Long-term Nursing Care Research Articles

Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review

BackgroundPerson-Centered Care is often seen as an indicator of quality of care. However, it is not known whether and to what extent person-centered care can be enhanced by continuing education interventions in older people’s long-term care settings. This systematic review aimed to analyze and synthesize the existing research literature about person-centered care-based continuing educational interventions for nurses working in long-term care settings for older people.MethodsFive databases were searched 6/2019 and updated 7/2020; PubMed (Medline), CINAHL, PsycINFO, Cochrane and Eric using the keywords person-centered car* OR person-centred car * OR patient-centered car* OR client-centered car* OR tailored car* OR resident-centered car* OR individualized car* AND older* OR elder* OR old person* AND Long-Term Care OR Nursing home OR 24-h treatment OR long-term treatment. Twenty-seven full texts from 2587 initially retrieved citations were included.ResultsThe continuing educational interventions found were divided into five themes: person-centered interventions focusing on medication; interaction and caring culture; nurses’ job satisfaction; nursing activities; and older people’s quality of life. The perspective of older people and their next of kin about the influence of continuing education interventions were largely absent. The background theories about interventions, the measurements taken, and the clarity around the building blocks of the continuing-care interventions need further empirical verification. The pedagogical methods used were mainly quite behavioristic mostly lectures and seminars.ConclusionMost of person-centered care continuing education interventions are effective. Still more empirical research-based continuing education interventions are needed that include learner-centered pedagogical methods, with measurable outcomes that consider the opinions of older people and their next of kin. Continuing educational interventions for nurses need to be further developed to strengthen nurse’s competence in person-centered care, job satisfaction and for better quality of care.

Prediction of 11-year incidence of psychophysically dependent status or death among community-dwelling younger elderlies: from an age-specified community-based cohort study (the NISSIN project)

BackgroundPredicting adverse health events and implementing preventative measures are a necessary challenge. It is important for healthcare planners and policymakers to allocate the limited resource to high-risk persons. Prediction is also important for older individuals, their family members, and clinicians to prepare mentally and financially. The aim of this study is to develop a prediction model for within 11-year dependent status requiring long-term nursing care or death in older adults for each sex.MethodsWe carried out age-specified cohort study of community dwellers in Nisshin City, Japan. The older adults aged 64 years who underwent medical check-up between 1996 and 2005 were included in the study. The primary outcome was the incidence of the psychophysically dependent status or death or by the end of the year of age 75 years. Univariable logistic regression analyses were performed to assess the associations between candidate predictors and the outcome. Using the variables with p-values less than 0.1, multivariable logistic regression analyses were then performed with backward stepwise elimination to determine the final predictors for the model.ResultsOf the 1525 female participants at baseline, 105 had an incidence of the study outcome. The final prediction model consisted of 15 variables, and the c-statistics for predicting the outcome was 0.763 (95% confidence interval [CI] 0.714–0.813). Of the 1548 male participants at baseline, 211 had incidence of the study outcome. The final prediction model consisted of 16 variables, and the c-statistics for predicting the outcome was 0.735 (95% CI 0.699–0.771).ConclusionsWe developed a prediction model for older adults to forecast 11-year incidence of dependent status requiring nursing care or death in each sex. The predictability was fair, but we could not evaluate the external validity of this model. It could be of some help for healthcare planners, policy makers, clinicians, older individuals, and their family members to weigh the priority of support.

A predictive model of the perceptions of patient-centered care among nurses in long-term care hospitals: A cross-sectional study

This study aimed to propose and examine a predictive model of the impacts of organizational and individual factors on the perceptions of patient-centered care (PCC) among nurses working in long-term care hospitals. A cross-sectional study was conducted at six hospitals in South Korea. Data collected from 187 nurses were analyzed using structural equation modeling. Findings showed that the model explained the impacts of the factors on how nurses perceive PCC, it explaining 47% of the variation in PCC. Organizational factors had stronger influences on PCC [innovative organizational culture (β = 0.34), teamwork (β = 0.30)] compared to individual factors [compassion (β = 0.15), self-leadership (β = 0.07)]. The hypothesized model has potential for determining the factors that influence the perceptions of PCC among nurses working in long-term care hospitals. Further strategies should focus on organizational factors in strategies for improving long-term care nurses’ perceptions of PCC.

