The transition from routine care to end-of-life care in a nursing home: exploring staff perspectives.

OBJECTIVES The objective of this study was to explore how nursing home staff members manage the transition from routine care to end-of-life care when a resident is dying. DESIGN The exploratory descriptive study used qualitative methods. SETTING A 122-bed nursing home on a continuum of long-term care campus. PARTICIPANTS Participants were 35 nursing home professionals (21 nurses, 9 CNAs, and 5 social workers). MEASUREMENTS In-depth interviews that involved open-ended questions about the transition to end-of-life care were audiotaped, transcribed, and submitted to qualitative data analysis for the development of emergent themes. RESULTS Three emergent themes characterize the central aspects of the transition in care as the management of (1) physical changes, (2) emotions, and (3) overlapping systems of care. CONCLUSION In balancing the sometimes conflicting expectations of routine, restorative, and end-of-life care needs, nursing home professionals have developed ways of managing the transition that can be important in developing specific end-of-life protocols. This study has 3 implications for practice: (1) focused end-of-life education and planning can help frontline staff prepare for the inevitable numbers of residents who will die in the nursing homes, (2) mechanisms for helping staff manage the intense emotional responses that accompany loss of long-term residents are important for long-term well-being of frontline staff, and (3) focused attention on the unique dynamics of "home" and "family" can assist nursing home professionals with ongoing losses and cumulative grief.