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Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

BACKGROUND: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when...

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Autores principales: Åvik Persson, Helene, Sandgren, Anna, Fürst, Carl-Johan, Ahlström, Gerd, Behm, Lina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000966/
https://www.ncbi.nlm.nih.gov/pubmed/29898674
http://dx.doi.org/10.1186/s12877-018-0825-0
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author Åvik Persson, Helene
Sandgren, Anna
Fürst, Carl-Johan
Ahlström, Gerd
Behm, Lina
author_facet Åvik Persson, Helene
Sandgren, Anna
Fürst, Carl-Johan
Ahlström, Gerd
Behm, Lina
author_sort Åvik Persson, Helene
collection PubMed
description BACKGROUND: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective. METHODS: The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS: The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS: This study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.
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spelling pubmed-60009662018-06-26 Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective Åvik Persson, Helene Sandgren, Anna Fürst, Carl-Johan Ahlström, Gerd Behm, Lina BMC Geriatr Research Article BACKGROUND: Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective. METHODS: The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS: The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS: This study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons. BioMed Central 2018-06-04 /pmc/articles/PMC6000966/ /pubmed/29898674 http://dx.doi.org/10.1186/s12877-018-0825-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Åvik Persson, Helene
Sandgren, Anna
Fürst, Carl-Johan
Ahlström, Gerd
Behm, Lina
Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title_full Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title_fullStr Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title_full_unstemmed Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title_short Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
title_sort early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000966/
https://www.ncbi.nlm.nih.gov/pubmed/29898674
http://dx.doi.org/10.1186/s12877-018-0825-0
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