Perceptions of Long-Term Care Nurses and Nursing Assistants about Communication Related to Residents’ Care

<strong>Context:</strong> Research shows ineffective healthcare team communication is linked to sentinel and adverse healthcare events (Gooch 2016; Robson 2016; Wagner et al. 2018). Long-term care (LTC) facilities face unique challenges of caring for frail elderly (Young 2003), who are at increased risk for cascading negative health events beginning with functional decline (Lakshmi 2014). Frequent, effective nursing team communication is essential to providing safe care for these individuals. (Castle 2007; Cortes et al. 2004; Foulkes 2011; Griffin et al. 2016; Howe 2013; Madden et al. 2017; Siegel &amp; Young 2010). <strong>Objective:</strong> The purpose of this study was to use findings from a survey of staff to inform a quality improvement initiative (Appendix A) to enhance nursing team communication. The study explored the perceptions of LTC nursing staff (i.e., registered nurses (RNs), licensed practical nurses (LPNs), and unlicensed assistive personnel (UAPs) about their communication related to resident care. <strong>Methods:</strong> A cross-sectional, descriptive survey design was used to explore perceptions of nursing staff working in a LTC setting about their communication. <strong>Findings:</strong> All levels of nursing staff contributed useful information regarding nursing staff communication, including their contributions, their communication, the frequency of communication, and the methods of communicating. <strong>Limitations:</strong> This study was done at one LTC facility, which limits the generalizability of the findings, though the study can be replicated easily at the city, state, regional, or national level to explore LTC nursing team communication in public and private facilities, including government LTC facilities (i.e., for veterans). <strong>Implications:</strong> Evidence-based standardized communication tools succinctly implemented for communication between nursing staff will bridge patient care communication barriers and positively impact teamwork, leadership, and workplace culture while improving resident and facility outcomes.

Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial

Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavorable outcomes resulting from unmet needs. In a six-center randomized pragmatic comparative effectiveness study, the BRITE trial (Brain Injury Rehabilitation: Improving the Transition Experience, ClinicalTrials.govNCT03422276), we compare the effectiveness of two existing methods for transition from IRF to community living or long-term nursing care. The Rehabilitation Discharge Plan (RDP) includes patient/family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference, for 6 months. Nine hundred patients will be randomized (1:1) to RDP or RTP, with caregivers also invited to participate and contribute caregiver-reported outcomes. Extensive stakeholder input, including active participation of persons with TBI and their families, has informed all aspects of trial design and implementation planning. We hypothesize that RTP will result in better patient- and caregiver-reported outcomes (societal participation, quality of life, caregiver well-being) and more efficient use of healthcare resources at 6-months (primary outcome) and 12-months post-discharge, compared to RDP alone. Planned analyses will explore which participants benefit most from each transition model. With few exclusion criteria and other pragmatic features, the findings of this trial are expected to have a broad impact on improving transitions from inpatient TBI rehabilitation. Trial registrationClinicalTrials.gov identifier NCT03422276

Development of a Long-Term Care Nurse Residency Program.

Nurses working in the long-term care (LTC) setting provide increasingly complex patient care, often without formal training on the specific needs of LTC patients, which can lead to burnout and high turnover rates. Nurse residency programs (NRPs) have been used effectively to orient novice RNs to their work setting, address transition-to-practice challenges, and promote retention, yet few LTC NRPs have been developed. The University of Utah Geriatric Education Consortium Geriatric Workforce Enhancement Program created an online LTC NRP to provide LTC nurses with the knowledge and skills to succeed in the LTC environment. RNs with <1 year of LTC experience were paired with experienced nurse mentors working within the same LTC facility. Synchronous and asynchronous curricular modules addressed leadership and communication, caring for older adult patients, quality improvement, and the LTC regulatory environment. A distance-based LTC NRP allows nurses flexibility in gaining gerontological nursing and leadership expertise that supports their professional goals. [Journal of Gerontological Nursing, 47(2), 37-43.].

