title: Factors that influence end-of-life care in nursing homes: the physical environment, inadequate staffing, and lack of supervision.
abstract: OBJECTIVE
  This study investigated the physical environment and organizational factors that influenced the process of providing care to terminally ill nursing home residents.
  
  
  METHODS
  Participant observation, interviews, and event analysis were used to obtain data in two proprietary facilities.
  
  
  RESULTS
  The physical environment was not conducive to end-of-life care. The rooms were crowded, there was little privacy, and the facilities were noisy. Inadequate staffing and lack of supervision were among the most significant organizational factors that influenced care. Often, residents did not receive basic care, such as bathing, oral hygiene, adequate food and fluids, and repositioning. A consequence of inadequate staffing was the development of pressure ulcers; 54% of the residents had pressure ulcers; 82% of these residents died with pressure ulcers.
  
  
  CONCLUSIONS
  Findings suggest that the nursing home environment in these two facilities, as now structured, is an inappropriate setting for end-of-life care.
authors.affiliation: Depaertment of Physiological Nursing, University of California-San Francisco, 2 Kirkham Street, Room N631, San Francisco, CA 94143-0610, USA. jeanie.kayser-jones@nursing.ucsf.edu
authors.forename: Jeanie
authors.initials: J
authors.lastname: Kayser-Jones
authors.forename: Ellen
authors.initials: E
authors.lastname: Schell
authors.forename: William
authors.initials: W
authors.lastname: Lyons
authors.forename: Alison E
authors.initials: AE
authors.lastname: Kris
authors.forename: Joyce
authors.initials: J
authors.lastname: Chan
authors.forename: Renée L
authors.initials: RL
authors.lastname: Beard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D013727:Terminal Care / Q000592:standards*; D014481:United States; D000078329:Workforce