Nurses’ Experiences on End-of-Life Care for Older Patients in Long-Term Care Hospitals: Focusing on the Process of Practice and Barriers

Purpose: The purpose of this study was to investigate the practical process and barriers of end-of-life nursing practice for older patients in long-term care hospitals by exploring nursing experts’ actual experiences.Methods: Qualitative data were collected through focus group interviews with 9 nurses in 3 different long-term care hospitals from April to May, 2019. All interviews were recorded and transcribed verbatim and analyzed using the content analysis method.Results: Five themes and 14 sub-themes emerged for nurses’ perception regarding end-of-life nursing practice in long-term care hospitals, whereas three themes and 10 sub-themes emerged for the barriers of end-of-life nursing practices. The results show that the end-of-life nursing practice is currently considered an additional area beyond nurses’ existing work in long-term care hospitals and the area of performance is focused almost exclusively on physical care. The care is especially lacking in psychological and spiritual areas. Moreover, aspects of practice vary by institutions, day or night shifts and individuals. Various factors that hinder nurses’ performances of end-of-life care are identified in the areas such as ignoring patients’ dignity, an underdeveloped system and lack of supportive environment.Conclusion: Findings of this study suggest the need to establish standardized protocols for end-of-life nursing care in long-term care hospitals and develop educational programs based on those protocols.

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Cost of shifting from healthcare to long-term care in later life across major diseases: analysis of end-of-life care during the last 24 months of life

Journal of Rural Medicine ◽

10.2185/jrm.2955 ◽

2018 ◽

Vol 13 (1) ◽

pp. 40-47 ◽

Cited By ~ 2

Author(s):

Tomoko Terada ◽

Keiko Nakamura ◽

Kaoruko Seino ◽

Masashi Kizuki ◽

Naohiko Inase

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Later Life ◽

Life Care ◽

Term Care

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Educational effects of end-of-life care education program for caring staff of long-term care facilities

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.51.191 ◽

2014 ◽

Vol 51 (2) ◽

pp. 191-191

Author(s):

Yoshihisa Hirakawa ◽

Kazumasa Uemura

Keyword(s):

End Of Life ◽

Education Program ◽

End Of Life Care ◽

Long Term Care ◽

Life Care ◽

Term Care ◽

Care Education ◽

Care Facilities

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END-OF-LIFE CARE PREFERENCES AND WELL-BEING IN LONG-TERM CARE RESIDENTS

Innovation in Aging ◽

10.1093/geroni/igz038.2474 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S669-S669

Author(s):

Kelly Shryock ◽

Jacinta Dickens ◽

Anisha Thomas ◽

Suzanne Meeks

Keyword(s):

Quality Of Life ◽

Positive Affect ◽

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Well Being ◽

Life Care ◽

Term Care

Abstract Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.

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Nursing Guidelines for End-Of-Life Care in Long-Term Care Settings: Sustainable Improvements to Care

Journal of Palliative Care ◽

10.1177/082585971102700308 ◽

2011 ◽

Vol 27 (3) ◽

pp. 229-237 ◽

Cited By ~ 1

Author(s):

Carole Gill ◽

Loretta M. Hillier ◽

Jacqueline M. Crandall ◽

Julie Johnston

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Life Care ◽

Term Care ◽

Nursing Guidelines

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Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives

BMJ Open ◽

10.1136/bmjopen-2020-037466 ◽

2020 ◽

Vol 10 (8) ◽

pp. e037466

Author(s):

Patricia Harasym ◽

Sarah Brisbin ◽

Misha Afzaal ◽

Aynharan Sinnarajah ◽

Lorraine Venturato ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Long Term Care ◽

Symptom Assessment ◽

Assessment Tools ◽

Life Care ◽

Community Based ◽

Term Care

ObjectiveThe COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities.DesignQualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.SettingResidential long-term care.Participants23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians.ResultsMotivation barriers include families’ lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population.ConclusionFindings reveal that validating families’ concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.

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