Background:Dying with dignity is regarded as a goal of quality end-of-life care. However, the meaning of dying with dignity is ambiguous, and no comprehensive synthesis of the existing literature has been published.Aim:To synthesize the meaning of dying with dignity and to identify common aspects of dignity in end-of-life care.Design:This is an integrative review article. Methodological strategies specific to the integrative review method proposed by Whittemore and Knafl were followed to conduct data analysis. The matrix method was used to summarize characteristics of included articles.Data sources:Five electronic databases were searched in October 2012, with no date restriction: PubMed, CINAHL, PsycINFO, Academic Search Premier, and Social Sciences Abstracts. Theoretical reports, and both qualitative and quantitative empirical reports, focused on dignity in end-of-life care were included.Results:Themes of dying with dignity are as follows: a human right, autonomy and independence, relieved symptom distre...

An integrative review of dignity in end-of-life care:

https://lup.lub.lu.se/search/ws/files/1920912/2364056.pdf

Having to focus on doing rather than being-Nurse assistants' experience of palliative care in municipal residential care settings.

Background
Spiritual dimensions such as hope, meaning in life and self-transcendence have been found to be predictors of successful ageing, life satisfaction and well-being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self-transcendence among nursing home patients.

Aims
This study aimed to investigate the associations between hope, meaning in life, self-transcendence and nurse–patient interaction in a nursing home population.

Design and methods
A cross-sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self-Transcendence Scale and the Nurse–Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested.

Results
The SEM model fit well with the present data. Significant direct relationships of nurse–patient interaction on hope, meaning in life and self-transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested.

Conclusion
Nurse–patient interaction influences hope, meaning in life and self-transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well-being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well-being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed.

Limitations
The SEM model tested comprised 20 variables, indicating a desirable sample size of n = 200, while the present effective sample was n = 187. Also, cross-sectional data do not allow making conclusion on the causality.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/scs.12028

Nurse-patient interaction is a resource for hope, meaning in life and self-transcendence in nursing home patients.

and physical health. Design and methods. The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQC15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended. Results. The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed. Conclusions. The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient’s physical and emotional health and global well-being. Relevance to clinical practice. Facilitating patients’ meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses’ competence in palliative care, symptom management and nurse–patient interaction is important for care quality and quality if life in nursing homes.

/pdf/meaning-in-life-in-nursing-home-patients-a-correlate-with-2r1w46r74m.pdf

Meaning-in-life in nursing-home patients: a correlate with physical and emotional symptoms.

Aims: This study examines the palliative care knowledge and attitudes towards caring for the dying patient of nurses working in care of older people settings in one rural region in Ireland Design: A cross-sectional survey design was used combining two questionnaires: the palliative care quiz for nurses (PCQN) and the thanatophobia scale (TS) Results: A total of 61 nurses completed the questionnaire There was a significant correlation found between level of knowledge and attitudes towards palliative care (p=0007), highlighting that as participants' level of palliative care knowledge increased, attitudes become more positive While palliative care training did not impact on the mean overall scores, there was a significant difference in the PCQN scores of those who had completed the European Certificate in Essential Palliative Care (ECEPC) compared with those who had attended information sessions within their unit Furthermore, increasing years as a registered nurse improved palliative care knowledge and

/pdf/knowledge-of-palliative-care-and-attitudes-towards-nursing-21n5du8edq.pdf

Knowledge of palliative care and attitudes towards nursing the dying patient.

This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in ...

Three Nursing Home Residents Speak About Meaning At the End of Life

Aims and objectives.  To explore nursing home staff members' experiences of what dignity in end of life care means to older people and to themselves. Background.  Dignity is a concept often used in end-of-life care, but its meaning is rarely clarified. Design.  Qualitative descriptive study. Methods.  Content analysis. This study is based on interviews with 21 staff members in four different nursing homes in Sweden. Findings.  The results show that staff members balanced between providing for the older person's physical needs while wishing to be able to deliver a 'deeper' level of care. The older people's dignity is presented in the main theme: Feeling trust - Showing respect. The staff members' dignity is presented in the main theme: Maintaining self-respect - Being shown respect. Threats to dignity are presented in the main theme: conflicts between the ideal and the reality. Conclusions.  The results reveal that nursing home staff members deal with a moral conflict between what they are able to deliver and what they would like to provide in the care of older people. Relevance to clinical practice.  To promote older people's dignity, there is a need to take account of staff members' work situation. Supervision and continuous education could be one way of achieving this.

Dignity as experienced by nursing home staff

dwyer l.-l., hansebo g., andershed b. & ternestedt b.-m. (2010) Nursing home residents’ views on dying and death: nursing home employee’s perspective. International Journal of Older People Nursing6, 251–260
doi: 10.1111/j.1748-3743.2010.00237.x

Aim.  To reveal nursing home employees’ views on dying and death among older people they cared for.

Background.  Palliative care stakeholders recently included more groups in their definition of palliative care; older people constitute one such group. Consequently, palliative care systems, which will serve a large, aging cohort, will require new skills. The first stage in skills acquisition is to gather current views on dying and death.

Design.  Qualitative descriptive study that uses focus group discussions for data collection; 20 employees in 4 Swedish nursing homes participated.

Method.  Data were analysed using qualitative content analysis.

Results.  The following categories were conceptualised: alleviating suffering and pain; finding meaning in everyday life; revealing thoughts and attitudes about death; taking care of the dead person’s body; and coping with the gap between personal ideals and reality.

Conclusions.  A deeper understanding of the palliative care philosophy is needed to further develop and tailor care for the dying persons in nursing homes.

Relevance to clinical practice.  To get public support for palliative care, the silence surrounding dying and death must be broken. Employees must receive education to prepare for all aspects of their work, and management must account for employees’ situation when planning the care.

/pdf/nursing-home-residents-views-on-dying-and-death-nursing-home-5c2wlyraxg.pdf

Lise-Lotte Dwyer

Papers

Three Nursing Home Residents Speak About Meaning At the End of Life

Dignity as experienced by nursing home staff

Nursing home residents’ views on dying and death nursing home employee’s perspective