97 Nursing Home Essay Topic Ideas & Examples

🏆 best nursing home topic ideas & essay examples, 📌 simple & easy nursing home essay titles, 🔎 most interesting nursing home topics to write about, ❓ nursing home research questions.

  • Issue of Falls at a Nursing Home: Professional Reflection The problem of patients’ falls in nursing homes is an urgent nursing issue, and my experience in one of these institutions in New Zealand is the object of evaluation.
  • Quality Costs for Building a Dementia Nursing Home Firstly, there will be the inclusion of the appraisal costs which entails the inspection and measurement of activities when the operation is ongoing to determine their conformity to the required standards. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
  • Older Patients’ Transition From a Hospital to a Nursing Home The example of transition of care chosen for further exploration is concerned with the transition of care from the hospital to the nursing home setting for patients that came to receive healthcare for various conditions.
  • The Rehabilitation Center and Nursing Home During the evaluation process, the nurse leader identifies the problems in the organization and determines the strong and weak points, resources, gaps, and other factors that determine how the project will develop.
  • A Nitrogen Gas Accident at a Nursing Home The nursing home workers failed to recognize this error and did not check the gas before hooking the tanks to the system.
  • Approach to Learning at Cloudview Nursing Home Since the approach adopted to learning determines an organization’s performance, it is essential to understand the motivations for learning and their influence on workplace education.
  • Regulation of a Large For-Profit Nursing Home Chain To solve the problem of unlawful actions of the stakeholders in nursing homes, there is a need for the implementation of the practical management theory.
  • “Implementation and Effects of MRC in a Nursing Home” by Henskens The research’s dependent variable is the outcome to be measured the treatment’s impact on the aforementioned patients’ ADL and QoL. However, the researchers did not provide a clear delineation of the above-mentioned variables in the […]
  • Nursing Home Beds: Fundamental Uncertainty and Values If it is assumed that the admission will stay the same, the decision to dismiss a certain amount of employees will reduce fixed costs in both facilities.
  • A Nursing Home Working Scenario Working in nursing homes has its opportunities and challenges; therefore, the paper will cover the multidisciplinary teams’ working scenario, their interaction and diversity, communication in client care, and support accorded to clients considering their family, […]
  • Nursing Home Blueprint and Requirements The aim of the facility should be geared towards the promotion of the health of the old patients through the prevention and treatment of diseases and disabilities.
  • Departmental Budget Preparation for Nursing Home However, while the total population in our area of operation is expected to decrease, the population of people who are above 65 years in the US is projected to rise.
  • Northern Cochise Nursing Home: Federal and State Surveys Following the findings of the health inspection carried out by Arizona Department of Health Services, the management of the Northern Cochise Nursing home took immediate steps to correct the deficiencies.
  • Redondo Nursing Home: Providing Above Average Care While the potential resident and family members are expected to disclose all information pertaining to medical conditions, the planner is required to provide a complete description of the home.
  • Organization Strategic Plan for a 40 Bed Nursing Home Unit The core values are to ensure that a team of the highest quality and honesty in delivering services attends to all.
  • Activities Coordinator and a Conflict of Interest Situation at Cooinda Nursing Home It is thereby imperative that the practitioner adhere to the guidelines set by the home in such regards because he needs to check how his values and emotions are at par with the organizations, and […]
  • Satisfaction With a Transitional Nursing Home Project The abstract does mention the dependant variable of the study viz.satisfaction with the transitional program; it does not, however, mention and discusses the various dimensions of the dependant variable that were measured in order to […]
  • Nursing Home Designs: Health and Wellness of Aging The Eden Alternative is a nursing home model of care that places decision-making power into the hands of its clients and their families.
  • Future Care Nursing Home in Baltimore City In the United States, up to one-half of the citizens will spend at least a few years of their lives in a nursing home.
  • Healthcare Research at Pearl City Nursing Home I can conclude that the methods used in our work are effective and improve the quality of patient care in the Pearl City Nursing Home.
  • Nursing Home and Its Impact on Lifespan A nursing home is a special nursing facility where the old, the mentally, and the physically challenged or handicapped people in society are taken care of.
  • Choosing an Adult Foster Home or a Nursing Home A nursing home is well known to health and social services professionals as the long-term care service for older adults that accounts for that vast majority of public funding.
  • Blumberg’s Nursing Home’s Staffing Crisis The present paper will seek to assess the current needs of the facility and develop a useful HR policy for inappropriate conduct.
  • Blumberg’s Nursing Home: Staffing Crisis The situation under analysis is complicated due to the level of awareness and the necessity to take immediate steps and fill the unstaffed positions.
  • Employee Compensation and Benefits. Senior Secretary at Capital Nursing Home Limited The proposal demonstrates that the value of the employee’s benefits augmented with the annual salary and provides the total compensation. The total compensation package for the position of Senior Secretary includes the base pay and […]
  • Fernhill Nursing Home Run by Colten Care Limited Staff management for my team is my responsibility; and of course I am a nurse so my basic role is providing general nursing care to the residents and any other role that might be allocated […]
  • Reduce Hospitalization of Nursing Home Residents Publicity of INTERACT as a program having the necessary infrastructure and leadership commitment in health care matters for the elderly is one promising way that can be used to overcome these issues.
  • The Effects of Group Music Making on the Wellbeing of Nursing Home Residents
  • Assessing French Nursing Home Efficiency
  • Assessing Nursing Home Care Quality Through Bayesian Networks
  • Can Family Caregiving Substitute for Nursing Home Care
  • Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains
  • The Difference Between Nursing Homes and Retirement Homes
  • Direct Care Workers’ Response to Dying and Death in the Nursing Home
  • Does Paid Family Leave Reduce Nursing Home Use
  • Economic Disability and Health Determinants of the Hazard of Nursing Home Entry
  • Effective Human Resources Leadership for Nursing Home
  • Elder Abuse Within Nursing Home Setting
  • Elderly Falls Within the Nursing Home
  • End-Of-Life Decision Making for Nursing Home Residents With Dementia
  • Impact of Family Structure on the Risk of Nursing Home Admission
  • Nursing Home Facility Versus a General Acute Care Hospital
  • Improving Wound and Pressure Area Care in a Nursing Home
  • Nursing Home Environment and Pet Therapy Programs
  • The Effects of 1935’s Social Security Act on the Nursing Home Industry
  • Nursing Home Care Versus Assisted Living Care
  • Health Care Utilization Nursing Home Administration
  • Nursing Home Staff Turnover and Better Practices
  • Mental Disorders Among Non-Elderly Nursing Home Residents
  • Forecasting Nursing Home Utilization of Elderly Americans
  • Incorporating Quality Into Data Envelopment Analysis of Nursing Home Performance
  • Interventions That Encourage High-Value Nursing Home Care
  • Lateral Violence and Uncivil Behavior in a Nursing Home
  • Medicaid and the Cost of Improving Access to Nursing Home Care
  • Medicaid Reimbursement and the Quality of Nursing Home Care
  • Who Makes the Decision to Go to a Nursing Home
  • Understanding the Medical Aspect of a Nursing Home
  • The Fate and Welfare of Nursing Home Residents
  • The Social Security Act of Nursing Home Facilities
  • Physical Restraint in Nursing Home Facilities
  • Predicting Nursing Home Utilization Among the High-Risk Elderly
  • How Many Nursing Home Residents Live With a Mental Illness
  • Improving the Nursing Home: A Framework for Professional Nursing Practice
  • Incapacitated vs. Incompetence: Employees in the Nursing Home Industry
  • An Argument in Enhancing the Care Quality in a Nursing Home
  • How to Prevent Accidents in Nursing Homes
  • Positive and Negative Views of Nursing Homes
  • What Are the Benefits of Living in a Nursing Home?
  • Do People Live Longer at Home or in a Nursing Home?
  • What Is the Main Purpose of a Nursing Home?
  • Why Is Assisted Living Better Than a Nursing Home?
  • Which Are the Most Important Problems of Nursing Home Residents?
  • How Do You Know When Someone Is Ready for a Nursing Home?
  • What Participation and Knowledge Are Associated with Nursing Home Admission Decisions Among the Working-Age Population?
  • Is It Bad to Put Your Parents in a Nursing Home?
  • What Is the Most Common Diagnosis in Nursing Homes?
  • How Did the Social Security Act of 1935 Affect the Nursing Home Industry?
  • Can a Doctor Put Someone in a Nursing Home?
  • How Can You Improve the Quality of Life in a Nursing Home?
  • What Are the Most Common Reasons Seniors Are Placed in a Nursing Home?
  • Are Nursing Homes Better Than Care Homes?
  • What Is the Difference Between a Nursing Home and a Senior Home?
  • How Can the Risk of Violence in Nursing Homes Be Reduced?
  • What Are the Perspectives and Expectations of Telemedicine Opportunities from Families of Nursing Home Residents and Nursing Home Caregivers?
  • How Do You Deal with the Guilt of Putting Your Parents in a Nursing Home?
  • What Percentage of Nursing Home Residents Are Depressed?
  • Is a Nursing Home the Best Choice for the Elderly?
  • What Are the Physical, Intellectual, Emotional, and Social Benefits of Various Stimulating Activities for Nursing Home Residents?
  • How to Deal With Collateral Violence and Indecent Behavior in a Nursing Home?
  • What Are Nursing Home Residents’ Views on Dying and Death?
  • How Often Should You Visit Your Mother in a Nursing Home?
  • What Is the Difference Between a Residential Care Home and a Nursing Home?
  • Should Elderly Parents Live in a Nursing Home or Not?
  • What Is the Social Security Act of Nursing Home Facilities?
  • How Can Human Resources Improve Nursing Home Management?
  • What Are the Disadvantages of Living in a Nursing Home?
  • How Important Is the Medical Aspect of a Nursing Home?
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essay about nursing home

