Research problem and questions
The article explicates the factors contributing to satisfaction and dissatisfaction with end-of-life care in the nursing homes, particularly among bereaved family members. It represents part of a larger study conducted to examine the end-of-life care in nursing homes. A qualitative approach was used in the study.
The authors framed four questions which were used to solicit a broad range of responses. The questions asked were:
- What, in your mind, is “good dying” or a “good death”?
- Thinking about your experience now, what were the positive experiences you had?
- What could the nursing home have done better?
- What advice do you have to share to improve end-of-life care?
Methodology
In this article, the authors used family member perspectives about the factors contributing to either their satisfaction or dissatisfaction with care accessed by using the focus group methodology. The focus groups were subjected to similar experiences in a safe environment. The members of the focus group were drawn from 12 nursing homes located in an urban center of central Canada. A modified version of the Toolkit of Instruments to Measure End-of Life Care (TIME) instrument was used to measure whether the care provided to the resident met the needs and expectations of family members, as well as an overall measure of their satisfaction with care. This instrument was used on those who wished to participate in the focus group even though they had been surveyed in previous larger studies. Apart from asking the four listed questions, researchers used probing to further discussion as well as asking open-ended questions, “Have we missed anything?”
Summary of study findings
The analysis of the focus group data resulted in a description of two divergent experiences between those who were satisfied and those who expressed dissatisfaction with the care provided in the nursing homes. The article compares and contrasts the two different experiences.
Recognizing Imminent Dying
It was found, according to the article, that family satisfaction with end-of-life care is unequivocally linked to nursing home staffs’ ability to recognize that the resident was about to die. Failure by staff members, as shared by the family members, to recognize and acknowledge that the resident was nearing death was the major cause of dissatisfaction. It was revealed that the staff members did not change the plan of care for the resident to match the needs of the dying. This made the family members to doubt the abilities of the care givers to provide quality end-of-life care.
On the contrary, those who had expressed satisfaction with the kind of care provided felt that staff members recognized and acknowledged that the resident was on the terminal phase of life. Besides changing the plan of care for the resident, the staff members were reported to have engaged the family members on hat to expect at the end f life.
Communication and Information Sharing
The article points out the second experience by those who were satisfied and those who felt dissatisfied. Dissatisfied family members reported breakdowns in communication and information sharing with the healthcare team at different levels. According to the article, they were not clearly informed of the resident’s illness and what to expect. However, those who were satisfied reported that the staff members became more attentive to the resident’s needs in the last month of life and provided timely information to the family members concerning the resident’s condition. Inadequate contact and communication with physicians was a common concern expressed by both the satisfied and dissatisfied family members.
Consequences of Dissatisfaction
The article reveals that the experience of dissatisfaction with the care provided at the end of life has significant emotional consequences. Dissatisfied family members feel immense sense of regret, anger, and frustration over the inadequate care there relative received during the terminal phase of life.
Conclusion: In general, this study emphasizes that to respond suitably to the needs of residents and their families, it is important to alter our awareness of when residents enter the terminal phase of life, thus reducing the possibility of undue suffering and dissatisfaction with care in nursing homes.
Reference
Thompson, G. N., Menec, V. H., Chochinov, H. M. & MacClement, S. E. (2008). Family Satisfaction with care of a dying loved one in nursing homes: What makes the difference? Journal of Gerontological Nursing, 34(12), 37-44.