Ways of relating to death: views of older people resident in nursing homes.

Few studies shed light on what older people themselves consider a good or dignified death. This study is part of a larger project where interviews were used to follow 12 nursing home residents over time. The aim of the present study was to reach a deeper understanding of seven older people's thoughts, feelings and attitudes towards death. The participants were interviewed on four occasions across 18-24 months, and the interviews were analysed using a hermeneutic method. The findings revealed three main themes: 1. Zest for life, 2. Indifferent attitude, 3. Longing for death. The themes mirror the complexity of what ageing and nearing the end of life can mean. A strong desire among the participants was to be more involved in their own personal care and in everyday life at the nursing home. Person-oriented care based on the philosophy of palliative care, and including conversation as a natural component, might promote the older person's possibilities to obtain a good death.

Views on dignity of elderly nursing home residents.

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

Complexity in caring for patients with advanced cancer.

BACKGROUND: The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi-centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge-exchange programme between nurse researchers, practitioners and students. AIM: The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors. FINDINGS: The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions. CONCLUSIONS: These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.