Identifying need for palliative care in nursing homes: Nursing's critical role [abstract]
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Purpose: To determine how registered nurses (RN) on a skilled nursing unit recognize that a resident is dying. Methods: A descriptive, exploratory, qualitative design was used to meet the aims of the study. Four-experienced nursing home RNs were recruited from a mid-western nursing home and interviewed. The interview instrument consisted of open-ended questions that were revised as necessary from interview to interview. The responses were coded, analyzed and categorized to reveal the cues indicating that the resident is transitioning to the end of life. Results: The data revealed recognizable stages of dying commencing several months prior to death up to the signs of imminent death. RNs were able to observe and interpret as cues for the transition from progressive aging into death. This trajectory comprised six stages: progressive decline, trigger event, inability to thrive/corrective treatment, preparing for death, a really good day, and imminent death/death. Although not the primary objective of this study, the data also revealed a need for the resident to maintain dignity into death through adequate pain control, individualized care, and the right to autonomy. Conclusion: The cues were specific to the timing in relation to death, thus placing the cues in six stages along a trajectory for dying. The importance of recognizing the dying phase of life is that nurses can then support the resident's preparations for death and promote dignity and comfort at the end of life.