The Role of the Nurses in End-of-life Care for Older Adults in Long-term Care Facilities

A Study Using the Plan-do-check-act Cycle of End-of-life Care

Abstract

Objectives: We aimed to elucidate the role of nurses in end-of-life care for older adults in long-term care facilities using the plan-do-check-act cycle of end-of-life care.

Methods: Semi-structured interviews were conducted with 12 nurses affiliated with long-term care facilities that have introduced end-of-life nursing care and the data were analyzed using qualitative descriptive research.

Results: We extracted 9 categories and 30 subcategories of nursing roles in end-of-life care for older adults in long-term care facilities, including [creating a system for older adults and their families to face the end-of-life with ease in a facility], [educational support for staff to provide end-of-life care with ease], [planning of medical care needed in end-of-life care], [clinical judgments to provide appropriate medical treatment in end-of-life care], [multidisciplinary coordination and information-sharing to provide pain-free end-of-life care for older adults], [support for the caregiver providing end-of-life care in the absence of a nurse], [support in accordance with the families’ thoughts and intentions], [reflection of end-of-life care for older adults], and [considerations for family members and caregivers who have experienced end-of-life care].

Discussion: On examining nursing roles required for the end-of-life care of older adults in long-term care facilities using the plan-do-check-act cycle, we found that nurses perform various roles from a medical perspective in preparing a system (Plan), performing end-of-life care (Do), and reflecting (Check). However, there was no category generated with regard to system improvement (action), and therefore, we believe the nursing roles undertaken, such as evaluating the state of implemented medical care and clarifying problems, are needed to improve the end-of-life care system.