End‐of‐life nursing care practice in long‐term care settings for older adults: A qualitative systematic review

Abstract

Aim To synthesize qualitative evidence on nurses' end‐of‐life care practices in long‐term care settings for older adults. Background Qualitative evidence on how nurses describe their own end‐of‐life care practice has not been reviewed systematically. Design Qualitative systematic review. Data Sources Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. Methods The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta‐aggregation. Results Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. Conclusion Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end‐of‐life care that ensures residents die with dignity.

Rebuilding and guiding a care community: A grounded theory of end‐of‐life nursing care practice in long‐term care settings

“…The remaining type was a fee-based home for the elders (FHE)-a private facility that receives LTC insurance benefits for providing EOL care. These facilities differ with regard to accommodation criteria, medical services offered, and staffing (Ministry of Health, Labour, & Welfare, 2016). Nursing roles in each facility somewhat differ in responsibilities for implementing medical care, but it is common to give daily care for residents in collaboration with other healthcare professionals in such facilities.…”

“…A cross-national comparison of death location (Broad et al, 2013) showed that a median of 18% older people died in LTC settings, with percentages doubling with each 10-year increase in age, indicating the need to optimize models of EOL care in these settings. In Japan, 10% of people die in LTC settings (Ministry of Health, Labour, & Welfare, 2019) and the number of older adults dying in the country's LTC settings is expected to increase markedly in the coming years because of the large older adult population (Ikegami & Ikezaki, 2013). While a systematic review (Nasu, Konno, & Fukahori, 2019) has described nurses' roles in providing EOL care in LTC settings, research has only provided short-term and partial explanations of nurses' involvement in residents' dying processes.…”

“…In Japan, 10% of people die in LTC settings (Ministry of Health, Labour, & Welfare, 2019) and the number of older adults dying in the country's LTC settings is expected to increase markedly in the coming years because of the large older adult population (Ikegami & Ikezaki, 2013). While a systematic review (Nasu, Konno, & Fukahori, 2019) has described nurses' roles in providing EOL care in LTC settings, research has only provided short-term and partial explanations of nurses' involvement in residents' dying processes. This study investigated the holistic process by which Japanese nurses give EOL care to LTC residents.…”

“…In Japan, 28.1% of the population is aged 65 years or older; over 1.3 million people die annually, with nearly 80% of deaths occurring in hospitals in these decades (Ministry of Health, Labour, & Welfare, 2019). Traditionally, family members care for older adults in local communities in Japan; however, this is becoming more difficult because of numerous factors (e.g., diversification of families, decline in local communities).…”

“…Most previous studies on EOL care in LTC settings have grouped nurses, nursing assistants, and care workers together. Nurses must clarify their specialties in EOL care to collaborate with other healthcare professionals because they feel a mismatch between responsibilities and their formal power; this may be related to the uncertainty of role delineation (Nasu et al, ). A more homogeneous sample could have allowed for more theoretical specificity of nursing roles in EOL care in LTC settings.…”