The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible?

Tracheostomy is very common in patients with severe traumatic brain injury (TBI), long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. This study was a before-after study design. Patients were divided into control groups (traditional nursing care) and HCH group(HCH nursing care). Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent a two-month long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) from caregiver and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy-related complications were recorded and compared. A total of 60 patients were included. There were no significant differences between the two groups in the GCS, Karnofsky, SAS from caregiver and Barthel index at discharge((all P>.05); the GCS, Karnofsky and Barthel index were all significantly increased after two-month follow-up for the two groups (all P<.05), and the GCS, Karnofsky and Barthel index at two-month follow-up in HCH group were significantly higher than that of the control group(all P<.05), but the SAS from caregiver at two-month follow-up in HCH group was significantly less than that of the control group(P=.009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all P<.05). HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.

Long-Term Care Nurses’ Intent to Stay, Job Characteristics, and Organizational Justice : A Structural Equation Model

Background：Gratifying the elderly health-care demands and promoting high-quality of nursing services are based on the effort of long-term care(LTC) nurses. However, the high turnover rate of LTC nurses has become very serious in China. What remains unclear is whether the organizational justice and job characteristics affect the LTC nurses’ intention to stay. Objective: The aim was to investigate intention to stay among LTC nurses in relation to organizational justice and job characteristics. Method: A cross-sectional study was conducted with a convenience sample of 545 LTC nurses. Data collection was performed between July and November 2019. Data were analyzed using structural equation modeling. Results: Most of LTC nurses reported to stay in nursing or current work place, however they still had strong desire to leave if there were other job opportunities. Organizational justice and job characteristics were significant predictors of LTC nurses intent to stay. LTC nurses job characteristics partially mediates the relationship between organizational justice and intent to stay. Conclusion: This would suggest the importance of administrators/ managers understanding how to promote organizational justice, foster a justice climate and increase LTC nurses’ perceived job characteristics. The organizational justice culture programs should be develop as LTC nurses retention strategy.

The Utah Experience: Our Secret Sauce for Long-Term Care Nurse Residency Programs

Nurses working in long-term care (LTC) have a paucity of geriatric knowledge and leadership skills. One method of meeting this challenge is by offering an online geriatric-focused nurse residency program (NRP) to LTC nurses. The goal of the NRP is to provide geriatric nursing competencies to prepare LTC nurses to care for complex older residents and lead staff. Construct measures include geriatric knowledge and skills, self-rated efficacy, and attitudes towards QI. To date, 46 nurses have enrolled in the program. Completers’ state they have increased knowledge and confidence; but turnover and workload issues often prevent nurses from completing the program. Thus, the current NRP with 6 nurse residents is streamlined to be completed in 4 months and with a focus on the 4 M’s, leadership and geriatric competencies and resilience. Future plans are for the NRP to be available for nurses from all long-term services and supports settings.

Long-Term Care Nurses and Their Experiences With Patients' and Families' End-of-Life Preferences: A Focus Group Study.

Long-term care (LTC) nurses are a critical nexus for patient communication and vital to advance care planning due to their professional role and breadth of patient relationships. The current study's aim was to explore the communication strategies Midwestern LTC nurses use to clarify patients' end-of-life (EOL) care preferences. Two focus groups used a phenomenological framework to elucidate the experiences of 14 RNs. Data analysis revealed two themes grounded in time: (a) nurses use time to assess patients' EOL situation and assist patients to discern care options; and (b) nurses educate patients about EOL care, adjust care plans, and develop trusting relationships. Two themes were grounded in clinical experience: (a) nurses become persistent advocates and educators to initiate and sustain EOL communication; and (b) nurses learn consistency in communication, including awareness of patients' nonverbal communication. Nurses shared that EOL communication is never "done"; time frames to assess, educate, and clarify are continuous. [Journal of Gerontological Nursing, 46(12), 23-29.].