What working in a nursing home taught me about life, death, and America’s cultural values

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The first thing I noticed when I began working in a nursing home was the smell. It's everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It's one of those smells that takes over everything — if you're not used to it, it's hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, "I want Mommy."

But it's also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It's an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. "Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?"

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven't gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

"This is all I have left," a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that's about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they're worth fighting for, while we still can.

2) Having a routine is key to happiness

More on dying well.

essay about nursing home

It's never too early to start thinking about your own death

I'm a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the "rehabilitation room," reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

"You are so handsome. Are you married?" is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn't feel anything except physical pain — especially not any sexual urges. That's not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip ("Did you know that this nurse is married to the social worker?"), flirt, make jokes, cry, feel helpless, complain of boredom. "What does someone in her 80s talk about?" a colleague asked me. "About the same things," I replied, "only with more urgency."

Some people don't get that, and talk to old people as if they were children. "How are we today, Mr. Goldstein?" I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, "Did we poopie this morning?" Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It's always on. How strange, then, that there are no old people on TV.

Here's a picture I see every day: It's the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let's say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how "great!" their dish or their new movie is, or how "sad!" the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don't see themselves there. They don't belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn't look "young!" and "great!" but might know something about life that we don't.

There isn't one Big Truth about life that the patients in the nursing home told me that I can report back; it's a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: "Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore."

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don't. They talk about other things instead, and it's rarely a sign of whether they are in pain or not.

Here's my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that's going to be the only thing you're going to think about. It's like a muscle — you developed the mundane muscle and not the other one.

And you can't start developing the spiritual muscle when you're old. If you didn't really care about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you're not going to start when you're old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you'll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her "inappropriately old" appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don't have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it's physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That's a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, "Trees die standing tall." This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — "Look here; pay attention to this!" the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don't want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that's also possible.

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn't. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

"It's going in a very clear direction," she told me. "Toward the end."

"It's true for all of us," I replied.

"No, sweetheart. There is a big difference: You have much more time."

Valery Hazanov, PhD , is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.

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Nursing Homes In The US Argumentative Essay Samples

Type of paper: Argumentative Essay

Topic: Elderly , Health , Home , Medicine , Services papers , Nursing , Family , Love

Words: 2500

Published: 03/16/2020


Employing the services of Nursing Homes is becoming a huge trend in the United States in recent years. Families can bring their elderly and ailing love ones to these nursing homes and pay for a certain cost to support their treatment. However, there is a growing debate within the country with regards to the use of these nursing homes as some groups believe families should take care of their love ones at home. Supporters to these alternative facilities argue that nursing homes would provide better care to their love ones, especially given the financial and living conditions. This paper will discuss the arguments surrounding the use of nursing home for love ones and answer as to why placing them to these homes would be beneficial or disadvantageous for the families thinking of using the service.

