Changes in our society increasingly place the old and impaired in institutions, where they spend their last remaining days. The authors explore the burden of being confronted with death and dying on nursing home staff using mixed methodology. Findings from open-ended interviews with 17 representatives of different occupational groups inform the design of a questionnaire used to conduct a survey in 52 nursing homes of the Federal Province of Carinthia (Austria). In total, 894 questionnaires were returned, yielding a response rate of 49%. Results indicate that it is more difficult to talk about death with family members of terminally ill residents than with the dying themselves. The need for end-of-life training is not only essential for nursing staff but is also needed for nonnursing staff, who are found to be substantially strained by aspects of death and dying in their workplace.
Adriaansen, M., & van Achterberg, T. (2004). A test instrument for palliative care. International Journal of Nursing Studies , 41, 107-117.
2.
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct 2002. Retrieved April 25, 2007, from http://www.apa.org/ethics/code2002.pdf
3.
Badger, J. (2005). A descriptive study of coping strategies used by medical intensive care unit nurses during transitions from cure- to comfort-oriented care. Heart & Lung, 34, 63-68.
4.
Boston, P., Towers, A., & Barnard, D. (2001). Embracing vulnerability: Risk and empathy in palliative care. Journal of Palliative Care, 17, 248-253.
5.
Bryman, A. (2007). Barriers of integrating quantitative and qualitative research. Journal of Mixed Method Research, 1, 8-22.
6.
Büssing, A., Glaser, J., & Höge, T. (2002). Screening psychischer Belastungen in der stationären Krankenpflege [Screening of psychological loads in inpatient health care] . Bremerhaven, Germany: Wirtschaftsverlag .
7.
Byrock, I. (1998). Hospice and palliative care: A parting of the ways or a path to the future? Journal of Palliative Medicine , 1, 165-176.
8.
Cohen, J., Bilsen, J., Hooft, P.P., Deboorsere, P., van der Wal, G., & Deliens, L. (2006). Dying at home or in institution using death certificates to explore the factors associated with place of death. Health Policy, 78, 319-329.
9.
Cohen-Mansfield, J. (1995). Stress in nursing home staff: A review and a theoretical model. Journal of Applied Gerontology, 14, 444-466.
10.
Creswell, J.W., & Plano Clark, V.C. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.
11.
Dunn, K., Otten, C., & Stephens, E. (2005). Nursing experience and the care of dying patients . Oncology Nursing Forum, 32, 97-104.
12.
Ersek, M., Grant, M.M., & Miller Kraybill, B. (2005). Enhancing end-of-life care in nursing homes: Palliative care educational resource team (PERT) program . Journal of Palliative Medicine, 8, 556-566.
13.
Exley, C., & Allen, D. (2007). A critical examination of home care: End of life care as an illustrative case. Social Science & Medicine , 65(11), 2317-2327.
14.
Fischer, N. (2001). Geschichte des Todes in der Neuzeit [History of death in the new age]. Erfurt, Germany: SuttonVerlag, GmbH.
15.
Fischer, S., Bosshard, G., Zellweger, U., & Faisst, K. (2004). Der Sterbeort: Wo sterben die Menschen heute in der Schweiz? [Place of death: Where do people die in Switzerland nowadays?] . Zeitschrift für Gerontologie und Geriatrie, 37, 467-474.
16.
Fleiss, J.L., & Cohen, J. (1973). The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement, 33, 613-619.
17.
Forbes-Thompson, S., & Gessert, S. (2006). Nursing homes and suffering: Part of the problem or part of the solution? Journal of Applied Gerontology, 25, 234-251.
18.
Hanson, L., & Henderson, M. (2000). Care of the dying in long-term care settings. Clinics in Geriatric Medicine, 16, 225-237.
19.
Hanson, L., Reynolds, K., Henderson, M., & Pickard, G. (2005). A quality improvement intervention to increase palliative care in nursing homes. Journal of Palliative Medicine , 8, 576-584.
20.
Hart, G., Yates, P., Clinton, M., & Windsor, C. (1998). Mediating conflict and control: Practice challenges for nurses working in palliative care. International Journal of Nursing Studies, 35, 252-258.
21.
Hirai, K., Miyashita, M., Morita, T., Sanjo, M., & Uchitomi, Y. (2006). Good death in Japanese cancer care: A qualitative study. Journal of Pain and Symptom Management, 31, 140-147.
22.
Jeong, S., & Keatinge, D. (2004). Innovative leadership and management in a nursing home. Journal of Nursing Management, 12, 445-451.
23.
Johnson, R.B., & Onwuegbuzie, A.J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher , 33, 14-26.
24.
Katz, J.T., & Peace, S. (2003). End of life in care homes. A palliative care approach . Oxford, UK: Oxford University Press.
25.
