scholarly journals Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia

BMC Nursing ◽  
2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Genevieve N. Thompson ◽  
Susan E. McClement
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Structured Interviews ◽  
Care Needs ◽  
Two Phase ◽  
Home Setting ◽  
Expert Nurses

Abstract Background With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population. Methods A qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors. Results Analysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying. Conclusions The critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.

scholarly journals Lower Extremity Amputation and Health Care Utilization in the Last Year of Life among Medicare Beneficiaries with ESRD

2019 ◽  
Vol 30 (3) ◽  
pp. 481-491 ◽  
Author(s):  
Catherine R. Butler ◽  
Margaret L. Schwarze ◽  
Ronit Katz ◽  
Susan M. Hailpern ◽  
William Kreuter ◽  
...  
Keyword(s):  
Health Care ◽  
Lower Extremity ◽  
End Of Life ◽  
End Of Life Care ◽  
Lower Extremity Amputation ◽  
Care Utilization ◽  
Life Care ◽  
Medicare Beneficiaries ◽  
Care Needs ◽  
Extremity Amputation

BackgroundLower extremity amputation is common among patients with ESRD, and often portends a poor prognosis. However, little is known about end-of-life care among patients with ESRD who undergo amputation.MethodsWe conducted a mortality follow-back study of Medicare beneficiaries with ESRD who died in 2002 through 2014 to analyze patterns of lower extremity amputation in the last year of life compared with a parallel cohort of beneficiaries without ESRD. We also examined the relationship between amputation and end-of-life care among the patients with ESRD.ResultsOverall, 8% of 754,777 beneficiaries with ESRD underwent at least one lower extremity amputation in their last year of life compared with 1% of 958,412 beneficiaries without ESRD. Adjusted analyses of patients with ESRD showed that those who had undergone lower extremity amputation were substantially more likely than those who had not to have been admitted to—and to have had prolonged stays in—acute and subacute care settings during their final year of life. Amputation was also associated with a greater likelihood of dying in the hospital, dialysis discontinuation before death, and less time receiving hospice services.ConclusionsNearly one in ten patients with ESRD undergoes lower extremity amputation in their last year of life. These patients have prolonged stays in acute and subacute health care settings and appear to have limited access to hospice services. These findings likely signal unmet palliative care needs among seriously ill patients with ESRD who undergo amputation as well as opportunities to improve their care.

Health Care Professionals’ Awareness of a Child’s Impending Death

2020 ◽  
Vol 30 (9) ◽  
pp. 1314-1325
Author(s):  
Kathie Kobler ◽  
Cynthia Bell ◽  
Karen Kavanaugh ◽  
Agatha M. Gallo ◽  
Colleen Corte ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Structured Interviews ◽  
Study Approach ◽  
Multiple Data ◽  
Impending Death ◽  
Record Review

Health care professionals’ (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs’ initial awareness of a child’s impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a “delicate dance of figuring out” key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

The nursing management required to provide effective end-of-life care in a care home setting: a case study

2021 ◽  
Vol 23 (2) ◽  
pp. 1-7
Author(s):  
Simona Hickey ◽  
Mary Williams
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Care Home ◽  
Life Care ◽  
Home Setting ◽  
Nursing Home Setting

Background: This case study is a practical experience example from a nursing home setting. It will describe how a holistic approach to care, provided to a resident living with dementia at end of life, ensured a peaceful death. Aims: The importance of advance care planning and effective pain and symptom management in end-of-life care will be explored. The psychosocial issues experienced by the resident and their family and any ethical issues associated with the delivery of care will be addressed. The factors and challenges that need to be overcome in order to ensure effective pain and symptom management for the dying patient, particularly in a nursing home setting, are discussed. Finally, this article will make recommendations for future practice. Methods: This is a case study based on an author's experience while working in a nursing home setting. Findings: Challenges associated with end-of-life care have been identified and recommendations have been made.

