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Feeling lonely in an unfamiliar place: older peoples experiences of life close to death in a nursing home
Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård. Karolinska institutet.
Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences. Linköpings universitet.
2017 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 12, no 1, 1-8 p., e12129Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death.

Background: A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death.

Method: Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen.

Findings: The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people's lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away.

Conclusion and implication for practice: It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people's wellbeing and identity near death.

Place, publisher, year, edition, pages
2017. Vol. 12, no 1, 1-8 p., e12129
Keyword [en]
End-of-life care, Nursing Home, Older People, Palliative Care, Transition
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-592DOI: 10.1111/opn.12129PubMedID: 27624362OAI: oai:DiVA.org:esh-592DiVA: diva2:346986
Note

Publication Status in Dissertation: Manuscript

Title in Dissertation: Life close to death in a nursing home : older peoples experiences.

Available from: 2010-09-02 Created: 2010-09-02 Last updated: 2017-07-10Bibliographically approved
In thesis
1. När livsrummet krymper: vård och omsorg av äldre personer i livets slutskede
Open this publication in new window or tab >>När livsrummet krymper: vård och omsorg av äldre personer i livets slutskede
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This research focused on the life situation of older people, who had moved to a nursing home at the end of life, from the perspectives of the older people themselves, care managers and nursing staff. The thesis is based on an analysis of 446 care manager assessments and decisions, interviews with seven care managers, six older people and 28 nursing staff. The main fi ndings are: (I); that there was a statistically signifi cantly shorter waiting time for a move to a nursing home for older people who were in hospital compared to those who were living in their own home at the time of the decision. Seventy percent of the decisions made by care managers’ concerned women. The waiting period for men was fi ve days shorter compared to women. (II); that the care managers’ descriptions revealed that their assessments of the needs and wishes of the older people were infl uenced by whether or not it was clear that the older person had only a limited time left to live. The care managers’ way of reasoning has been conceptualised as two approaches, the medical and the natural path to death, where the former was characterised as fl exible and collaborative, whereas the latter was governed to a greater extent by a “wait and see attitude”. (III); that the older people’s experiences of living in a nursing home have been conceptualised into three themes: feeling like a stranger in an unfamiliar culture, being excluded from life, and living while waiting for death. The latter involved a deep insight that life would soon come to an end; a fact the staff appeared to take into account to only a minor extent. (IV); that dying and death was characterised by a discourse of silence, with tension between avoidance of and a confrontation with death. Staff members who expressed a fear of death held it at a distance by concentrating on practical tasks and avoiding close contact with older people who were dying. The thesis highlights the fact that the dying and death of older persons was characterised by a discourse of silence and several transitions. Death was not a topic that the staff members or older people generally talked about, and care in the fi nal phase of life was not actively or explicitly planned. In terms of access to a nursing home bed, only older people with an extensive need for care obtained such a place. These fi ndings imply that all older people can be said to be in need of palliative care. The older people in our study were in a liminal phase, and waiting for death. Feelings of social and existential loneliness and that their living space was shrinking were evident. It was also clear that the older people and staff members inhabit the same place but appear to be in two different sub-cultures, where the norms and values that guided the staff members’ attitudes were dominant. Keywords: transition, older people, end of life care, palliative care, nursing home, caring, care manager and staff

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2009. 94 p.
Series
Örebro Studies in Caring Sciences, ISSN 1652-1153 ; 24
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-594 (URN)
Public defence
2009-09-25, Hörsal P1, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2010-09-02 Created: 2010-09-02 Last updated: 2011-05-16Bibliographically approved

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Österlind, JaneTernestedt, Britt-MarieHansebo, GörelHellström, Ingrid
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