Gerontological Nursing Interventions Research Center (GNIRC)

Title: Recognizing Dying in the Nursing Home: Pilot Study
Principal Investigator: Davina Porock, PhD, RN
Study Site: University of Missouri-Columbia

Abstract
One fourth of deaths in the US occur in nursing homes (NHs) but little is known about how dying is recognized in practice. This pilot study will describe how direct care giving staff and family members in the NH recognize that a resident is dying. The research questions are: 1. What cues do staff and families use to identify that a NH resident is near the end of life? 2. What are the similarities and differences in the cues used by staff and families?

The living-dying interval hypothesized by Pattison (1977) and modified for NHs by Engle et al (1998) underpins this study. The hypothesis suggests that many NH residents live in a living-dying interval meaning that rehabilitation is not a reasonable expectation and that as deterioration occurs modifications to goals of care are required. Failure to recognize that a resident is dying can result in inappropriate treatment decisions and that the work of dying may not be completed.

One urban and one rural NH, with hospice contracts will be studied. Interviews with family members, registered nurses and social workers and focus groups with certified nursing assistants and licensed practical nurses are proposed. Approximately 12 people will participate. The data will be coded following a rigorous method of independent analysis and consensus building; then categorized and analyzed according to themes that emerge. The results of the proposed study will be used to design interventions to improve end of life care in NHs. Thus, discovering how key personnel in NHs currently recognize dying is vital to the success of improving decision making and practice in the future. Furthermore the proposed study addresses the NINR research priority of transition to palliative care and end of life decision making.