A qualitative study of nurses’ perspective about the impact of end‐of‐life communication on the goal of end‐of‐life care in nursing home

Abstract

Background With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident’s wishes for care at the end‐of‐life and organise the care plan accordingly. Aim To explore nurses’ perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses’ perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers’ preferences, knowledge of residents’ preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares’ and resident’s preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes

“…The theorizing process of this situation-specific theory is clinically grounded and started with a simultaneous induction from three literature reviews [11,37,38]. Then, the initial theorizing process was validated through interviews with the FCs of NH residents [9,39] and nurses [40] who work in NHs and led to a first theory of end-of-life communication in NHs [21]. The theorizing process moved forward by integrating the experience from a transnational quality improvement project [27] and updated research findings emerged from the implementation of such project in Italy [41].…”

Qualitative research on end‐of‐life communication with family carers in nursing homes: A discussion of methodological issues and challenges

“…A qualitative descriptive study (Gonella, Basso, Clari, & Di Giulio, 2020;Gonella, Basso, Clari, Dimonte, & Di Giulio, 2020) involving 32 family carers and 14 nurses from 13 Italian NHs was conducted from December 2018-May 2019 with the primary intent of assessing the extent to which bereaved family carers of NH residents felt involved in end-of-life communication.…”

Challenges Experienced by Italian Nursing Home Staff in End-of-Life Conversations with Family Caregivers during COVID-19 Pandemic: A Qualitative Descriptive Study

“…FCs usually expect HCPs to start end-of-life conversations [ 12 , 14 ], and HCPs acknowledge they should take a leadership role in this regard; conversely, they are uncertain about the right time to initiate such conversations [ 15 , 16 ]. The timing is often determined by the patient’s health status, and HCPs usually wait for physical (e.g., weight loss, swallowing difficulties) and/or social (e.g., level of readiness to initiate an end-of-life conversation) cues to prompt these conversations [ 17 , 18 ]. Cues from patients and FCs as well as HCPs’ intuition that they are open to such conversations also play an essential prompting role [ 15 ].…”