Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A discourse of silence: professional carers resoning of death and dying in nursing homes
Ersta Sköndal University College, Enheten för forskning i palliativ vård.
Ersta Sköndal University College, Department of Health Care Sciences.
Institutionen för samhälls- och välfärdsstudier, LInköpings universitet.
Ersta Sköndal University College, Enheten för forskning i palliativ vård. Ersta Sköndal University College, Department of Health Care Sciences.
Show others and affiliations
2011 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 31, no 4, 529-544 p.Article in journal (Other academic) Published
Abstract [en]

Nursing homes are a setting in which death and dying is common. How death and dying is articulated and the actions that take place in a nursing home constitute adiscourse that guides the staff in their work. The aim of this studywas to explore thediscourse of death and dying in nursing homes from the perspective and understandingof the staff. The study draws on Foucault’s discourse analysis. Data arefrom fivefocus-group discussions held with 28 staff of four different nursing homes in Sweden. The findings show that the discourse had three characteristics :(a) dying was silent and silenced, (b) emotions were pushed into the background,and (c) attentiveness to death arose after the moment of the elderly person’s death. The structure of the discourse was characterised by a movement between twopositions, avoiding and confronting death, themain focus being on avoidance. Thearticulation and practices of silence highlight a need to regard dying as a processthat requires attention. One way to ensure appropriate attention could be to instil the philosophy of palliative care in nursing homes, including training and supportfor the staff in their work. The study demonstrates that nursing-home staff needmore knowledge and support to enable them to feel that they do a good job.

Place, publisher, year, edition, pages
Cambridge: Cambridge university press , 2011. Vol. 31, no 4, 529-544 p.
Keyword [en]
older people, death and dying, nursing home, staff, focus-group discussions, discourse analysis
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-593DOI: 10.1017/S0144686X10000905OAI: oai:DiVA.org:esh-593DiVA: diva2:346988
Available from: 2010-09-02 Created: 2010-09-02 Last updated: 2017-01-17Bibliographically 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

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Österlind, JaneHansebo, GörelTernestedt, Britt-MarieHellström, Ingrid
By organisation
Enheten för forskning i palliativ vårdDepartment of Health Care Sciences
In the same journal
Ageing & Society
Nursing

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 174 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf