Recognizing Dying by Staff in Long-Term Care

Abstract

This study describes how staff in long-termcare facilities recognize dying in residents.From the staff interviews, a process ofincreasing death awareness was revealedidentifiable through five cue groups.‘‘Ambiguous Cues’’ begin the process inwhich an adverse event precipitates thinkingabout the end of life and culminates in‘‘Decision Cues.’’ ‘‘Ready-to-Go Cues’’ markthe resident’s preparation for dying andculminate with the ‘‘Withdrawing and SayingGoodbye Cues.’’ ‘‘The Look About ThemCues’’ indicate that death is imminent.A counter process of diminishing death denialwas also noted and the interaction betweenthe two processes caused staff tension. Thecontinuum of death denial is represented atone end by the theme ‘‘We Don’t Say It’’ andat the other by ‘‘We Don’t Shut the Door,’’ inwhich the staff actively ensure that all personscan say goodbye to the dying resident.KEY W ORD Sdyingend-of-life carenursing homesprognosis