Having to focus on doing rather than being—Nurse assistants’ experience of palliative care in municipal residential care settings

Abstract

BackgroundPalliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education. AimThe aim of this study was to illuminate nurse assistants’ experience of palliative care for older people in residential care. DesignThe study had an explorative, descriptive design. SettingsThirteen residential care units in three different districts in a large city in southern Sweden. ParticipantsTwenty-five nurse assistants selected to represent variations in age, gender workplace and work experience. MethodsData were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phenomenon. ResultsThe nurse assistants described palliative care as a contrast to the everyday care they performed in that they had a legitimate possibility to provide the care needed and a clear assignment in relation to relatives. Palliative care also meant having to face death and dying while feeling simultaneous that it was unnatural to talk about death and having to deal with their own emotions. They emphasised that they were in need of support and experienced leadership as invisible and opaque, but gained strength from being recognized. ConclusionIn order to support nurse assistants in providing high quality end-of-life care, more focus is needed on the trajectory of older peoples’ dying, on the importance of involving relatives throughout the period of care provision, and on support when encountering death and dying. There is also a need for engaged care leaders, both registered nurses and managers, to recognize the work of nurse assistants and to support care provision for older people within the framework of palliative care philosophy.