Assistant Nurses' Descriptions of Signs of Dying among Older People in Nursing Homes

Sahlberg‐Blom, Eva; Hårsmar, Anna-Lena; Österlind, Jane

doi:10.1177/010740831303300305

Cited by 2 publications

(6 citation statements)

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“…Porock and Oliver [ 22 ] raise one possible reason why early signs preceding dying get little attention at the nursing homes: talking about death is taboo among the staff, for which reason an increasing awareness that the older person is going to die can be hard to handle. An earlier study by Sahlberg-Blom and colleagues [ 23 ] on assistant nurses’ experiences of signs of dying found signs similar to those we ourselves found. The signs presented in their study cover physical and psychosocial changes in older persons and include both subtle signs of dying such as feeling a desire to die and manifest signs such as body changes, for example fatigue and difficulty in breathing.…”

Section: Discussionsupporting

confidence: 89%

“…they are familiar, clear and prominent in the last days or weeks. The late signs are also similar to those that have been described in the literature [ 21 – 23 ] and the staff are well aware of them. In contrast to the holistic view of the older person connected to early signs preceding dying, the participants mainly highlight the physical and psychological aspects of late signs.…”

Section: Discussionsupporting

confidence: 83%

“…One profession which was represented in all focus groups was that of assistant nurse. Studies [ 23 , 34 ] show that the assistant nurses’ practical knowledge is of great importance for the multidisciplinary team. This was also evident in the interviews.…”

Section: Discussionmentioning

confidence: 99%

“…There have been a few studies focusing on identifying dying in older persons in nursing homes [ 21 – 23 ]. Brandt et al [ 21 ] focused on physicians’ experiences of dying among older persons with life expectancy of 6 weeks or less.…”

Section: Introductionmentioning

confidence: 99%

“…The results indicated that it was difficult for the physicians to predict dying among the older persons who did not have cancer. However, a study [ 23 ] focusing on assistant nurses’ experiences has shown that assistant nurses are able to identify both manifest and subtle signs of dying in general. Another study [ 22 ] that also focused on assistant nurses’ experiences but also registered nurses’, showed that these professions were able to identify several signs that precede dying, for example that the older person starts falling and stops taking medicines.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review

Cronin¹,

McCarthy²,

Cornally³

2020

J Gerontol Nurs

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The changing age profile of the human population globally means that the requirement for residential long-term care (LTC) for older adults is escalating, with an associated increase in deaths in these facilities. Health care assistants (HCAs), whose main role is provision of direct care to residents, comprise the largest staff cohort in residential care for older adults. The purpose of this scoping review was to explore three key areas related to HCAs: their role and responsibilities, end-of-life (EOL) education, and their views and experiences of caring for residents at EOL. The literature search included five databases and 32 studies were ultimately reviewed. Key issues were as follows: HCAs feel marginalized and undervalued, they need and desire EOL education, and resident deaths impact negatively on them. The changing care needs for older adults with complex comorbidities at EOL in LTC will place an increased onus on HCAs' skills, knowledge, and personal and professional development. [ Journal of Gerontological Nursing, 46 (1), 21–29.]

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