Placing Love Ones in Nursing Homes

When a person reaches the age of 70, family members would start clamoring for ideas as to what would be done in order to take care of their elderly family member. Some families opt to consider assigning someone to take care of their love ones at home due to the strict schedules of people today. Others would take care of their love ones by themselves due to the sentiment that it is the child’s responsibility to give back to their love ones. However, in recent years, there is a growing interest in many families to seek the assistance of nursing homes in order to take care of these elderly or ailing family members. Positions have greatly varied within the public regarding the presence of these nursing homes. Some argue that these nursing homes should not be trusted, while a few welcome its use. Families should place their love ones in nursing homes because these love ones would be taken care well by these nursing homes as they specialize in taking care of the specialized needs of these elderly and ailing family members despite the costs it entails. The exact definition of nursing homes have varied throughout the years given the lack of terminology for these services in the early years. However, according to Giacalone (2001), the National Center for Health Statistics (NCHS) defined nursing homes as “facilities with three or more beds that is either licensed as a nursing home by the state, certified as a nursing facility under Medicare or Medicaid, identified as a nursing unit in a retirement center, or determined to provide nursing or medical care”. Some institutions also call these facilities as extended care facilities, intermediate care facilities for the mentally retarded and SNFs. Nursing homes often have state-of-the-art medical facilities and medical staff that can be called to duty 24/7. Before nursing homes can operate in the United States, they would have to apply for state licenses and adhere to reimbursement regulations, classification and termination policies. Most of these policies vary per state and some states would require separate licenses for nursing homes that have separate operations on all-day care facilities or medical accreditation . Purdy (2013) stated that nursing homes became known in the US since the 1930 when many American families brought their ailing family members to “poor houses.” Many criticized these poor houses due to their deplorable living conditions and health care. In 1935, the Congress passed the Social Security Act which was included in the New Deal program to support its aging population. Federal grants were given per state in order to improve health care, as well as the creation of nursing homes for the elderly and ailing. By the 1950s, nursing homes were licensed and at the same time, criticized for their operations. From the 50s to the 80s, exploitation was prominent in the industry and misled many Americans in the process. The government immediately responded in 1965 by passing the Older Americans Act and the Title III grants which would establish the community program for the elderly which would cater not just for their medical needs but also for their maintenance. Studies were also supportive over the initiative of the government and aided in the establishment of the Nursing Home Reform Act of 1987, which would regulate Medicare and Medicaid in providing financial assistance to nursing homes. The Act also added the necessary requirements for nursing home licensing. Since the growth of these nursing homes throughout the country, there are several sentiments that have been raised with regards to leaving loved ones in these nursing homes. Opponents cited three major arguments against nursing homes: cost and quality, reduction of self-reliance and independence and the trauma it entails to the loved ones. In terms of costs, it is reported by Ellis (2013) that nursing home services now costs up to $80,000 a year in comparison to its $67,527 five years ago. According to the Genworth 2013 Cost of Care Survey, factors such as insurance, food, maintenance and labor have triggered the increase of nursing home costs. As a result of these higher costs, a simple semi-private room nowadays now rate up to $75,405, 23% higher than it was five years ago. With these high fees, people tend to prefer using assistive living facilities that cost only up to $41,400. Others also prefer at-home care because it is cheaper to do these treatments at home, and they would also find it cheaper to pay for food and services . Hand in hand with the high costs is the quality of care these nursing homes can provide to family’s loved ones. Pesis-Katz, Phelps, Temkin-Greener, Spector, Veazie, and Mukamel (2013) stated that consumers are often misled by the high hotel-like quality of nursing homes around the country due to the misleading and inaccurate information available. Some of the information available for prospect residents come from the internet and sometimes, it is not easy to understand. Since customers cannot interpret and understand the information with regards to the quality of health care, they often prefer to select nursing homes with high grade hotel type service. They often use indirect methods to observe if the nursing home is good for their love ones. Some factors they take into consideration are nonprofit ownership and the number of occupancy, seeing it as a sign for high quality for its service and capability. As a result of the inconsistency of information, it is likely that the service they would get would not be suitable for their love ones . Loved ones who are placed in these nursing homes also feel the reduction of self-reliance and independence. According to the Illinois Council on Long Term Care (n.d.), any person who is admitted to nursing homes would lose their privileges to keep their apartments and homes. Most of their possessions would also be sold or given to charity, removing the possibility for the person to give the possessions as an inheritance to their children or grandchildren. Nursing homes only allow just a few possessions for these loved ones to hold; however, they would have to fit it on a small space that sometimes, they share with another person. Aside from losing their homes, loved ones admitted to nursing homes would also cause a loss of status, finances and relationships that may affect the loved one’s confidence and independence. Residents are also restricted from their movements considering that every activity is now timed by the institution and where the resident would need to stay. Finally, there are also implications to loved ones when they are placed in nursing homes, mostly changing their attitudes and development of trauma. Many would become angry for being placed in a nursing home especially with the loss of their possessions and rights. Some elderly often get angry because of the restrictions placed on their movements while in these institutions. As a result of their anger, they would become trouble-makers in the nursing home and it may hinder their recovery. Some, especially those who lose their love ones prior to their admission to these institutions, would feel bouts of depression or even regression. These residents would become overly dependent towards their caretakers or their love ones. There are also bouts of denial for these residents as they would feel that their condition or placement in the nursing home is not true. They believe that they would be removed from these centers soon and go home afterwards . However, while there are people against the use of nursing homes in the country, many Americans today prefer to use nursing homes due to the benefits it has for both the family and the love one that would be enrolled in this service. Many often prefer sending their loved ones on these nursing homes due to the all-round care provided by these facilities. According to the report by Sun Advocate (2008) and EHealthMedicare (n.d.), many of America’s nursing homes have available professionals to cater to emergencies and immediate medical support 24 hours a day. While doctors may not always be available in the early hours of the day, nurses are trained to take care of their patients and do rounds regularly. If these love ones were taken care of at home, their family members would not be able to cater to the exact need of the ailing or elderly loved one. The family would have to adopt with the schedule of the elder, which may prevent them from going to their own duties on time. With nursing homes available, families can visit their family members on free days and be assured that their love ones are treated and monitored regularly. In addition, these professionals and personnel can also provide specialized treatment necessary to improve the health and well-being of the citizen. Nursing homes have custodial care, which aids in preparing meals, bathing and dressing for their residences. The skilled nursing care unite is where the nurses and rehabilitation specialist would determine what type of care or treatment would be done. This type of care would include activities such as medication management, wound care and specialized functions depending on the availability of medical equipment in the facility. Some facilities also offer rehabilitation services, especially for patients which have been placed under surgery and other strenuous activity. The doctor of the resident would be able to determine as to how long rehabilitation would occur. Finally, nursing homes are also well known for their long-term care facilities to aid patients with major diseases. Prescription drugs and medical supplies are also readily available for use by these workers to ensure continuous service and treatment for residents. Nursing homes also allow their love ones to meet up new friends and acquaintances as nursing homes are like small communities. In at-home treatments and care, the elderly or ailing family member would only have limited contact with their peers. However, in nursing homes, they are able to be with their age group and even go on regular social gatherings and celebrations: may it be visits to museums or simple group meals in the nursing home. In some instances, nursing homes actually incite socialization given that the nursing home acts as a special home for its patients and residents. They can use the open kitchens and public areas to meet up with their fellow residents. Nursing homes also may have sectors catering for other in-need residents, who are not necessarily elderly. They may also find certain nursing homes that would permit couples in staying together to provide a good environment for their development and recovery. Nursing homes are also quite safe and promises to provide excellent service as these nursing homes are regularly checked by the United States government for their capacity and services. Medicare and Medicaid also provide regular reviews to the public in order to determine which nursing homes adhere to their policies. Evaluations are done regularly to ensure that quality is not compromised and it is expected that nursing homes update their programs to stay up-to-date to the new improvements in healthcare . Nursing homes also make sure that patients do not endanger themselves further especially with the onset of very complicated diseases like dementia and Alzheimer’s . Family must always be cherished no matter what one feels about each family member. As these family members get older, it is crucial that they are given all the love and care possible to make their lives comfortable in their final years. However, taking care of these ailing and elderly family members can be very difficult especially due to the medical and financial needs of these loved ones. With the introduction of nursing homes, families now have a choice to use these services to take care of their love ones. On the one hand, these nursing homes can be quite costly each year and it is a question as to whether or not the service matches the cost. These nursing homes can even make the situation of the elderly and ailing family members to worsen due to the impact of their residencies. On the other hand, using nursing homes not only benefits the family member but also the family in general. The family member would greatly benefit due to the ready access to health care, while family members would be relieved with the financial burden attached with taking care of these love ones.

Centers for Disease Control and Prevention. (2014, May 14). Nursing Home Care. Retrieved from CDC FastStats: http://www.cdc.gov/nchs/fastats/nursing-home-care.htm EHealth Medicare. (n.d.). Nursing Homes and Medicare. Retrieved from EHealthMedicare: http://www.ehealthmedicare.com/about-medicare/nursing-homes/ Ellis, B. (2013, April 9). Nursing home costs top $80,000. Retrieved from CNN Money: http://money.cnn.com/2013/04/09/retirement/nursing-home-costs/ Giacalone, J. (2001). The U.S. Nursing Home Industry. New York: M.E. Sharpe. Illinois Council on Long Term Care. (n.d.). Understanding the Transition to Life in a Nursing Home. Retrieved from Family Resource Center: http://nursinghome.org/fam/fam_004.html Pesis-Katz, I., Phelps, C. E., Temkin-Greener, H., Spector, W. D., Veazie, P., & Mukamel, D. B. (2013). Making Difficult Decisions: The Role of Quality of Care in Choosing a Nursing Home. American Journal of Public Health, 103(5). Purdy, E. (2013). Nursing homes. Ipswich: Salem Press. Sun Advocate. (2009, April 10). Advantages and disadvantages of nursing home care for the elderly. Retrieved from Sun Advocate: http://www.sunad.com/index.php?tier=1&article_id=12944


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Guest Essay

Nurses Deserve Better. So Do Their Patients.

essay about nursing home

By Linda H. Aiken

Dr. Aiken is a professor of nursing and sociology and the founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

The Covid-19 pandemic exposed strengths in the nation’s health care system — one of the greatest being our awesome nurses. But it also exposed many weaknesses, foremost among them being chronic nurse understaffing in hospitals , nursing homes and schools .

More nurses died of job-related Covid than any other type of health care worker. The more than 1,140 U.S. nurses who lost their lives in the first year of the pandemic knew the risks to themselves and their families. And yet they stayed in harm’s way. They cared for their fallen co-workers. They went to New York from around the country to fight on the front lines in the first Covid surge. Nurses from Northwell Health in New York returned that support by deploying to the Henry Ford Health System in Detroit in December when a surge occurred there.

We celebrate nurses now. We call them heroes. But if we value their sacrifices and want them to be there when we need them, we must prevent a return to the poor prepandemic working conditions that led to high nurse burnout and turnover rates even before Covid.

As a nurse with extensive clinical experience in hospitals, I found it nearly impossible to guarantee safe, effective and humane care to my patients. And so I established the world’s leading research center on nursing outcomes to understand the causes of nurse understaffing in the United States and abroad and to find solutions to the problem.

The United States has a robust supply of nurses . And there is no evidence that recruits to nursing have been deterred by Covid. To the contrary, applications to nursing schools increased during the pandemic.

Death, Through a Nurse’s Eyes

A short film offering a firsthand perspective of the brutality of the pandemic inside a covid-19 i.c.u..

