Factors that influence good end of life care in long stay residential care for older people
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Aim: To generate a grounded theory to understand the factors that influence end of life care in long stay residential care homes. Background: In this study, the term of ‘end-of-life’ is described as a continuum, rather than a point in time for residents in long stay residential care. Literature has revealed various factors that impact on end of life care, however, little research has examined end of life care for older people in long stay residential care homes from the simultaneous perspectives of residents, their relatives and nursing staff. Methods: In-depth semi-structured interviews were conducted with a purposive sample of 41 participants selected from 3 publicly managed long stay residential care homes. Interviews were conducted over three times intervals and were analysed using constant comparative analysis, theoretical sampling and memo writing according to the Straussian Grounded theory (Corbin & Strauss 2008) Findings: The emergent core category was ‘Dying well within a tapestry of relations’. The metaphor ‘tapestry’ is used to describe the way in which all categories within the model weave and relate to one another to focus on end of life in residential care. A model to depict a substantive theory of dying in residential care was used to illustrate four inter-related categories which were: ‘Ethos of Caring’, ‘Organising Care’, ‘Living Environment’ and ‘Resident Centred Relationships’ describes the influencing factors to dying well. Dying well was the chief concern to all participants as were the relationships between residents, care staff and relatives which impacted on residents’ end of lire care. Conclusion: Living well while in care was important to dying well. The relationships that existed between residents, staff and relatives sustained them throughout dying. The triad of relationships were key in having a good death, and this was explained further using the framework of relational ethics (Bergum & Dossetor 2005) which places emphasis on communication and relationship building. The model of compassionate relationship centred care (Dewar and Nolan 2013) was also used to provide an understanding the practices and processes that support compassionate care.