Current status on the ability of the elderly in rural China: implications for future nursing and policy.

Aging is a global problem, and the ability assessment of the elderly plays an important role in the formulation of pension policies. It's necessary to evaluate the ability of the elderly in rural China to provide insights into future nursing care and policy making. The elderly in 20 rural villages were selected by convenience sampling. We used "Elderly Ability Evaluation Form" issued by the Ministry of Civil Affairs of China as survey tool. The characteristics and score differences of the elderly of different ability level were compared and analyzed. And logistic regression analyses were conducted to identify the potential risk factors for disability in the elderly. A total of 2,878 elders were included, of which there were 1,916 elders with intact ability, 866 elders with mild disability, 42 elders with moderate disability, 54 elders with severe disability. The incidence of disability among respondents was 33.43%. There were significantly statistical differences in the dimensions of activities of daily living, mental state, perception and communication, and social participation among elders with intact ability, mild, moderate and severe disability (all P<0.05). The age, education level, marital status and living situations were all corrected to the scores on the activities of daily living, mental state, perception and communication, and social participation among elders (all P<0.05), and the elderly with age ≥75 years, illiteracy, unmarried and live alone had higher risk for disability (all P<0.05). The current situation of the ability level of the elderly in rural China seems to be worrying, and it's necessary to establish a long-term nursing care system and aging policy to meet the needs of the elderly with regards to those potential influencing factors.

The importance of the assurance that “humans are still in the decision loop” for public trust in artificial intelligence: Evidence from an online experiment

This study investigates the public's initial trust in an artificial intelligence (AI) decision aid utilized in the delivery of public services. Amidst societal anxiety surrounding AI, the study posited that the information communicated to the public about the use of AI matters to the public's initial trust in AI. More specifically, the study hypothesized that an assurance that “humans are still in the decision loop” (HDL) makes a difference in the public's initial trust (H1), which might also depend on the stated purposes for using AI (H2). This article reports on the results from an online experiment testing these hypotheses in the context of Japan's long-term nursing care sector, based on the responses of care users and their families (N = 1542). The study did not find strong evidence to support H2. However, it found some support for H1: the proportion of those who trusted a care plan prepared with AI assistance more than a care plan not involving AI was higher by 8.95 percentage points with the HDL assurance than without. This highlights the importance of the HDL assurance and reveals respondents' reservations about a complete AI takeover in care planning.

Determination of nurses' level of knowledge on the prevention of pressure ulcers: The case of Turkey

Aim of the studyPressure ulcers (PUs) constitute a health issue that has a high prevalence and incidence rate in acute and long-term care, requiring long-term nursing care for treatment and prevention. Therefore, nurses should have adequate knowledge of the interventions and practices used to prevent PUs. Materials and methodsThis study employed a descriptive and cross-sectional design to assess the level of nurses’ knowledge concerning preventive interventions for PUs. Based on data found in the literature, researchers developed a 16-question Participant Information Form (including age, gender, level of education, employed ward, and training on PUs) and used this form, along with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), to collect data. ResultsA group of 471 nurses working in two foundation hospitals in 2018 participated in the study by completing a questionnaire. Among the participants, 44.2% worked in surgery, 21.2% in internal medicine, and 34.6% in other wards (such as intensive care, pediatrics, and the operating theater). Most of the nurses(73.5%) held a bachelor's degree, and their average work experience was 7.27 ± 7.00 years. It was determined that 69.4% of the nurses had not received in-service training relating to PUs, 55.6% did not attend lectures/conferences or read articles on the prevention of PUs, and 59.7% rated themselves as “adequate” in interventions used to prevent PUs. Based on the use of PUPKAI-T, 17 individuals (3.6%) scored equal to or more than the 60% cut-off value, and 454 individuals (96.4%) scored less than 60%. The mean level of knowledge on PUs was calculated as 11.1 ± 2.659 (range: 1-18) out of 26 questions. ConclusionsResults of the study showed that the general level of knowledge of nurses in preventing PUs are extremely insufficient. Therefore, various strategies should be developed to increase nurses' level of knowledge on the etiology and development, classification and observation, and risk assessment of PUs, as well as on nutrition plans and preventive interventions.