I was looking through the window of a Covid I.C.U. And that’s when I realized I might see someone die. I didn’t even know who she was. But I was filled with immense grief as she edged closer to death by the hour. What I didn’t know yet was that by the time I left just two days later, at least three patients would be dead. The vaccine offers hope, but the sad truth is that the virus continues its brutal slaughter in I.C.U.s like this one in Phoenix, Ariz. The only people allowed in are health care workers. They’re overworked and underpaid in a deluged hospital. I wanted to know what it is like for them now, after a year of witnessing so much death. Eager to show us their daily reality, two nurses wore cameras so that for the first time we could see the I.C.U. through their eyes. “Unless you’re actually in there, you have no idea. Nobody can ever even imagine what goes on in there.” [MUSIC PLAYING] This I.C.U. contains 11 of the hospital’s sickest Covid patients. Most of them are in their 40s and 50s. And they are all on death’s door. It’s an incredibly depressing place. I blurred the patients faces to protect their privacy. But I also worried that blurring would rob them of their humanity. The family of this patient, the one who is rapidly declining, allowed her face to be shown. And they readily told me about her. Her name is Ana Maria Aragon. She’s a school administrator and a 65-year-old grandmother. Sara Reynolds, the nurse in charge of this I.C.U., organized a video call with Ana’s family to give them a chance to be with her just in case she didn’t make it. “It just breaks my heart when I hear families saying goodbye.” You might expect the doctors to be running the show. But it is really the nurses who are providing the vast majority of the care. “We do everything. We give them baths every night.” “Rubbing lotion on their feet.” “Shave the guys’ faces.” “Cleaning somebody up that had a bowel movement. It doesn’t even register as something gross.” “Look, I walk into the room. I say, hey, sounds like you have Covid. And I might order a chest X-ray. I might order blood work. I might order catheters. All that stuff is done by the nurse. I may have spent 10 minutes. The nurse might spend seven or eight hours actually in the room, caring for them. Let’s say there was a day that nurses didn’t come to the hospital. It’s like, why are you even opening?” “Ibuprofen.” 12-hour-plus shifts, isolated in this windowless room, these nurses survive by taking care of each other. “Aww, thank you.” And by finding small doses of levity. [MUSIC - JAMES BAY, “LET IT GO”] “(SINGING) Wrong. Breeze.” “I’m getting older now, and there’s all these new young nurses coming out. And I feel like a mom to all of them. Morgan, she’s got big aspirations. She loves to snowboard, and she’s so smart. And Deb, Deb’s just— she’s funny.” “I tease her all the time. I can tell her to do anything, and she’ll just do it because I think she’s scared of me because I just always say, make sure you have no wrinkles in those sheets.” The patients spend most of their time on their stomachs because it makes it easier to breathe. But the nurses have to turn them often to prevent pressure sores. There was one woman in her 50s who was so critical that this simple procedure risked killing her. “Even just turning them on their side, their blood pressure will drop. Their oxygen levels will drop.” “Her heart had actually stopped the day before. And so the concern was if it was going to make her heart stop again.” “Then come over. Push.” “We were all watching the monitors.” “I felt relieved like, whew, we did it.” Arizona’s a notoriously anti-mask state. And it faced a huge post-holiday surge in Covid cases. In January, the month I was there, Arizona had the highest rate of Covid in the world. As a result, I.C.U.s like this one have too many patients and not enough nurses. “Because they’re so critical, they need continuous monitoring, sometimes just one nurse to one patient with normally what we have is two patients to one nurse. But there definitely are times when we’re super stretched and have to have a three-to-one assignment.” A nurse shortage has plagued hospitals over the past year. To help, traveler nurses have had to fly into hotspots. Others have been forced out of retirement. Especially strained are poorer hospitals like Valleywise, which serves a low-income, predominantly Latino community. “Many of our patients are uninsured. Some of them have Medicaid, which pays something but unfortunately not enough.” This means they simply can’t compete with wealthier hospitals for nurses. “There is a bidding war. The average nurse here, give or take, makes about $35 an hour. Other hospitals, a short mile or two away, might pay them $100.” “We lost a lot of staff because they took the travel contracts. How can you blame them? It’s sometimes a once-in-a-lifetime opportunity to make a lot of money.” “Every single day I’m off, I get a call or a text. ‘Hey, we desperately need help. We need nurses. Can you come in?’” This nursing shortage isn’t just about numbers. “Physically it’s exhausting. We’re just running. We don’t have time to eat or drink or use the restroom.” “They have kids at home, doing online school. And I think, gosh, they haven’t even been able to check on their kids to see how they’re doing.” “My days off, I spend sleeping half the day because you’re exhausted. And eating because we don’t get to eat here often.” Nurses have been proud to be ranked the most trusted profession in America for nearly two decades. But during Covid, many worry they aren’t able to uphold the standards that earned them such respect. “I can’t give the quality of care that I normally would give.” “It’s absolutely dangerous.” “That’s demoralizing because we care. We’re nurses. It’s our DNA.” Ana had been in the hospital for over a month. Her family told me she was born in Mexico. She came to the States 34 years ago, first working in the fields before eventually landing her dream job in education. She’s beloved at her school. Former students often stop her in town and excitedly shout, Miss Anita. She was very cautious about Covid. She demanded her family always wear a mask and yelled at them to stay home. Yet, tragically, she somehow still caught it. “She had been declining over the course of several days. It’s a picture we have seen far too often that we know, this one is going to be coming soon.” Because there is no cure for Covid, the staff can only do so much. Once all the ventilator settings and the medications are maxed out, keeping a patient alive will only do more harm than good. So Ana’s family was forced to make a tough decision. “And I talked to family and let them know that we have offered her, we have given, we have done everything that we can, there’s nothing more that we can do. The family made the decision to move to comfort care.” “If I’m there while someone’s passing, I always hold their hand. I don’t want somebody to die alone. That’s something that brings me peace.” “Thank you.” “Thank you.” “Dance floor is packed. People hugging, holding hands, and almost no one wearing a face mask.” “I think like many health care workers, I’m angry a lot. And my faith in humanity has dwindled.” “How can you think this isn’t a real thing? How can you think that it’s not a big deal?” “Free your face. Free your face.” Arizona Gov. Doug Ducey has advocated for personal responsibility over mask mandates even though he’s been photographed maskless at a gathering and his son posted a video of a crowded dance party. “Even on the outside, they go, I don’t care. I’m not wearing a mask. I’m not getting the vaccine. That’s bullshit. The second they come into the hospital, they want to be saved. Never do they say, ‘I made the decision. I’m accepting this. Don’t do anything, doctor.’” Half a million people in this country have died from Covid. Many have been in I.C.U.s with nurses, not family members holding patients’ hands. “I always wonder, are they still going to be there when I get to work? It’s on my mind when I get home. Are they going to make it through the night? There’s one that I can think of right now.” One patient in his late 50s was so critical that he required constant supervision. Each of his breaths looked painful. “There was one day that he was kind of— he was looking a little bit better. And so he was able to shake his head and smile. And we set up a video call for him. And it was just the sweetest thing ever. I could hear his little grandson— he was probably 4 years old or so. And I saw him on the screen, too. And he was just jumping up and down, so excited. ‘You’re doing it, Grandpa. You’re doing it. We love you. Look at you. You’re getting better.’ It just broke my heart. It broke my heart. He’s one that I don’t think is going to be there when I get back on Sunday.” But I’d already been told something Sara hadn’t. The patient’s family had decided to take him off life support. “Yesterday they did? Oh. And I just think of his little grandson. And ‘you’re doing it, Grandpa. You’re doing it.’” He wasn’t the only patient who didn’t make it. When I went back to the hospital, I noticed that the bed of the patient I’d seen get flipped over was empty. My heart sank. I knew this meant she’d passed away. “What’s sad is when I go back, those beds will be full. They’ll have somebody else there just as sick with another long stretch of a few weeks ahead of them before it’s time for their family to make that decision.” I’d never before seen someone die. And even though I didn’t know these people, witnessing their deaths left me sleepless, exhausted, and depressed. It’s unfathomable to me that these nurses have gone through that every single week, sometimes every single day for an entire year. I assumed the nurses must block out all the deaths to be able to keep going, but they don’t. They grieve every single one. “I’ve always loved being a nurse. It’s what I’ve always wanted to do. And these last couple months, it’s definitely made me question my career choice.” And what makes their situation so tragic is that many of these nurses hide their trauma, leaving them feeling isolated and alone. “We’re the only ones that know what we’re going through. I don’t really want to tell my family about everything because I don’t want them to feel the same emotions that I feel. I don’t want them to know that I carry that burden when it— that it is a lot. I’m Mom. I’m strong. I can do anything. And I don’t want them to see that.” Leadership in the pandemic hasn’t come from elected officials or spiritual guides but from a group that is underpaid, overworked and considered secondary, even in their own workplaces. As so many others have dropped the ball, nurses have worked tirelessly out of the spotlight to save lives, often showing more concern for their patients than for themselves. I worry their trauma will persist long after we re-emerge from hibernation. Covid’s legacy will include a mass PTSD on a scale not felt since World War II. This burden should not be ignored. “Thank you. Thank you. I feel, yeah. And you’re all amazing.” [MUSIC PLAYING]

