End-of-Life Care in Nursing Homes: A Qualitative Interpretive Meta-Synthesis

Background: Due to large number of deaths occurring in nursing home (NH) settings, along with reports of pain and suffering, there is great need for improvements in the provision of end-of-life (EOL) care in NHs. Objective: The aim of this study was to develop a comprehensive understanding of the experience of dying in NHs through the perspective of residents, family, and facility staff. Design: This study uses a qualitative interpretive meta-synthesis to provide a holistic view of EOL care in NHs across multiple qualitative studies. Setting/Subjects: Researchers synthesized the findings of 13 qualitative articles, including the diverse perspective of 91 dying residents, 419 NH staff, and 156 family members/caregivers across at least 44 NHs. Methods: A qualitative meta-synthesis employs the following steps: identification of studies, theme extraction, translation, and synthesis of findings. Results: Thematic analysis is organized using a conceptual model demonstrating the links between environmental and personal factors impacting EOL care in NHs. Conclusions: Findings provide support for the importance of a relational community and culture change within NHs for positive EOL experiences, in addition to providing a model to guide future research priorities.