Authentic leadership and job satisfaction among long-term care nurses

PurposeThe purpose of this study is to examine the effects of managers’ authentic leadership, person–job match in the six areas of worklife (AWLs) and emotional exhaustion on long-term care registered nurses’ job satisfaction.Design/methodology/approachA secondary analysis of baseline data from a national survey of 1,410 Canadian registered nurses from various work settings was used in this study, which yielded a subsample of 78 nurses working in direct care roles in long-term care settings. Hayes’ PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model.FindingsFindings showed that authentic leadership significantly predicted job satisfaction directly and indirectly through AWLs and emotional exhaustion.Practical implicationsAuthentic leadership may provide guidance to long-term care managers about promoting nurses’ job satisfaction, which is essential to recruiting and retaining nurses to meet the care needs of an aging population.Originality/valueAs demand for care of the aged is increasing and creating challenges to ensuring a sufficient and sustainable nursing workforce, it is important to understand factors that promote long-term care nurses’ job satisfaction. Findings contribute to knowledge of long-term care nurses by suggesting that managers’ authentic leadership can positively affect nurses’ job satisfaction directly and indirectly through positive perceptions of AWLs and lower emotional exhaustion.

Infections caused by medical products at longterm nursing care

Nosocomial infections in the elderly, often suffering from many ailments, patients in homes for the disabled and the old are among the problematic diseases that specialized nursing staff and doctors have to deal with more often in such institutions. Review work from the USA introduces relevant information about infectious risks, as well as possible preventive and therapeutic measures.

Housing Orientations and Needs of Above-Average Length of Stay Hospitalized Psychiatric Patients.

A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-patients who could be discharged to residential or long-term nursing care facilities. Program clinical professionals of regional residential facilities sent adapted standardized questionnaires to ward staff. Evaluators also collected the residential preferences of both staff and patients, and then made their own assessments. The 194 in-patients were mostly middle-aged single men. Over 80% had a psychosis diagnosis and half had judicial constraints. The staff evaluated that 71.1% could be discharged from hospital within 24 h. Of these, 55% could be referred to group resources with continuous 24 h, 7 days a week staff presence, 32% could be transferred to apartments with 7-day continuous or non-continuous staff presence, 12% could be transferred to institutional care and only 2% could be moved to an apartment of their own. Evaluator and ward staff residential preferences were highly similar, but differed with patient preferences, half of whom prefer their own apartment. Discrepancy between staff evaluations and patient preferences were higher for longer stay patients with more severe symptoms and comorbidity of personality disorders.

Recruitment Best Practice for Organizations: Realistic Job Preview vs. Best Foot Forward