Video player loading

Nevertheless, we find ourselves too often with a shortage of nursing care. Many decades of research reveal two major reasons: First, poor working conditions, including not enough permanent employer-funded positions for nurses in hospitals, nursing homes and schools. And second, the failure of states to enact policies that establish and enforce safe nurse staffing; enable nurses to practice where they are needed, which is often across state borders; and modernize nurse licensing rules so that nurses can use their full education and expertise.

Training more nurses cannot solve these problems. But more responsible management practices in health care, along with better state policies, could.

Not only are states not requiring safe nurse staffing, but individuals also do not have the information and tools they need to pick hospitals and nursing homes based on nurse staffing or to advocate better staffing at their hospitals and nursing homes.

Ninety percent of the public in a recent Harris Poll agreed that hospitals and nursing homes should be required to meet safe nurse staffing standards. But powerful industry stakeholders — such as hospital and nursing home organizations and, often, medical societies — are strongly opposed and usually defeat legislation.

The New York State Legislature is the first in the postpandemic era to fail to approve proposed safe nurse staffing standards for hospitals. The legislature passed a bill that did not require safe nursing ratios, opting instead for internal committees at hospitals to oversee nursing and patient safety. This happened despite compelling evidence that the legislation would have resulted in more than 4,370 fewer deaths and saved more than $720 million over a two-year study period through shorter hospital stays.

What are the solutions? While there are some actions the federal government could take, the states have most of the power because of their licensing authority over occupations and facilities. The hospital and nursing home industries have long failed to police their members to remove the risk of nurse understaffing. So states should set meaningful safe nurse staffing standards, following the example of California, where hospital nurses cannot care for more than five adult patients at a time outside of intensive care. State policies are tremendously influential in health care delivery and deserve greater public attention and advocacy, as they are also ripe for exploitation by special interests.

In states with restrictive nurse licensing rules, many governors used their emergency powers during Covid surges to waive restrictions. If they were not needed during a national medical emergency, why are they needed at all?

Still, the federal government has a role to play: It should require hospitals to report patient-to-nurse staffing ratios on the Medicare Hospital Compare website, because transparency motivates improvement. The federal government could incentivize the states to pass model nurse practice acts.

We need influential champions taking on special interests so that states will make policy changes that are in the public’s interest. AARP is using its clout to advocate nurse-friendly policies. But health insurers and companies such as CVS, Walgreens and Walmart that provide health care have been on the sidelines.

While we long to go back to pre-Covid life, returning to chronic nurse understaffing in hospitals, nursing homes and schools would be a big mistake. We owe nurses and ourselves better health care resources. The so-called nurse shortage has become an excuse for not doing more to make health care safe, effective and patient-centered. State legislators must do their job. Health care leaders must fund enough positions for nurses and create reasonable working conditions so that nurses will be there to care for us all.

Linda H. Aiken is a professor of nursing and sociology and the founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

Follow The New York Times Opinion section on Facebook , Twitter (@NYTopinion) and Instagram .

An earlier version of this article misstated the status of legislation on nurse staffing standards in New York State. The bill passed without setting minimum nursing ratios; it did not fail to pass.

How we handle corrections

essay about nursing home

How to Write a Nursing Essay with a Quick Guide

essay about nursing home

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

How to Start a Nursing Essay

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

How to Structure a Nursing Essay

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :


  • Opening Hook: Share a brief, impactful patient care scenario.
  • Relevance Statement: Explain why the chosen topic is crucial in nursing.
  • Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

  • Definition: Clarify what patient-centered care means in nursing.
  • Personal Experience: Share a relevant encounter from clinical practice.
  • Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

  • Scenario Presentation: Describe a specific ethical challenge faced by nurses.
  • Decision-Making Process: Outline steps taken to address the dilemma.
  • Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

  • Current Trends: Highlight technological advancements in nursing.
  • Case Study: Share an example of technology enhancing patient care.
  • Challenges and Benefits: Discuss the pros and cons of technology in nursing.
  • Summary of Key Points: Recap the main ideas from each section.
  • Real-world Implications: Emphasize the practical significance in nursing practice.
  • Closing Thought: End with a reflective statement or call to action.

A+ in Nursing Essays Await You!

Ready to excel? Let us guide you. Click now for professional nursing essay writing assistance.

Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Writing a Nursing Essay: Essential Tips

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Writing a Nursing Essay: Essential Tips

Connect with Personal Experiences:

  • Approach: Weave personal encounters seamlessly into your narrative.
  • Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

  • Approach: Go beyond describing situations; delve into their analysis.
  • Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

  • Approach: Integrate patient stories or feedback into your discussion.
  • Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

  • Approach: Support your arguments with the latest evidence-based literature.
  • Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

  • Approach: Explicitly discuss the ethical dimensions of your topic.
  • Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

  • Approach: Connect theoretical concepts to real-world applications.
  • Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

  • Approach: Discuss collaborative efforts with other healthcare professionals.
  • Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

  • Approach: Conclude with a thoughtful reflection on personal growth or lessons from your exploration.
  • Reasoning: This not only provides a satisfying conclusion but also demonstrates your self-awareness and commitment to continuous improvement as a nursing professional.

As we wrap up, think of your essay as a story about your journey into nursing. It's not just about getting a grade; it's a way to share what you've been through and why you want to be a nurse.

Imagine the person reading it – maybe a teacher, a future coworker, or someone starting their nursing journey. They're trying to understand your passion and why you care about nursing.

So, when you write, remember it's more than just an assignment. It's your chance to show why nursing matters to you. And if you ever need help – there's always support from our essay writer online .

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How to Write a Nursing Essay?

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Nurses play a vital role in the caring for our loved ones. They have tight schedules and are in various healthcare facilities. Today, nurses are involved in more challenging roles than what they were doing in the past as some of the work they are now doing, initially, was reserved for the physicians and the doctors as more areas introduced in the field of nursing than what it used to be in the past. As more medical research and advances continue, so is the growth of new specialties such as labor, psychiatry, pediatric that are being introduced by many nursing institutions ensuring that the students have the right skillsets after finishing their learning.

Nurses are care parents in most facilities as their individual responsibilities are the first vital skill they possess. Many of them come from different patients suffering from serious health problems. Juggling one’s emotions and the physical pressures to care and treat patients are some but of the few responsibilities, they should have.

So, why are most of them in most residential homes? Nursing homes are vital to the elderly community as they provide 24 hrs 7 days a week nursing care to the elderly. These homes also provide short-term stays for people with illnesses or injuries, those coming out of surgery, others who require therapy be it physical or occupational.

Nursing Homes

Nursing homes started as early as the 17th Century. At that time, they were known as poorhouses or almshouses, which first came into existence in the US after the first English settlers, settled in their country. The poorhouses housed the poor elderly, mentally ill people and the orphans since they offered them a place to have shelter and daily meals.

For one to offer care to these homes, they require a nurse who is registered and must be present in the residential area for daily assessment of the patient’s health. Their job description involves the administering of medications, writing and implementing care plans and monitoring any medical changes that are visible and take the necessary steps.

Becoming a registered nurse requires one to complete nursing programs laid by their institutions and pass. Licensed practical nurses had to complete a state-approved the program and pass the national licensing examination for them to begin working in these facilities.

