Abstract
Aim: The purpose of this study is to determine the nature of connectedness (attachment) between residents with palliative care needs and their families and staff in nursing homes.Background: In this study, the term “palliative care” was described as a continuum, rather than a point in time during residents’ stay in nursing homes. While the theoretical concept was that palliative care was formerly reserved for people who were dying, it was now acknowledged that this type of care was appropriate at any point in the course of a chronic illness. Literature had revealed that many nursing home residents have chronic, life-limiting conditions for which palliative care might be most appropriate, but it was found that most nursing home residents were transferred to hospital before their deaths, often resulting in aggressive but medically futile treatments, leading to a waste of money and resources.
The current practice of transferring residents to another facility with unfamiliar faces at the end of life could lead to uncertainty and fear for these residents. Although there had been efforts to improve palliative care services in nursing homes through collaboration with external providers, important knowledge gaps remained regarding the provision of palliative care in nursing homes and the wishes of residents to remain in nursing homes for continuity of care. Currently, there were no studies conducted in Singapore investigating the provision of palliative care as part of nursing home care for residents from the simultaneous perspectives of residents, their family members, nurses, doctors and administrators.
Beyond the medical model and institution-based care, nursing homes were the last port of call for many residents. Therefore, there was a need for a review of policies to ensure they remained relevant to keep pace with the psychological needs associated with end-of-life care in this population group. This study would serve as the initial step in examining the relationship between attachment and palliative care at the end of life, specifically how attachment insecurity influenced an individual’s responses to various stages of their illness. This study would provide a useful lens for understanding the relationship between care staff, residents and family members to advance palliative care improvements and constitute sustainable end-of- life programmes across nursing homes in Singapore.
Methods: An interpretative phenomenological approach was used to uncover the meaning of the experiences to gain a deeper understanding of the lived experience through Smith’s (2009) interpretative phenomenological analysis using data derived from (1) in-depth semi-structured interviews conducted with a purposive sample of five residents, five family members, and three nursing home administrators, and (2) focus group discussions conducted with five nurses and three doctors across seven different nursing homes in Singapore.
Findings: There was extensive overlap in the results across the groups, indicating a shared experience of what constituted “attachment” in the nursing home context, irrespective of whether the interviewee was a care recipient or care provider.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Jo GIBSON (Supervisor) & Joanne LEWIS (Supervisor) |
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