Ideas of home in palliative care research: A concept analysis

Dying at "home" - a qualitative study of end-of-life care in rural Northern Norway from the perspective of health care professionals

BACKGROUND

'Most patients want to die at home' is a familiar statement in palliative care. The rate of home deaths is therefore often used as a success criterion. However, providing palliative care and enabling patients to die at home in rural and remote areas may be challenging due to limited health care resources and geographical factors. In this study we explored health care professionals' experiences and reflections on providing palliative care to patients at the end of life in rural Northern Norway.

METHODS

This is a qualitative focus group and interview study in rural Northern Norway including 52 health care professionals. Five uni-professional focus group discussions were followed by five interprofessional focus group discussions and six individual interviews. Transcripts were analysed thematically.

RESULTS

Health care professionals did their utmost to fulfil patients' wishes to die at home. They described pros and cons of providing palliative care in rural communities, especially their dual roles as health care professionals and neighbours, friends or even relatives of patients. Continuity and carers' important contributions were underlined. When home death was considered difficult or impossible, nurses expressed a pragmatic attitude, and the concept of home was extended to include 'home place' in the form of local health care facilities.

CONCLUSIONS

Providing palliative care in patients' homes is professionally and ethically challenging, and health care professionals' dual roles in rural areas may lead to additional pressure. These factors need to be considered and addressed in discussions of the organization of care. Nurses' pragmatic attitude when transfer to a local health care facility was necessary underlines the importance of building on local knowledge and collaboration. Systematic use of advance care planning may be one way of facilitating discussions between patients, family carers and health care professionals with the aim of achieving mutual understanding of what is feasible in a rural context.

Away from Home or Returned Home? What Iranian Participants with Dementia Experience while Living in a Culturally Profiled Nursing Home in Sweden

This study explores Iranian immigrants with dementia living in a culturally profiled Swedish nursing home and what it means to be at "home." The meaning given to a place, in general, is understood to be generated and formed by experiences, expectations, hopes, and chains of events, and its significance can change over time. Life changes will mainly affect the understanding of what constitutes "home." Such a concept can be challenging to define, especially amongst some immigrant populations and those with dementia, for whom parameters change and choice can be limited. This qualitative research study is based on ethnographic fieldwork following ten participants. The data was analyzed, and three main categories that contribute to understanding "home" as part of the delivery of care to elderly immigrants with dementia, namely "a place to escape to", "a place to be", and "a place to live", were identified. The findings show that living in a culturally profiled nursing home in Sweden gave residents a feeling of self-rule, although the institution did have its codes and rules. Considering the feeling of home, none of the participants felt at home; instead, they stated that the culturally profiled nursing home was merely a place to live. Factors that strengthened their independence were the ability to speak the language they were familiar with and receiving medical help without relying on their children.

End-of-life palliative home care for children with cancer: A qualitative study on parents' experiences

BACKGROUND

There is insufficient knowledge available about the impact of paediatric palliative care at home on meeting family needs and ensuring the highest quality of care for the dying child. The aim of this study was to elucidate parents' experiences of how and why home-based paediatric palliative care impacted the entire family during their child's final phase of life.

METHODS

The study used a qualitative design. Semi-structured interviews were conducted with the bereaved parents of children who had received palliative care at home from a paediatric cancer hospital department programme that was based on collaboration with community nurses and the paediatric palliative care service. The interviews were transcribed verbatim, and qualitative content analysis was applied. The Ecocultural theory was used to explain the findings.

RESULTS

Three main themes emerged: (1) involvement enabling a sense of control and coping, (2) sustaining participation in everyday family life routines and (3) making room for presence and comfort during and after the end-of-life trajectory.

CONCLUSION

End-of-life palliative care at home can enable parents and other family members to maintain a sense of control, presence and semblance of everyday life. It contributes to managing and alleviating the burden and distress during the last phase of the child's life and during bereavement. We suggest that healthcare professionals support family members in participation and daily life routines and activities during a child's EOL care, as it affects the well-being of the entire family.

Space and place for health and care

Purpose: This discussion paper aims to contribute to a greater understanding of the state of the art of research engaged with conceptual matters of space and place for health and care. Method: The authors, who represent a variety of academic disciplines, discuss and demonstrate the conceptual recognition of space and place in research in health and caring sciences building upon own work and experience. Results: To explore the concepts of space and place for health and care is a research pursuit of utmost importance, and should be made through transdisciplinary research collaborations, whereby spatial theories from various disciplines could be communicated to cultivate truly novel and well-informed research. Furthermore, engaging with relational and topological perceptions of space and place poses methodological challenges to overcome in future research on health and care. Conclusions: We argue that there is a need for accelerating spatially informed research on health and care that is informed by current theories and perspectives on space and place, and transdisciplinary research collaborations are a means to achieving this.

Exploring the Perspectives of Older People on the Concept of Home

Objectives

Continuing to live at home is arguably one of the most important challenges older persons face as they age. The aim of this study was to clarify how older adults conceptualise home through age-related lifestyle changes.

Methods

Principles from grounded theory were used to examine the perspectives of 21 older adults obtained from three focus group discussions and 10 in-depth semistructured interviews.

Results

Four major categories were developed: “anchoring self,” “enabling freedom,” “being comfortable,” and “staying in touch.” Discussion. For the participants in this study remaining at home enabled a sense of independence and freedom, self-worth and identity, comfort, and an ongoing active role in the community. However, some aspects of home could be renegotiated despite changes to living location, with new social connections able to be forged and personal comforts being transferrable. This holds important implications for supporting older persons to both sustain living at home and to adjust to changing circumstances, suggesting the importance of drawing on the experiences of older persons themselves in developing strategies to promote successful aging.