Carers' and nurses' appraisals of needs of nursing home placement for frail older in Norway.
OBJECTIVE
The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.


BACKGROUND
Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.


METHODS
This is a descriptive and comparative cross-sectional study using qualitative methods.


METHODS
The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.


RESULTS
Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.


CONCLUSIONS
Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues.


CONCLUSIONS
Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
Department of Nursing and Health Sciences, University of Tromso, Tromsø, Norway. Aud.Mari.Fjelltun@fagmed.uit.no
Aud-Mari Sohini
AM
Fjelltun
Nils
N
Henriksen
Astrid
A
Norberg
Fredricka
F
Gilje
Hans Ketil
HK
Normann
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009664:Norway; D009726:Nurses / Q000523:psychology*; D009735:Nursing Homes