Essence of caring for a person dying

The present paper aims to illustrate the essence of caring through the philosophical lens of palliative care gained from one family's experience within a home environment. The narrative used provided a vehicle through which a family member recalled the experience of caring for her mother, who was dying. The essence of caring is portrayed by the use of exemplars gained from the narrative situated within a palliative context depicting both the person dying and the carer's perspective. The narrative offers the opportunity to better understand cultural knowledge, history and social practices from the perspective of the family unit, and to understand how families might be best supported by health professionals engaged in care delivery. The commitment demonstrated by family members in caring for a family member dying is significant and needs to be more valued as a contribution to our understanding of this life event. From the analysis of this family's experience, health professionals are afforded an insight into the diversity of needs that encompass the essence of care being provided in the home. This opportunity allows health professionals to gain further insight into this significant life event, leading to an enhancement of their practice and enabling them to be better equipped to meet the individual needs of family units.     

The influence of registered nurse staffing on the quality of nursing home care

The purpose of this study was to determine the extent to which registered nurse (RN) staffing patterns influenced nursing home quality. Based upon extensive literature review, a model for nursing home quality was developed. Using data from reports of 455 Medicare-certified skilled nursing facilities, structural, process, and outcome factors thought to influence quality were entered into the model and analyzed using ordinary least squares regression. A small, though statistically significant, proportion of the variance in quality nursing home care was explained by the equation. A positive, significant relationship existed between nursing home quality and the ratio of RN hours to licensed vocational nurse (LVN) hours per resident day.     

Positive aspects and challenges associated with caring for a dying relative at home

Research has consistently shown that family caregivers have a variety of unmet needs, despite comprehensive professional support for caregivers being a central aim of palliative care. This sub-study of a larger randomized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care. During semi-structured interviews in their homes, family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges. These were associated with their own ill health, family circumstances, insufficient skills to manage patient symptoms, limited time for themselves and inadequate support from health professionals. Despite these challenges, 60% of family caregivers were readily able to identify positive aspects of the role. Previous research has tended to focus on the negative impact of caregiving. The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration, as does the long-term impact of the caregiver role on those who are unable to recognize positive elements.     

Transitions in men's caring identities: experiences from home-based care to nursing home placement

Objectives.  The aim of this study is to describe, from a gender identity perspective, the experiences of older men involved in the process of caring for a partner at home and the placement into a nursing home.
Background.  Few studies have paid attention to the importance of gender when considering the social experiences of older men providing care for an ill spouse and finally placing a partner in a nursing home. Further understanding is much needed of how older men experience the process of caring for a spouse from a gender identity perspective.
Design.  A qualitative constructivist approach was adopted for this study.
Participants.  Data consists of interviews with seven men that have been informal carers and experienced the placement of their wife in a nursing home.
Methods.  Interviews were analysed with a constructivist approach.
Results.  The results indicate that men go through two transitions in their gender identity during the caregiving process and placement. From the mutual loving relationship of being a loving husband , the social responsibility of daily care of their wives changes the situation into that of being a caring husband , and finally with the move to a nursing home there is a transition from intimate care to a relationship based on friendship .
Conclusions.  The results show that older caregiving men undergo a process involving a reconstruction of gender identity. To formally recognize men's caring activities and to make them sustainable, we believe that men in an informal caring relationship need support.
Relevance to clinical practice.  Nurses need to recognize the identity struggles resulting in sadness and suffering that are related to changes in men's lives during the caregiving process. Understanding the dynamics and changes that occur when men take on a caring task is important for the development of their role as carers.     

Caregivers talk about experiences of caring for an older person with dementia

This study explored caregivers' experiences of caring for an older person with dementia by listening to the voices of 15 carers to identify successful management strategies. Some successful management strategies did emerge none saw their approach as a 'successful strategy', just that things worked on certain days. It is suggested that families can be prepared for a 'career' in caring and that early assessment and diagnosis is essential.     

Spiritual caring: end of life in a nursing home

The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting.     

The roles and clinical activities of registered nurses and nurse practitioners in practices caring for older adults

BackgroundPopulation aging and physician shortages have motivated recommendations of increased use of registered nurses in care provision; little is known about RN and NP employment in primary care and geriatric practices or service types each provide.PurposeDetermine current RN and NP employment frequency in practices in the U.S., identify services provided by RNs, and whether NP presence in practice is associated with the types and frequency of services provided by RNs.MethodsNational survey of 410 primary care and geriatric clinicians.FindingsOnly half of practices employed RNs. RNs most frequently provide teaching or education for chronic disease management. RNs provide significantly more primary care and geriatric services when practices employed a NP.DiscussionReasons for RN underuse in practices should be identified, clinical placements in such practices should increase, and NP education programs should include care models using RNs to their full scope of practice.     

Professional development: Iranian and Swedish nurses' experiences of caring for dying people

Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses' experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self-oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.