Huntington’s Disease: A Caring Approach to the End of Life

2008 ◽  
Vol 9 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Joseph Klager ◽  
Ayana Duckett ◽  
Susan Sandler ◽  
Carol Moskowitz
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Disease Progression ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Life Care ◽  
Home Setting

This article describes the challenges of end-of-life care encountered in a specialized long-term care program for people with Huntington’s disease (HD). The Promoting Excellence in End-of-Life Care Huntington’s Disease Workgroup defines the initiation of palliative care as the point at which independent living is no longer possible. Mobility and lifestyle accommodations for people in the nursing home setting with an early-onset disease are a major feature of this program. The primary end-of-life considerations are advance directives decision-making and anticipating end-stage care needs. Disease progression, denial, family conflict, and clinician blind-spots may impede the development of timely advance directives. The unpredictable and idiosyncratic nature of disease progression impacts decision making for end-of-life care settings and approaches: hospitalization, nursing home stay, and in-house hospice care are the available options. The Workgroup has delineated several priority areas for patient care in HD: autonomy; dignity; meaningful social interaction; communication; comfort; safety and order; spirituality; enjoyment, entertainment, and well-being nutrition; and functional competence. This review also includes a description of the program features in each of these areas.

scholarly journals COMPETENCY BASED TRAINING IN THE NURSING HOME SETTING: PROMOTING QUALITY END-OF-LIFE CARE

2014 ◽  
Vol 4 (Suppl 1) ◽  
pp. A15.1-A15
Author(s):  
Dorry McLaughlin ◽  
Felicity Hasson ◽  
Sue Foster ◽  
Noleen McCorry ◽  
George Kernohan ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Competency Based

The Importance of End-Of-Life Care in Nursing Home Settings is Not Diminished by a Disaster

2012 ◽  
Vol 64 (2) ◽  
pp. 143-155 ◽  
Author(s):  
Kathryn A. Frahm ◽  
Lisa M. Brown ◽  
Maggie Gibson
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Disaster Response ◽  
Nursing Home Residents ◽  
Life Care ◽  
Care Needs ◽  
Nursing Home Population ◽  
Skilled Nursing ◽  
Emergency Responders

The emphasis in disaster situations is on preserving life, and this goal is both appropriate and laudable. There is a risk, however, that the needs of people who are dying can become lost when there is a sudden surge of people needing acute intervention. There are significant ethical considerations inherent in society's prioritization of care needs across the acute, rehabilitative, and palliative spectrum in general, let alone in a disaster situation. These ethical conundrums are not the focus of this article. Rather, we anchor our discussion on the assumption that care needs are equally valid, and our purpose is to explore the issues that impact the provision of quality end-of-life care in nursing home settings for those who require this care when a disaster occurs. Nursing home residents, in particular, are at heightened risk for experiencing negative disaster-related outcomes due to compromised physical or mental health that requires skilled nursing care. Moreover, within the already vulnerable nursing home population are many people who are receiving palliative end-of-life services when a disaster strikes. Education and training in end-of-life services for nursing home staff, disaster emergency responders, and other lay people is vital to build capacity for adapting the delivery of these services in disaster situations in the interest of equity and human rights. Given the present lack of guidance in the literature as to what end-of-life care looks like when adapted to the context of disaster response, there is also a pressing need for research to inform this discussion. The purpose of this article is to draw attention to this topic and highlight some of the critical issues, gaps, and opportunities.

End of Life Care in the Nursing Home Setting

2010 ◽  
Vol 11 (3) ◽  
pp. B10
Author(s):  
Petra Flock ◽  
Petra Flock ◽  
Jill M. Terrien
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Home Setting ◽  
Nursing Home Setting

End-of-life care in a nursing home: Assistant nurses’ perspectives

2018 ◽  
Vol 26 (6) ◽  
pp. 1721-1733 ◽  
Author(s):  
Bodil Holmberg ◽  
Ingrid Hellström ◽  
Jane Österlind
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Persons ◽  
Qualitative Content Analysis ◽  
Well Being ◽  
Life Care ◽  
Care Needs ◽  
Assistant Nurses

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.

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