Abstract
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.
Highlights
Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering
The theme “From unawareness to obviousness” describes the overall manner in which the participants identify early and late signs preceding dying among older persons in nursing homes
From unawareness to obviousness It was clear from the interviews that dying was seen as a happening and not a process, which meant that dying was associated with end-of-life
Summary
Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. 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. Recognizing that a person is dying is often a difficult and complex process [5, 10] but identification of physical, psychological and other changes may help the staff to enable the older person to participate in planning the care in accordance with their own preferences and values and to prepare themselves and their families [11]. The importance of a palliative care approach at an early stage of dying, together with early planning, is confirmed by other studies [15,16,17]
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