Also Read: Nursing Personal Statement Writing Service

There reaches a time where care is vital to the elderly. Most of them require assistance with daily activities which some may be tough or too much for them. The aged usually have bad or negative thoughts towards nursing homes but looking at the positive side, it does make more sense to offer health and safety to them an activity you may not be able to cope up. Therefore, what are the advantages of nursing homes?

Benefits of a Nursing Home

1. These facilities have expert trained staffs who are mostly nurses who offer great medical healthcare that is 24-hours a day. Nurses here are of various specialties i.e. Dieticians, Nutritionists etc. Who ensure proper health and nutrition given to the patient.

2. These homes offer social activities and community care to patients making them feel at home.

3. All homes registered with the state often require evaluation and reports sent to Medicare. It ensures that the facilities offer exceptional health and guidance to the elderly and that they run in the best possible manner.

4. A lot of demands that most of these patients require to seem costly, therefore, it will reduce the workload as some of the people may not have the time and resources needed for the great caring of the patients.

The average ages for many patients found in the facilities are between the ages of sixty and above. Although nursing homes are good, not all people are able to afford the payments required for their loved ones. Some of the institutions also find it difficult to obtain a license from the state as some of the standards cannot be easily met.

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Nursing Essay Examples

Cathy A.

Nursing Essay Examples That Will Help You Write a Stellar Paper

Published on: May 6, 2023

Last updated on: Jan 29, 2024

nursing essay examples

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Many nursing students struggle with writing effective nursing essays, which are an essential part of their education and professional development.

Poor essay writing skills can lead to low grades and an inability to effectively communicate important information.

This blog provides a comprehensive guide to writing nursing essays with examples and tips for effective writing. Whether you are a nursing student or a professional looking to improve your writing skills, this blog has something for you. 

By following the tips and examples provided, you can write compelling nursing essays that showcase your dedication to the field.

Let’s get started.

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What is a Nursing Essay?

A nursing essay is a type of academic writing that aims to explore a particular topic related to nursing. It also presents a clear and concise argument or viewpoint supported by evidence. 

Nursing essays can take many forms, including:

  • Descriptive essays
  • Reflective essays
  • Analytical essays
  • Persuasive essays

What is the Importance of the Nursing Essay?

Nursing essays are important for several reasons. First, they help nursing students develop critical thinking skills by requiring them to analyze and evaluate information.

Second, they help students develop research skills by requiring them to locate and use credible sources to support their arguments. 

Third, nursing essays help students develop communication skills by requiring them to present their ideas clearly and concisely in writing. Finally, nursing essays are important for nursing education because they prepare students for the types of writing.

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To help students better understand how to write nursing essays, it can be helpful to review examples.

Below are some examples of nursing essays.

Nursing School Essay Examples

College Nursing Essay Examples

Graduate Nursing Essay Examples

Nursing Scholarship Essay Examples

Nursing Essay Conclusion Examples

Nursing Essay Examples of Different Fields

Nursing is a diverse field with many different specialties and areas of focus. As a result, nursing essays can take many different forms and cover a wide range of topics. 

Given below are some examples of different types of nursing essays:

Personal Philosophy Of Nursing - Essay Examples

Cal State Fullerton Nursing Essay Examples

Evidence Based Practice Nursing In Medical Field - Essay Examples

Leadership In Nursing And Healthcare Professionals - Essay Examples

Principles Of Professional Practice Of Nursing Professionals And Pharmacists

If you're seeking additional examples of nursing essays, you're in luck! 

Below are some more examples that can help you gain a better understanding of nursing essays:

Health Care And Reflective Models For Nursing - Essay Examples

History Of Nursing Essay Examples

Ethical Dilemma In Nurses Work - Essay Examples

Mental Health Nursing Essay Examples

Why I Want To Be A Nurse Essay

Working In A Team And Collaboration In Nursing

How to Write a Nursing Essay

Writing a nursing essay can seem daunting, but with the right approach, it can be a rewarding experience.

Here are the key steps involved in writing a nursing essay:

Understanding the Topic and Question

The first step in writing a nursing essay is to carefully read and understand the topic and question. 

This will help you determine what information you need to research and include in your essay. Make sure you understand any key terms or concepts related to the topic. Consider different perspectives or viewpoints that may be relevant.

Researching the Topic

Once you have a clear understanding of the topic and question, it's time to research. 

Start by gathering information from credible sources such as academic journals, textbooks, and government websites. 

Consider both primary and secondary sources, and make sure to take detailed notes as you read.

Organizing and Outlining the Essay

Once you have completed your research, it's time to organize your ideas and create an outline for your essay. 

Start by identifying the main points or arguments you want to make, and then organize them into a logical order that flows well. 

Your outline should include an introduction, body paragraphs, and a conclusion.

Writing the Essay

With your outline in place, it's time to start writing your essay. Make sure to follow your outline closely, and use clear and concise language that effectively communicates your ideas. 

Use evidence from your research to support your arguments, and cite your sources appropriately.

Editing and Revising the Essay

Once you have completed a first draft of your essay, take some time to edit and revise it. Look for any errors in grammar, spelling, or punctuation, and make sure your essay is well-organized and flows well. 

Consider asking a peer or instructor to review your essay and provide feedback.

What To Include In Your Nursing Essay

When writing a nursing essay, there are several key elements that you should include. Here are some important things to keep in mind:

  • Introduction

Your introduction should provide a brief overview of the topic and purpose of your essay. It should also include a clear thesis statement that presents your main argument or point of view.

  • Background Information

Provide some background information on the topic to help the reader better understand the context of your essay. This can include relevant statistics, historical information, or other contextual details.

  • Evidence and Examples

Use evidence and examples from your research to support your arguments and demonstrate your knowledge of the topic. Make sure to cite your sources appropriately and use a variety of sources to strengthen your argument.

  • Analysis and Evaluation

Provide analysis and evaluation of the evidence and examples you've presented. This can include discussing strengths and weaknesses, comparing and contrasting different viewpoints, or offering your own perspective on the topic.

Your conclusion should summarize the main points of your essay and restate your thesis statement. It should also offer some final thoughts or suggestions for further research or action.

Nursing Essay Topic Ideas

Choosing a topic for your nursing essay can be challenging, but there are many areas in the field that you can explore. Here are some nursing essay topic ideas to consider:

  • The role of technology in nursing practice
  • The impact of cultural diversity on healthcare delivery
  • Nursing leadership and management in healthcare organizations
  • Ethical issues in nursing practice
  • The importance of patient-centered care in nursing practice
  • The impact of evidence-based practice on nursing care
  • The role of nursing in promoting public health
  • Nursing education and the importance of lifelong learning
  • The impact of nursing shortages on healthcare delivery
  • The importance of communication in nursing practice

These are just a few ideas to get you started. You can also explore other topics related to nursing that interest you or align with your academic or professional goals. 

Remember to choose a topic that is relevant, interesting, and feasible to research and write about.

Tips for Writing an Effective Nursing Essay

Writing a successful nursing essay requires careful planning, research, and attention to detail. Here are some tips to help you write an effective nursing essay:

  • Writing Concisely and Clearly

Nursing essays should be written in clear and concise language, avoiding unnecessary jargon or technical terms. Use simple language and short sentences to help ensure that your ideas are communicated clearly and effectively.

  • Stating a Clear Thesis Statement

Your thesis statement should clearly state your main argument and provide a roadmap for the rest of your essay. It should be clear, concise, and located at the end of your introduction.

  • Using Proper Citation and Referencing

Citing and referencing your sources is crucial in any academic writing, including nursing essays. Make sure to use proper citation and referencing styles, such as APA or MLA. Include a reference list or bibliography at the end of your essay.

  • Seeking Feedback and Revising

Before submitting your nursing essay, seek feedback from peers, professors, or writing tutors. Use their feedback to revise and improve your essay. Make sure that it is well-structured, coherent, and effectively communicates your point of view.

By following these tips, you can write a nursing essay that demonstrates your knowledge and skills in the field.

In conclusion, writing a successful nursing essay requires careful planning, research, and attention to detail. 

To showcase your knowledge in the field of nursing, it is important to have a clear understanding of the topic at hand. When writing your nursing essay, be sure to include relevant examples, incorporate current research, and use proper citation and referencing. 

And remember , seeking feedback and revising your essay is key to ensuring that it effectively communicates your ideas and arguments.