Introduction: It is forecasted that in the near future, the United States will not have enough long-term care (LTC) nurses qualified or interested in the LTC arena to sustain the healthcare delivery system. The overall effectiveness of any health care delivery system hinges on a sustainable nursing workforce, which is the largest health professional group. Globally, a significant segment of the nursing workforce is nearing retirement age. Methods: Using pre- and post-intervention recruitment strategy surveys detailing the Realistic job preview (RJP), the Best-Foot-Forward, and a control brochure, this study investigated senior nursing students’ image and perception of long-term care nursing compared to their image and perception of other areas in nursing. The effects of prior experience with or exposure to LTC on students’ intention to apply for a position in LTC were examined in 221 senior year students earning the Bachelor of Science in nursing degree from three California universities. Results: The first hypothesis stated that pre-intervention students’ intent to apply for a position in LTC upon graduation would be significantly and positively associated with their pre-intervention image of LTC. A Pearson correlation coefficient between pre-intervention intent to apply and pre-intervention image was statistically significant, r = -.368, n = 221, p &lt; .001, supporting the first hypothesis. Hypothesis 2: Post-intervention RJP students would have a significantly more positive perception of LTC nursing than BFF or control-group students. There would be no significant difference in the RJP, BFF and control group students’ pre-intervention image of LTC nursing. Hypothesis 2 was not significant. Hypothesis 3: Post-intervention RJP students would have a significantly stronger intent to apply for jobs in LTC nursing than BFF or control-group students. There would be no significant difference in RJP, BFF, and control group students’ pre-intervention intent to apply for a position in LTC nursing. Hypothesis 3 was not significant. Hypothesis 4: Senior nursing students’ pre-intervention intent to apply for a position in LTC upon graduation would be significantly and positively associated with prior experience in or exposure to LTC. Hypothesis 4 was not significant. Conclusions: To enhance LTC nursing image and to improve students’ perceptions of this line of nursing may be accomplished, in part, through program curriculum, including internships in LTC, offering multiple dedicated courses in LTC, and increasing the emphasis on LTC during nursing programs. Realistic job preview technique shows significant positive result over the Best-Foot-Forward technique. Keywords: Recruitment methods, realistic job preview, long-term care, nursing, LTC experience

Prevalence of Spasticity in Nursing Home Residents

ObjectivesTo determine the prevalence, rate of underdiagnosis and undertreatment, and association with activities of daily living dependency of spasticity in a nursing home setting. DesignCross-sectional study. Setting and participantsThis study is an analysis of a deidentified data set generated by a prior quality improvement project at a 240-bed nursing home for residents receiving long-term care or skilled nursing care services. MethodsEach resident was examined by a movement disorders specialist neurologist to determine whether spasticity was present and, if so, the total number of spastic postures present in upper and lower limbs was recorded. Medical records, including the Minimum Data Set, were reviewed for neurologic diagnoses associated with spasticity, activities of daily living (ADL) dependency, and prior documentation of diagnosis and past or current treatments. Ordinary least squares linear regression models were used to evaluate the association between spasticity and ADL dependency. ResultsTwo hundred nine residents (154 women, 81.9 ± 10.9 years) were included in this analysis. Spasticity was present in 22% (45/209) of residents examined by the neurologist. Only 11% of residents (5/45) had a prior diagnosis of spasticity and were receiving treatment. Presence of spasticity was associated with greater ADL dependency (χ2 = 51.72, P < .001), which was driven by lower limb spasticity (χ2 = 14.56, P = .006). Conclusions and implicationsThese results suggest that spasticity (1) is common in nursing homes (1 of 5 residents), (2) is often not diagnosed or adequately treated, and (3) is associated with worse ADL dependency. Further research is needed to enhance the rates of diagnosis and treatment of spasticity in long-term care facilities.

Partnering to Educate Nurses in Long-Term Care

Despite a 2008 national call to retool a health care workforce for an aging America, the geriatrics-trained workforce is declining while the U.S. population continues to age. Formalized academic-practice partnerships between long-term care facilities and schools of nursing are one response to strengthening the work-force caring for older adults. This article details the activities of an intentional, synergistic, 3-year partnership between National HealthCare Corporation (NHC) and University of Alabama at Birmingham (UAB) School of Nursing. The partnership focused on providing continuing education and leadership development for NHC nurses while also providing nursing faculty with access to clinicians and patients in long-term care for the purposes of education, research, and quality improvement. The ultimate goal for both partners was improved patient outcomes. [J Contin Educ Nurs. 2020;51(2):75-81.].

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

To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. A qualitative study based on grounded theory developed by Corbin and Strauss. 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. 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 werethe integral members of the care community, as well as guides who helped and encouraged the community. 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. 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.