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End of life care in care homes: understanding and mapping innovative solutions: executive summary
- Authors:
- SEYMOUR Jane, FROGGATT Katherine, KUMAR Arun
- Publisher:
- University of Nottingham. Sue Ryder Care Centre for Palliative and End of Life Studies
- Publication year:
- 2008
- Pagination:
- 14p.
- Place of publication:
- Nottingham
The aims of the study reported in this paper were to identify key drivers and barriers in the health and social care system influencing quality of end of life care in care homes with nursing for older people, and to develop practical guidance for the implementation of solutions relating to factors influencing such quality of end of life care. The study consisted of 2 in-depth case studies of care homes in northern England, one located in a large city and the other in a predominantly rural area, and a survey of 180 nursing homes surrounding the case study sites. Key themes for discussion emerging from the study were: the importance of leadership, inequality in capacity to implement end of life care tools, variability in access to outside resources (including key staff, information, funding, equipment, resources and training), facilitators to end of life care, and commissioning practices. The report includes recommendations for care home providers and staff, for strategic health authorities, primary care trusts, and local authorities, and for acute hospital trusts. A diagrammatic map of the key facilitators and barriers to end of life care in nursing homes is included as an appendix.
‘Powerlessness’ or ‘doing the right thing’ – Moral distress among nursing home staff caring for residents at the end of life: an interpretive descriptive study
- Authors:
- YOUNG Amanda J., FROGGATT Katherine, BREARLEY Sarah G.
- Journal article citation:
- Palliative Medicine, 31(9), 2017, pp.853-860.
- Publisher:
- Hodder Arnold
Aim: To describe how nursing home staff experience moral distress when caring for residents during and at the end of life. Methods: An interpretive descriptive design, using the critical incident technique in semi-structured interviews to collect data from nursing home staff. Data were analysed using a thematic analysis approach. Setting: Four nursing homes in one large metropolitan area. Participants: A total of 16 staff: 2 nurse managers, 4 nurses and 10 care assistants.Findings: Participants described holding ‘good dying’ values which influenced their practice. The four practice-orientated themes of advocating, caring, communicating and relating with residents were found to influence interactions with residents, relatives, general practitioners, and colleagues. These led staff to be able to ‘do the right thing’ or to experience ‘ powerlessness’, which could in turn lead to staff perceiving a ‘bad death’ for residents.Conclusion: When there are incongruent values concerning care between staff and others involved in the care of residents, staff feel powerless to ‘do the right thing’ and unable to influence care decisions in order to avoid a ‘bad death’. This powerlessness is the nature of their moral distress. (Publisher abstract)
Life and death in English nursing homes: sequestration or transition?
- Author:
- FROGGATT Katherine
- Journal article citation:
- Ageing and Society, 21(3), May 2001, pp.319-332.
- Publisher:
- Cambridge University Press
Nursing homes as care institutions seek to offer a home where people can live until their death. A potential conflict, therefore, exists as nursing homes are both a place where life is lived and where life is lived and where death is regularly encountered. It has been proposed that within residential care homes for older people, dying individuals are separated from living people. Drawing on fieldwork undertaken in four English nursing homes the management of the dying process and the relationship between life and death is explored. Argues that the relationship between life and death for these residents is less about the sequestration of dying people from living people, but rather the creation of transitional states between these two polarities.