If you need help with your nursing essay or any other type of academic writing, consider using our AI essay writer . 

Our nursing essay writing service can provide personalized support to help you succeed in your academic goals.

So, why wait? Contact us to get college essay writing help today! 

Cathy A. (Literature)

For more than five years now, Cathy has been one of our most hardworking authors on the platform. With a Masters degree in mass communication, she knows the ins and outs of professional writing. Clients often leave her glowing reviews for being an amazing writer who takes her work very seriously.

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Appropriate leadership in nursing home care: a narrative review

Nick zonneveld.

1 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

Carina Pittens

2 Vrije Universiteit, Athena Institute, Amsterdam, The Netherlands

Mirella Minkman

3 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors.


A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified.

A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care.

Research limitations/implications

Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice.

Practical implications

A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice.


Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes.

1. Background

Leadership is seen as essential for the creation of cultural and structural change within organizations and the delivery of good quality nursing home care ( Anderson et al. , 2005 ; Martin and Learmonth, 2012 ). Various studies confirm that leadership affects e.g. business management, information flows, health-related quality indicators, long-term vision, organizational structure, organizational culture, work environment and quality of care in nursing homes ( Anderson et al. , 2005 ; Castle and Decker, 2011 ; Cummings et al. , 2010 ; Jeon et al. , 2015 ). Therefore, more insight is needed into how leadership should look to contribute to organizational and cultural change in nursing home care.

Leadership can be defined as “a process whereby individual influences a group of individuals to achieve a common goal” ( Hunt, 2004 , p. 3). Based on a review of leadership literature, Hunt (2004) distinguishes four common features of leadership. Leadership: is a process, involves influence, occurs in a group context and involves goal attainment. Leadership theory still divides leadership styles into two main groups: relationship-oriented leadership styles and task-oriented leadership styles. While relationship-oriented leadership focuses on individual persons and relationships, task-oriented leadership aims at the accomplishment of tasks. This division could also be interpreted as transformational leadership and transactional leadership ( Avolio et al. , 1999 ). Transformational leadership is reflected in a process, in which a leader connects with his/her followers, with the aim of increasing intrinsic motivation to enhance performance. The driving force is a shared vision. Transactional leadership is a more top-down style, focusing on transactions between the leader and followers. There are clear structures, rules and procedures and the extrinsic motivation of employees is addressed ( Avolio et al. , 1999 ). An example of transactional leadership is giving a personal reward for employees that achieve a certain goal, like a financial bonus. In our study, the two main streams of transformational and transactional leadership are used as an ordering framework, supplemented with a contingency approach category: context-dependent leadership styles. These styles assume that there is no universal leadership style and that different contexts and circumstances require different leadership styles ( Northouse, 2018 ).

Various publications have been written about leadership in nursing home care. In most of these studies relational and transformative-related leadership styles are considered to be most appropriate in a nursing home and aged care ( Anderson et al. , 2005 ; Corazzini et al. , 2015 ; Jeon et al. , 2015 ). The focus of most studies is the relationship between particular leadership styles and desired outcomes rather than understanding the behaviors and context behind them. However, as leadership is a process that takes place between people ( Hunt, 2004 ), it consists of many components and influencing factors. It could also take place at multiple places in an organization, both formally and informally. The relationship between how leadership is executed and the outcomes achieved are, therefore, not simple or linear ( Northouse, 2018 ). Therefore, more in-depth knowledge is required regarding leadership behaviors, the effects and the factors influencing them.

This study aims to provide a deeper understanding of what leadership is appropriate in nursing home care, also considering the changing context. To this end, various leadership behaviors, their effects and their influencing factors are examined by performing a narrative literature review with a systematic search.

The objective of this study is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. A narrative review with a systematic search was conducted, drawing on the principles of hermeneutic review ( Boell and Cecez-Kecmanovic, 2014 ). A hermeneutic review has two main characteristics:

  • accessing and interpreting the literature and
  • developing an argument.

The literature search is not only systematic but also flexible and iterative. As the identified literature increases, initial insights and ideas arise and less relevant literature could be rejected through progressive focus. It is argued elsewhere that a narrative review like a hermeneutic review should be the method of choice for interpreting a large and diverse set of literature in which authors have approached the topic differently ( Greenhalgh et al. , 2018 ), as is the objective of our literature review. The review was executed in three steps: definition of scope, systematic search and assessment and analysis of the literature identified. To structure these three steps, a search protocol was developed beforehand.

2.1. Step 1: Establishment of scope

Definition of the search area included the formulation of a set of inclusion criteria. Manuscripts were included if they:

  • studied leadership;
  • targeted long-term care, nursing home/facility care or elderly care and were thereby applicable to the current nursing home care context;
  • behavioral characteristics of leadership;
  • effects of leadership; and/or
  • factors influencing leadership;
  • were published between 2007 and December 2019 (because of the rapidly changing context);
  • were written in English; and
  • presented research findings of empirical work or reviews.

The search terms were developed through an iterative process in which three researchers were involved. Based on the two main elements of the study objectives – leadership and nursing home care – multiple search terms and combinations were explored in two databases (Pubmed/Medline and EBSCO).

2.2. Step 2: Systematic search

Using the terms described, systematic searches were performed in the PubMed/Medline, Cochrane, Cinahl, PsycInfo and Google Scholar databases. The snowballing technique was also applied: i.e. the reference lists of all articles included were studied to identify any additional relevant literature. After identifying all potentially relevant literature, assessment and analysis of the articles took place.

2.3. Step 3: Assessment and analysis of the literature identified

Assessment and analysis of the literature took place in three steps: the articles were screened based on the title, abstract and full-text to determine inclusion, data extraction took place and analysis was carried out on the articles that had been included.

  • Screening on the title, abstract and full-text: All titles and abstracts were screened independently by two researchers to decide whether articles met the inclusion criteria. If the two researchers assessed the article differently, a third researcher was consulted. The full-text of the selected articles was then independently assessed for eligibility by two researchers. Again, a third researcher was consulted if there was any disagreement. For this, the principles of the hermeneutic review were applied, meaning that the inclusion of articles in a later stage (for instance, full-text screening) was stricter due to progressive insights.
  • Data extraction: Two types of data were extracted from the articles. First, for each article the author(s), year of publication, journal, title, country, study design and applied methods, sector and organizational level were noted. Second, the main findings of the articles were extracted. The data extraction took place by two researchers, supervised by a third researcher. A fourth researcher was consulted if there was any disagreement.
  • Analysis: Descriptive analysis was chosen, as a large and diverse set of articles was included in which leadership was approached and studied differently. As the aim was to build an understanding of leadership, the analysis focused on interpreting the findings of the articles included. Reflection on the content analysis took place with a fourth researcher.

The systematic database search resulted in the identification of 2,332 scientific articles. After removal of duplicates, 2,031 records were screened on title and abstract, based on the formulated inclusion criteria. After this screening 76 scientific articles remained for full-text assessment. During the full-text screening, 36 papers were excluded due to the following reasons: no focus on leadership ( n  =   20), not applicable to the nursing home care context ( n  =   3), leadership only focuses on external stakeholders ( n  =   2), articles report only opinions or vision ( n  =   6), no full text available ( n =  3) and no focus on the interaction between leaders and professionals ( n  =   2). As a result of the “snowballing” technique, 3 extra scientific articles were included. This resulted in a total of 44 included articles. Figure 1 shows the PRISMA flow chart, which displays the systematic literature search process. Table 1 presents the characteristics of the articles, including an overview of study design: 17 qualitative, 16 quantitative, 4 mixed methods and 7 (systematic) reviews were included.

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PRISMA flow chart

Characteristics of the articles included

3.1. Leadership behaviors

The articles included in this review describe many sorts of leadership behaviors. In most articles, the studied set of leadership behaviors is given a name/title/term such as “partnered leadership,” “connective leadership” and “adaptive leadership.” In the articles, they are often connected to one of the main leadership styles. Descriptions of leadership behaviors identified are, therefore, distributed over three main categories: relationship-oriented leadership, task-oriented leadership and context-dependent leadership.

