The Transition from Routine Care to End-of-life Care in a Nursing Home: Exploring Staff Perspectives

Waldrop, Deborah P.; Nyquist, Kathy

doi:10.1016/j.jamda.2010.04.002

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…However, an early preparation for end-of life seems to be lacking. Waldrop and colleagues [ 41 ] argue that all nursing home residents are admitted because of a medical crisis which has necessitated institutionalized long-term care and that this fact implies that all nursing home residents are to be considered as dying, although not necessarily imminently. Thus a palliative care approach could be put into place from the very start of a person’s residence at a nursing home, e.g.…”

Section: Discussionmentioning

confidence: 99%

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

et al. 2018

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BackgroundNursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.MethodsThe focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey.ResultsThe analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death.ConclusionsThis study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

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Section: Discussionmentioning

confidence: 99%

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

et al. 2018

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“…These ‘family-like’ relationships between care staff and clients have also been observed in other settings, such as dementia care [ 34 ]. In a nursing home study, care staff pinpointed the loss of the close attachment to their client as the biggest challenge to overcome in the transition to end-of-life care [ 35 ]. Yet for care staff in ID care services ‘letting go’ might be even more intense, as providing end-of-life care is not regular care for them.…”

Section: Discussionmentioning

confidence: 99%

‘From activating towards caring’: shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians

et al. 2015

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BackgroundProfessionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people with ID.This paper describes the shifts in care approaches and attitudes that relatives and professionals perceive as the death of a person with ID approaches, as well as the values underlying these shifts.MethodsA qualitative design was used to reconstruct the cases of twelve recently deceased people with ID. Relatives and professionals who were closest to the person at the end of their life were interviewed. Interviews were transcribed verbatim and data were analyzed inductively, using elements of thematic analysis.ResultsFive shifts were found: 1) adapting to a new strategy of comforting care, taking over tasks and symptom relief, 2) interweaving of emotional and professional involvement, 3) stronger reliance on the joint interpretation of signals expressing distress and pain, 4) magnified feeling of responsibility in medical decisions, 5) intensified caring relationship between ‘two families’: relatives and care staff.Six relational values were behind these shifts: ‘being there’ for the person with ID, ‘being responsive’ to the person’s needs, ‘reflection’ on their own emotions and caring relationships, ‘attentiveness’ to the ID person’s wishes and expressions of distress, ‘responsibility’ for taking joint decisions in the best interests of the person, and ‘openness to cooperation and sharing’ the care with others.ConclusionsEnd-of-life care for people with ID involves curtailing expectations of participation and skill acquirement, and an increase in teamwork featuring intensified comforting care, symptom management and medical decision making. Three caring relationships need to be fostered: the relationship with the person with ID, relationships among professionals and the relationship between relatives and professionals. ID care services should invest particularly in the emotional support and expertise level of care staff, and in the collaboration between relatives and professionals.

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“…10 However, when a patient with life-threatening illness nears EOL, staff must often make a difficult shift from a restorative approach to a model more consistent with palliative care. 10,11 Good communication, comprehensive training in EOL care, and staff support may help NH staff facilitate this shift. 12–14 In addition to staff communication, psychosocial support 7 and previous experience with death and dying 13 may also influence staff members’ comfort level with providing EOL care.…”

Section: Introductionmentioning

confidence: 99%

Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

Cagle

Unroe

Bunting

et al. 2017

Journal of Pain and Symptom Management

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Context Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care. Objective To describe, from the staff perspective, positive/negative experiences related to caring for dying residents. Methods Qualitative analysis using survey data from staff working in 52 Indiana nursing homes. Results A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31–50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord. Conclusion Findings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.

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The Transition from Routine Care to End-of-life Care in a Nursing Home: Exploring Staff Perspectives

Cited by 12 publications

References 33 publications

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

‘From activating towards caring’: shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians

Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

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