The Challenges and Opportunities in Providing End-of-Life Care in Nursing Homes

Ersek, Mary; Wilson, Sandra Jo

doi:10.1089/10966210360510118

Cited by 91 publications

(78 citation statements)

References 73 publications

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“…However, ADs have limited scope: 32 they have not been shown to reduce unmet needs, 18 to facilitate conversations, or to enhance planning for EOL. 33 Staff sentiments suggested they viewed residents like family, 11 which may have created assumptions regarding residents' preferences and confusion between personal and professional relationships. 21 Existing literature has focused on the completion of an AD; 17 our research has revealed that conversations around the content of ADs was sparse.…”

Section: Discussionmentioning

confidence: 99%

“…10 Research indicates quality of care in NHs is suboptimal, with deficits in staff training, symptom management, treating residents with dignity and respect, and communication. [11][12][13] Few NHs have systematic approaches to elicit and communicate information about resident preferences; 14 therefore staff may be unaware of resident preferences for EOL care. During care preference discussions, surrogate decision makers' perspectives often overshadowed residents' perspectives.…”

Section: Introductionmentioning

confidence: 99%

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Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Towsley

Hirschman

Madden

2015

Journal of Palliative Medicine

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Background: Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. Objective: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. Methods: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n = 16), family (n = 12), and interdisciplinary staff (n = 10) from four NHs. Results: The overarching theme-missed conversations-describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry (''No one asked''); assumptions (presence of an advance directive [AD], ''They know me''); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. Conclusions: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Towsley

Hirschman

Madden

2015

Journal of Palliative Medicine

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“…Broader acceptance of palliative care requires a shift in the culture of long-term care (Kristjanson et al, 2005). Advocates have identified a number of cultural barriers to providing adequate end-of-life care in nursing facilities, including inadequate support of staff caring for dying residents, the emphasis of regulations on restorative care (Ersek and Wilson, 2003;Froggatt et al, 2002) and a reluctance to collaborate with outside hospice providers (Zerzan et al, 2000). In addition, previous ethnographic and mixed-methods research has found that nursing facilities that incorporate the idea of caring for the dying individual into daily care processes and policies provide optimal palliative care (Travis et al, 2002;Forbes-Thompson and Gessert, 2005;Currow and Hogarty, 2006).…”

Section: Discussionmentioning

confidence: 99%

Palliative care in nursing homes: a comparison of high- and low-level providers

Hodgson

Lehning

2008

Int J Palliat Nurs

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The purpose of this study was to explore staff perceptions and concerns about the use of palliative care services in the nursing home setting. Six administrators from nursing homes were purposively selected for key informant interviews. Four common themes emerged, including issues related to the culture of care, the model of care, the relationships with hospice partners, and the role of staff. Recognition of staff perceptions is an important first step in improving the utilization of palliative care services. Staff insight provided clarification related to impediments in promoting a culture of care that was person-centered and relationshipbased. We conclude by identifying the solutions for raising the level of dialogue to promote palliative care practice in the nursing home environment.

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“…As a result of frequent and sustained contact with residents over time, RCAs frequently report developing close, family-like relationships with residents (Moss, Moss, Rubinstein, & Black, 2003;Wilson & Daley, 1998). Though this may help RCAs provide better quality end-of-life (EOL) care (and indeed, may sustain them in their work), it can also be a 'double-edged sword' entailing considerable grief and distress when a resident dies (Ersek & Wilson, 2003;McClement, Wowchuk & Klaasen, 2009). …”

Section: Abstract Managing Grief and Difficult Emotions Related To Ementioning

confidence: 99%

Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care

2014

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ABSTRACT. Managing grief and difficult emotions related to end of life (EOL) care is an oftenunder-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that eleven RCAs in one Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked "consoling refrains" to manage grief, including "such is life," "they are better off" and "they had a full life." To manage guilt and moral distress, RCAs reminded themselves "I did my best" and "I experience rewards." Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.Author's Postprint Copy 3 Population demographics, technology and health care service delivery have been reshaping the nature of older populations in residential care facilities. More residents have chronic life-limiting conditions such as dementia, leading some to suggest that "long-term care facilities will become the hospices of the future" (Abbey, Froggatt, Parker, & Abbey, 2006: p.56). In Canadian residential care facilities, the most substantial portion of direct care is provided by resident care aides (RCAs). As a result of frequent and sustained contact with residents over time, RCAs frequently report developing close, family-like relationships with residents (Moss, Moss, Rubinstein, & Black, 2003;Wilson & Daley, 1998). Though this may help RCAs provide better quality end-of-life (EOL) care (and indeed, may sustain them in their work), it can also be a 'double-edged sword' entailing considerable grief and distress when a resident dies (Ersek & Wilson, 2003;McClement, Wowchuk & Klaasen, 2009).Staff members in residential care settings frequently lack opportunities to grieve resident deaths (Kaaslainen, Brazil, Ploeg & Martin, 2007;Moss et al., 2003) and many desire greater practical and/or emotional support after a death (Hanson, Henderson & Menon, 2002;Katz, Sidell & Komaromy, 2001;Katz, Sidell & Komaromy, 2000;Rickerson, Somers, Allen & Lewis, 2005). Bereavement support in these facilities is often non-existent or poorly resourced, due in part to resource constraints and an inability to recognize staff bereavement needs (Moss, Braunschwieg & Rubinstein, 2002;Katz, Sidell, & Komaromy, 2001). When deaths and relationships are unacknowledged, grief may be disenfranchised, which may have negative effects on personal growth, as documented in one study (Anderson & Gaugler, 2006).In addition to grief, RCAs providing EOL care deal with difficult emotions such as helplessness that can be involved when watching a resident suffer (Goodridge, Bond, Cameron & McKean, 2005;Palan Lopez, 2007). Additionally, RCAs may work in environments with inadequate staffing, lack of supervision, high turnover, lo...

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The Challenges and Opportunities in Providing End-of-Life Care in Nursing Homes

Cited by 91 publications

References 73 publications

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Palliative care in nursing homes: a comparison of high- and low-level providers

Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care

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