Nursing care for patients on the edge of life in nursing homes: obstacles are overshadowing opportunities.
BACKGROUND
Patients in nursing homes have comprehensive needs for nursing care and medical treatment. Most patients benefit from the treatment, but some are 'on the edge of life'-in a borderland between living and dying with an unpredictable outcome, and questions are sometimes raised whether to withhold/withdraw curative treatment.


OBJECTIVE
The aim was to describe nurses' conceptions of good nursing care, and how this could be carried out for patients on the edge of life in nursing homes.


METHODS
In order to discover variations in the nurses' understandings a phenomenographic approach was chosen. Phenomenography is concerned with qualitatively different ways of conceiving a phenomenon. Methods.  Fourteen nurses from two nursing homes were individually interviewed twice. A phenomenographic analysis was used.


RESULTS
The outcome-space included two main categories. The first, 'good nursing care is to meet patients' needs for dignity,' included three description-categories: needs for 'preparedness', 'human relationship' and 'bodily comfort and safety'. The second, 'opportunities were overshadowed by obstacles' in carrying out nursing care encompassed three description-categories: 'organisational factors,''relational factors' and 'personal factors'.


CONCLUSIONS
This study shows nurses' conceptions of the importance of good nursing care for comforting patients on the edge of life.


CONCLUSIONS
Several obstacles related to resources, communication, cooperation and nurses' professional strength and power need to be overcome if good nursing care can be performed.
Faculty of Health Studies, Hedmark University College, Elverum, Norway. reidun.hov@hihm.no
Reidun
R
Hov
Birgitta
B
Hedelin
Elsy
E
Athlin
D001291:Attitude of Health Personnel; D003142:Communication; D003220:Conflict, Psychological; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008132:Loneliness; D008297:Male; D009664:Norway; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009735:Nursing Homes / Q000458:organization & administration; D028723:Personhood; D010561:Personnel Staffing and Scheduling; D019452:Terminally Ill