burnout for nurses and missed opportunities for patients and families. By articulating and naming these roles, we hope to legitimise them—so they can be taught, supported, and embedded in systems of care.
We see this theory not just as an academic model, but as a conversation starter. How can we better support nurses in doing this work? How can education, staffing, and policy make space for emotional and cultural labour alongside technical skill?
Our hope is that Orchestrating Transitions will help patients receive more person-centred care, help nurses feel more recognised in their contributions, and help healthcare systems better appreciate what it takes to care for someone not just medically, but humanly, as they transition through to the end of life.
Reference
- George G, Kirk D, Porock D. The Nurse's Role in Curative-to-Palliative Transitions in Advanced Cancer: A Theory Synthesis Using Turner's Method. J Adv Nurs. 2025 Jun 9. doi: 10.1111/jan.17088.
Authors
Geya George
PhD Candidate, School of Nursing & Midwifery, Edith Cowan University
Educator, Nursing & Health, Chisholm Institute
Lecturer, La Trobe University
Professor Davina Porock
VC's Professional Research Fellow
School of Nursing & Midwifery, Edith Cowan University
Professor Deborah L. Kirk
Associate Dean & Professor
School of Nursing & Midwifery, La Trobe University