End‐of‐life care in two Norwegian nursing homes: family perceptions

Aim and objective. The aim of this article is to report a study exploring experiences of relatives who have been present immediately prior to and after the death (in the last 72 hours) of a next‐of‐kin in a nursing home. The purpose of the study was to acquire research‐based knowledge to improve practice. Background. Globally, a growing number of older people, often with increased morbidity and complexity of conditions, require specialised nursing care, particularly at the end of life. Several international studies describe end‐of‐life care in nursing homes as insufficient, mainly owing to shortage of qualified staff and other essential resources. There are few studies in this field in Norway; none of them focus on the final days and hours of a patient’s life from the perspective of their relatives. Design. A mixed methods design was used. Methods. Data were collected through structured interviews with 50 relatives during Spring 2006 and analysed by SPSS version 14 and theme‐based analysis. Results. With a few exceptions, the quality of nursing care was considered professional and good. Care was described as supportive, individualised and based on patients’ needs – in a safe atmosphere and supported by good relations between patients and nursing staff. Information and communication between staff and relatives, however, were described as unsystematic and casual. That some patients died alone became a source of distress for their relatives. Conclusions. Information and communication between staff and relatives need to be improved. There is need for change to avoid the situation where patients die in solitude. Relevance to clinical practice. End‐of‐life care is performed at a time when patients and their relatives are at their most vulnerable. Nurses and other health workers need information, as this study suggests, to provide high‐quality care to ease this situation.