Abstract
This study aimed to clarify the advanced assessment and skills used by certified nurses in dysphagia nursing to support oral intake in older adult patients with severe dysphagia until the end of life.
A qualitative inductive research method was employed, involving semi-constructive interviews conducted with 10 certified nurses regarding their experiences with patients nearing death and the feeding management. The nurses also provided insights on the Kuchikara Taberu Balance Chart （KTBC），which assesses eating function, three months prior to and just before death.
Content analysis revealed five key categories of care provided by certified nurses. They implemented ［observation and evaluation of physical and mental deterioration hindering oral intake］ to understand when aspiration might occur, and ［observation and evaluation of the possibility of oral intake］，focusing on what the patients can do. Considering the timing of aspiration, they practiced ［risk management strategies to minimize aspiration using expert knowledge］. In addition, as ［pursuit of comfort and preference］，they ensured patients could eat their favorite foods in a way that minimized fatigue and pain. They carried out their ［feeding practices at the end of life, balancing life and death considerations］，believing that feeding before death did not pose an emotional burden.
The results of this study suggest that certified nurses with a background in professional education can help patients fulfill their desire to eat orally until the end of life by using their advanced assessment and skills.
