This study describes how staff in long-term care facilities recognize dying in residents. From the staff interviews, a process of increasing death awareness was revealed identifiable through five cue groups. "Ambiguous Cues" begin the process in which an adverse event precipitates thinking about the end of life and culminates in "Decision Cues." "Ready-to-Go Cues" mark the resident's preparation for dying and culminate with the "Withdrawing and Saying Goodbye Cues." "The Look About Them Cues" indicate that death is imminent. A counter process of diminishing death denial was also noted and the interaction between the two processes caused staff tension. The continuum of death denial is represented at one end by the theme "We Don't Say It" and at the other by "We Don't Shut the Door," in which the staff actively ensure that all persons can say goodbye to the dying resident.
Author Affiliations: Davina Porock, PhD, RGN, is Professor of Nursing Practice, University of Nottingham, Queen's Medical Centre, Nottingham, England.
Debra Parker Oliver, PhD, MSW, is Associate Professor, Family and Community Medicine, University of Missouri-Columbia, MO.
This article was funded in part by the Gerontological Nursing Interventions Research Center NIH #P30 NR03979 (PI: Toni Tripp-Reimer, The University of Iowa College of Nursing) and the Hartford Center for Geriatric Nursing Excellence at Iowa, The John A. Hartford Foundation (PI: Meridean Maas, The University of Iowa). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Nursing Research or the Hartford Foundation.
Address correspondence to Davina Porock, PhD, RGN, University of Nottingham, B Floor, Queen's Medical Centre, Nottingham, England NG7 2HA (Davina.Porock@nottingham.ac.uk).