Stressors for visiting nurses supporting the end of life of older people with dementia who are living at home and their families:

qualitative content analysis of interviews

Abstract

The purpose of this study was to identify stressors for visiting nurses supporting the end-of-life of older people with dementia who are living at home and their families. Study participants included 19 visiting nurses with more than four years of experience in visiting nursing and end-of-life care for older people with dementia who were living at home. Narrative data from nurse respondents were collected through semi-structured interviews and analyzed using qualitative descriptive research methods. Nurses’ narratives about the difficulties, anxieties, and burdens they experienced in supporting of older people and their families were coded and categorized according to similar phrases. Based on the results, 10 categories and 29 subcategories were extracted as stressors. The 10 categories follow: “Responding to difficulties in daily living due to cognitive decline,” “Older people with dementia living at home and having difficulty understanding nursing interventions ,” “Emotionally unstable behavior of the older people with dementia and their families,” “Difficulties helping family members accept dementia,” “Addressing the difficulty of bearing the costs of reviewing home health and nursing care,” “Difficulty supporting family members who make decisions on their behalf,” “Family confusion conceming end-of-life care for older people with dementia who cannot communicate,” “Difficulties in multidisciplinary cooperation,” “Fatigue due to busy schedules with multiple tasks,” and “Lack of knowledge and skills necessary for a wide range of nursing practices.” The similarities and relationships among the stressors of visiting nurses were examined, and the results were classified into four categories: difficulty coping with core and peripheral symptoms associated with dementia, difficulties with continuing home care, difficulty supporting family members at the end of life, and task-oriented difficulties in visiting nursing. These four perspectives of stressors suggest visiting nurses’ need to cope with stress.