Kayser-Jones, J., Schell, E., Lyons, W., Kris, A., Chan, J., & Beard, R. (2003). Factors that influence end-of life care in nursing homes: The physical environment, inadequate staffing, and lack of supervision . The Gerontologist, 43, 76-84.
26.
Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
27.
Lloyd-Williams, M., Kennedy, V., Sixsmith, A., & Sixsmith, J. (2007). The end of life: A qualitative study of the perceptions of people over the age of 80 on issues surrounding death and dying. Journal of Pain and Symptom Management, 34, 60-66.
28.
Mayring, P. (2005). Qualitative content analysis. In U. Flick, E. V. Kardorff , & I. Steinke (Eds.), A companion to qualitative research (pp. 266-270). London: Sage.
29.
Paice, J., Ferrell, B., Virani, R., Grant, M., Malloy, P., & Rhome, A. (2006a). Appraisal of the graduate end-of-life nursing education consortium training program. Journal of Palliative Medicine, 9, 353-360.
30.
Paice, J., Ferrell, B., Virani, R., Grant, M., Malloy, P., & Rhome, A. (2006b). Graduate nursing education regarding end-of-life care. Nursing Outlook, 54, 46-52.
31.
Parker Oliver, D., Porock, D., & Oliver, D. (2006). Managing the secrets of dying backstage: The voices of nursing home staff. Omega, 53, 193-207.
32.
Patton, M.Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.
33.
Pleschberger, S. (2006). Palliative care in Pflegeheimen [Palliative care in nursing homes]. Zeitschrift für Gerontologie und Geriatrie , 39, 376-381.
34.
Rabow, M., Hauser, J., & Adams, J. (2004). Supporting family caregivers at the end of life . Journal of the American Medical Association, 291, 483-491.
35.
Raudonis, B.M., Kyba, F.C., & Kinsey, T.A. (2002). Long-term care nurses' knowledge of end-of-life care. Geriatric Nursing, 23, 296-299.
36.
Rest, F. (1998). Sterbebeistand, Sterbebegleitung, Sterbegeleit [Dying assistance, hospice care, dying attendance]. Stuttgart , Germany: Kohlhammer.
37.
Sander, R., & Russel, P. (2001). Care for dying people in nursing homes. Nursing Older People, 13, 21-24.
38.
Sandgathe Husebø, B., Husebø, S., & Hysing Dahl, B. (2004). Old and given up for dying? Palliative care units in nursing homes. Illness, Crisis & Loss, 12, 75-89.
39.
Seale, C. (2000). Changing patterns of death and dying. Social Science & Medicine, 51, 917-930.
40.
Statistik Austria. (2007). Statistik des Bevölkerungsstandes [Vital statistics.]. Retrieved September 12, 2007, from http://www.statistik.at
41.
Steinhauser, K., Clipp, E., McNeilly, M., Christakis, N., McIntyre, L., & Tulsky, J. (2000). In search of a good death: Observations of patients, families, and providers. Annals of Internal Medicine, 132, 825-832.
42.
Steinke, I. (2004). Quality criteria in qualitative research. In U. Flick, E. V. Kardoff, & I. Steinke (Eds.), A companion to qualitative research (pp. 184-190). London: Sage.
43.
Teno, J. (2003). Now is the time to embrace nursing homes as a place of care for dying persons. Journal of Palliative Medicine , 6, 293-296.
44.
Toscani, F., Di Giulio, P., Brunelli, C., Miccinesi, G., & La Quintana, D. (2005). How people die in hospital general wards: A descriptive study. Journal of Pain and Symptom Management, 30, 33-40.
45.
Vachon, M. (2001). The nurse's role: The world of palliative care nursing. In B. Ferrel & N. Coyle (Eds.), Textbook of palliative nursing (pp. 647-662). New York: Oxford University Press.
46.
Weitzman, P.F., & Levkoff, S.E. (2000). Combining qualitative and quantitative methods in health research with minority elders: Lessons from a study of dementia caregiving. Field Methods, 12, 195-208.
47.
Whittaker, E., Kernohan, W., Hasson, F., Howard, V., & McLaughlin, D. (2006). The palliative care education needs of nursing home staff. Nurse Education Today, 26, 501-510.
48.
Wilkening, K., & Kunz, R. (2003). Sterben im Pflegeheim [Dying in nursing homes] . Göttingen, Germany: Vandenhoeck & Ruprecht.
49.
Wilson, D.M., Northcott, H.C., Truman, C.D., Smith, S.L., Anderson, M.C., Fainsinger, R.L., et al. (2001). Location of death in Canada: A comparison of 20th century hospital and non-hospital locations of death and corresponding population trends. Evaluation & Health Professions, 24, 385-403.
50.
Winchester, T.A. (2003). Teaching communication skills to nursing home certified nursing assistants. Geriatric Nursing, 24, 178-181.
51.
Zerzan, J., Stearns, S., & Hanson, L. (2000). Access to palliative care and hospice in nursing homes. Journal of the American Medical Association, 284, 2489-2494.
