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

Abstract

Aims To investigate the end‐of‐life (EOL) nursing care practice process in long‐term care (LTC) settings for older adults in Japan. Design A qualitative study based on grounded theory developed by Corbin and Strauss. Methods Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next‐stage analysis decisions. Semi‐structured interviews were conducted from March 2015‐March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. Results The core category, “guiding the rebuilt care community to assist the dying resident” comprised five categories: “assessing the resident's stage,” “harmonizing care with the dying process,” “rebuilding a care community,“ “helping community members care for the resident,” and “encouraging community members to give meaning.” The participants were described as “traditional village elders“ who were the integral members of the care community, as well as guides who helped and encouraged the community. Conclusion Results revealed the holistic process of EOL nursing‐care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents’ uncertainties and vulnerabilities as well as their cultural backgrounds. Impact This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

Competencies relevant for gerontological nursing: Focus-group interviews with professionals in the nursing of older people

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Ambulance use and emergency department visits among people with dementia: A cross‐sectional survey

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Long‐term care nurses’ perceptions of a good death for people with dementia: A qualitative descriptive study

“…This study adopted a qualitative descriptive design (Sandelowski, 2000), in conjunction with a qualitative study of EOL nursing care practice in LTC settings for older adults. The content on EOL nursing care has already been published (Nasu, Sato, et al, 2020). We report the analysis results of the interview data on a good death for PwD in LTC settings, which were not analysed or detailed in the first paper.…”