Promoting end-of-life care in nursing homes using an 'integrated care pathway for the last days of life'

The purpose of this study was to promote quality end-of-life care in eight independent nursing homes using an 'integrated care pathway (ICP) for the last days of life' document. Action research methodology underpinned the design of this study in order to promote collaboration between staff in the nursing homes and the research team, empower staff in the practice of quality end-of-life care, and promote sustainable development of end-of-life care once the study finished. Considerable barriers within the nursing home context highlighted initial difficulties. This is reported elsewhere (Watson et al., in press) (Bridges Initiative, 2004). However, key champions appointed in each nursing home and their subsequent support was a major part of facilitating the ICP implementation. This paper reports the qualitative analysis from the summative evaluation of the study. One overarching pattern of 'dying being more central to care in the nursing homes' emerged as a result of the study; five themes that contributed to this shift were: greater 'openness' around death and dying; recognising dying and taking responsibility; better 'teamwork'; critically using palliative care knowledge to influence practice; more meaningful communication.