Enabling at-homeness for older people despite their severe ilness and impending death

Abstract

The overall aim of this thesis was to describe the phenomenon of at-homeness and how at-homeness could be enabled for older people with severe illness and impending death. The project comprises four studies and was guided by an interpretive description design. Data generation for studies I and II was through individual qualitative narrative interviews with older people who were severely ill or facing impending death and living in their ordinary homes or in long-term or short-term nursing homes. Data generation for study III was based on seven reflective group discussions with the nursing staff in a nursing home (III) and study IV was based on participant observations and directed interviews (IV) with both older people and nursing staff in long-term and short-term nursing homes. The studies were analyzed using phenomenological hermeneutic interpretation (I, II) and constant comparative technique (III, IV).

The results showed (I) that for the older people at-homeness meant being oneself and being connected, which were interpreted as agency and communion. The results of the older people’s experiences of how the meanings of at-homeness were temporally a nd spatially shaped (II) showed that the phenomenon is interrelated, where at-homeness was shaped through relying on a familiar place and through continuous balancing between the past, present and future. The reflections of the nursing staff regarding how at-homeness was enabled for older people resulted in patterns such as (III) striving to get to know the older people, showing respect for the older people's integrity, creating and working in family-like relationships, helping to find a new ordinariness and preparing and making plans to ensure continuity for the older people. The last study (IV) explored how the nursing staff enabled at-homeness for older people in a nursing home who were at the end of life. The results showed that strategies used by the nursing staff to enable at-homeness were presenting themselves as reliable, respecting the resident’s integrity, being responsive to the resident’s needs, collaborating with the resident in decision-making and through nurturing comforting relationships.

This thesis shows that older people can experience at-homeness despite being severely ill and facing impending death. However, the results show that having time to be able to become familiar with new people and places is of importance for how older people experience at-homeness as are the older people’s earlier experiences in life and how they come to terms with changes and losses. This thesis shows specifically that, through person knowledge, respect for integrity and nurturing comforting relationships, nursing staff can enable at-homeness for older people who are severely ill and facing impending death.