Conversations about Death and Dying with Older People: An Ethnographic Study in Nursing Homes

Abstract

Nursing homes are often places where older persons “come to die.” Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nurses’ experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residents’ reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residents’ contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.

‘We have no crystal ball’ - advance care planning at nursing homes from the perspective of nurses and physicians

“…However, previous studies show that the physician in charge does not always involve nurses before making decisions involved in the ACP [17][18][19]. Recent research has illuminated ACP from the perspective of nurses [11,[20][21][22][23]. According to Seymour et al [21] nurses understood ACP to be an important part of good nursing care, e.g.…”

Evaluating person‐centredness for frail older persons in nursing homes before and after implementing a palliative care intervention

“…The evaluation of the KUPA project addresses several different outcomes reported in previous papers (Alftberg et al, ; Bökberg Behm, & Ahlström, , ; Bökberg, Behm, Wallerstedt, & Ahlström, ; Bökberg et al, ) and will be further reported in future papers. The intervention was implemented during a 6‐month period with different staff and front leaders (8–12 in each nursing home) in 20 nursing homes in two different counties in southern Sweden (Ahlström et al, ).…”

Older persons’ thoughts about death and dying and their experiences of end-of-life care: a qualitative study

“…These fears and worries need to be adequately addressed by caregivers. A possible explanation for why older persons worry about dying is that they are not often given the opportunity to discuss such questions [9]. It has been found that caregivers rarely open up for a discussion about death and dying [7,9], despite the idea that older persons have a need for conversations about this topic [8,11,18].…”