• Cara L Wallace, Gail Adorno, and Daniel B Stewart.
• 1 School of Social Work, College for Public Health and Social Justice, Saint Louis University , St. Louis, Missouri.
• J Palliat Med. 2018 Apr 1; 21 (4): 503-512.

BackgroundDue 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.ObjectiveThe 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.DesignThis study uses a qualitative interpretive meta-synthesis to provide a holistic view of EOL care in NHs across multiple qualitative studies.Setting/SubjectsResearchers 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.MethodsA qualitative meta-synthesis employs the following steps: identification of studies, theme extraction, translation, and synthesis of findings.ResultsThematic analysis is organized using a conceptual model demonstrating the links between environmental and personal factors impacting EOL care in NHs.ConclusionsFindings 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.

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