Continuous Commitment: Registered nurses in long-term care experience communicating with residents and their families about end-of-life care preferences

Abstract

This dissertation begins with an introduction to the current state of the science in nursing research regarding long-term care (LTC) registered nurses’ communication with residents regarding their end-of-life (EOL) care preferences. In LTC registered nurses lead care planning and evidence suggests residents, their families and nurses all benefit from engaging in EOL care communication, but systemic and individual barriers and obstacles impede it. With a large and growing population of older adult residents in U.S. LTC facilities, most of whom have not articulated their EOL care preferences, there is a pressing need to understand LTC registered nurses’ EOL care communication strategies and facilitators. Three manuscripts are presented. The first reviews the literature regarding EOL care communication in LTC, finding there is a gap in nursing research about registered nurses’ experientially-derived knowledge. These findings led to the design of an interpretive phenomenological interview study of LTC registered nurses’ EOL care communication experience. The second manuscript presents insights from an innovative application of video conferencing technology to permit virtual, remote qualitative research data gathering during the novel coronavirus (COVID-19) pandemic. The third manuscript presents thematic and conceptual findings from a phenomenological interview study of 10 LTC registered nurses describing their EOL care communication process with residents and families. Finally, the body of aggregated work is synthesized, and implications for LTC organizational policy, nursing education, research and practice are noted.