Especially more recent articles move away from leadership styles and focus more on behaviors essential for new developments in nursing homes. In the articles of Brodtkorb et al. (2019) and Backman et al. (2018) , important leadership characteristics were identified to support the implementation of person-centered care. Havig and Hollister (2018) focused on the interplay of independent workgroups (resembling self-organization) and appropriate supportive leadership.

3.1.1. Relationship-oriented leadership behavior.

In total, 15 different sorts of leaderships related to relationship-oriented leadership were identified in 34 articles. Transformational leadership was studied the most ( n  =   16), followed by relational leadership ( n  =   7) and the resonant, coaching, consensus and consultative autocratic behavioral styles ( n  =   3). Although “partnered leadership” ( Jennings et al. , 2011 ; Leutz et al. , 2010 ), “individualized consideration” ( Cummings et al. , 2010 ), “authentic leadership” ( Hakanson et al. , 2014 ) and “connective leadership” ( Jennings et al. , 2011 ) were also mentioned as research objectives, no outcomes regarding these behaviors were given in the articles.

When looking more closely at behaviors, the leadership types identified shows a lot of overlap. In relationship-oriented leadership behaviors identified, leaders focus on relationships, using emotional skills such as listening and empathy, to increase the involvement of employees ( Cummings et al. , 2008 ; Forbes-Thompson et al. , 2007 ; Havig et al. , 2011 ; Havig et al. , 2011 ; Jeon et al. , 2015 ). As Havig et al. (2011) describe: “relationship-oriented style constitutes the behaviors of supporting […], developing […] and recognizing” ( Havig et al. , 2011 , p. 2). Transformational leadership aims to create awareness and involvement of employees in line with the objectives of the organization ( Nielsen et al. , 2010 ).

3.1.2. Task-oriented leadership behaviors.

Task-oriented leadership behaviors were studied less extensively. Furthermore, they were often contrasted with relationship-oriented leadership behaviors. In total 9 task-oriented types of leadership were mentioned as study objectives in 9 of the articles included in the review. In most of the articles, no specific characteristics were described.

The similarity between task-oriented and transactional leadership behavior is that it is rational, concise and business-like. Task-oriented leadership deals with the management of tasks and activities (who does what, when and how), distribution of roles, objectives, monitoring and results ( Havig et al. , 2011 ; Havig et al. , 2011 ). Transactional leadership takes transactions between leaders and employees as a starting point ( Cummings et al. , 2010 ). In terms of behavior, this is reflected in rewarding and “punishing” employees. “Shareholder management” is characterized by behavior in which minimal attention is paid to the development of relationships between people ( Havig et al. , 2011 ). Employees work relatively autonomously, there is not much communication and decisions are made centrally. Autocratic leaders also make their own decision, but their employees face a relatively low amount of autonomy ( Castle and Decker, 2011 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ).

3.1.3. Context-dependent leadership behaviors.

Although the studies in this review focus predominantly on relationship-oriented leadership behaviors, the literature also recommends interpreting with caution. Various studies emphasize that leadership is a complex phenomenon that depends on situations and individuals ( Jennings et al. , 2011 ). Some of the articles conclude that a combination of leadership behaviors is needed. Havig et al. (2011) conclude that a combination of both relationship-oriented and task-oriented leadership behaviors is preferred in their study of job satisfaction in nursing homes ( Havig et al. , 2011 ). Nursing homes with a more hierarchical structure and more mutual interdependence could benefit from task-oriented leadership and vice versa. The authors conclude that leadership is context-dependent. Jennings et al. (2011) state:

The strongest statement that can be made based on empirical studies is that it is unwise to view transformational leadership as a preferred style, particularly when this style is assessed independently of other leadership styles and organizational variables ( Jennings et al. , 2011 , p. 15).

Some leadership behaviors identified in this review embrace this context-dependency and represent a combination of leadership behaviors. Lynch et al. (2011) describe the application of situational leadership to residential care. This is characterized by multiple behaviors of a leader, depending on the situation and the individual. Corazzini and colleagues focus on “adaptive leadership,” which makes a distinction between technical and adaptive challenges ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ). In this context, technical challenges refer to issues that can be easily defined and solved with the appropriate expertise or resources. Adaptive challenges, on the other hand, require new and innovative solutions which may also require a change in values or attitudes. Issues often include both technical and adaptive challenges, in which different leadership behaviors are needed ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ).

Both situational and adaptive leadership is built on the belief that appropriate leadership behaviors should be chosen based on situation and context ( Corazzini and Anderson, 2013 ; Lynch et al. , 2011 , 2018 ). Situational leaders exhibit leadership behavior, which fits with a particular situation and adapts this behavior accordingly to achieve results in a planned way. Central to adaptive leadership, which has roots in complexity theory, is the belief that there are no fixed solutions for complex issues. The behavior of adaptive leaders can, therefore, be characterized as highly flexible and adaptive, to cope with (sudden) changes and developments in complex environments ( Table 2 ).

Leadership styles and their associated characteristics and behaviors

3.2. Reported effects of leadership

In 38 articles effects of leadership were described. The effects of leadership were measured quantitatively in 15 of the articles identified. In 4 articles effects were studied using mixed-methods, in 13 articles effects were measured using qualitative methods and effects were described in 6 reviews. The described effects in the qualitative articles are less “hard” and were not taken into consideration in the table. Reported effects can be separated into five categories: the effects of leadership on:

  • quality of care;
  • quality of life;
  • person-centered care; and
  • innovation processes.

Table 3 presents the effects studied in these articles.

Reported effects of leadership

Most studies report that relationship-oriented leadership has a positive impact on employees. Relationship-oriented leadership leads to higher job satisfaction ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ; Nielsen et al. , 2010 ), a better relationship with work (for example, a higher organizational commitment) ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Lundgren et al. , 2016 ; Nielsen et al. , 2010 ), higher productivity and effectiveness ( Buljac-Samardzic and van Woerkom, 2015 ; Cummings et al. , 2010 ) and more empowerment and development opportunities ( Cummings et al. , 2014 , 2010 ; Lundgren et al. , 2016 ; Nielsen et al. , 2008 ). Among the articles is one systematic review ( Cummings et al. , 2010 ), in which 53 articles are studied. This study concludes that relationship-oriented leadership is more likely to have positive effects on employees.

In 11 of the articles, the relationship between leadership and quality of care was studied. In these articles, different effects were observed. In four articles no effects were found ( Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Four papers conclude that relationship-oriented leadership results in a higher quality of care ( Castle and Decker, 2011 ; Harvath et al. , 2008 ; McKinney et al. , 2016 ; Westerberg and Tafvelin, 2014 ), while in one article it is concluded that a combination of task-oriented and relationship-oriented leadership leads to a higher quality of care (with the emphasis on task-oriented leadership) ( Jennings et al. , 2011 ). Based on their study in Sweden, Westerberg and Tafvelin (2014) present an indirect positive relationship between transformational leadership and quality of care, via mediating variables such as organizational support, support by experienced colleagues, workload and control ( Westerberg and Tafvelin, 2014 ). In all articles quality of care is either not defined consistently or not defined at all. One article studied the impact of leadership on quality of life in the USA. McKinney et al. (2016) report that consensus leadership behavior is “associated with a lower likelihood of deficiencies for quality of life” ( McKinney et al. , 2016 , p. 230).

Furthermore, in three articles a relationship between leadership and person-centered care is described ( Backman et al. , 2016 ; Brodtkorb et al. , 2019 ; Lynch et al. , 2011 ). Backman et al. (2016) for instance conclude that there is a significant relationship between the leadership behavior (of older managers) and person-centered care and psychosocial climate. In this Swedish study, the most appropriate type of leadership and the associated behavior is not specified. Concerning the implementation of person-centered care, Backman et al. (2016) mention “Person-centered care moderates the relationship between leadership behavior” ( Backman et al. , 2016 , p. 8). The authors conclude that leadership is more important in organizations that offer less person-centered care. In these organizations, leaders need to provide direction toward a more person-centered way of working. In line with this, Brodtkorb et al. (2019) revealed: “a close connection between leadership style [participative leadership] and culture change processes toward PCC” ( Brodtkorb et al. , 2019 , p. 134).

On the other hand, a number of studies present contrasting findings or caveats (weak or even no evidence) with respect to the positive effects of relationship-oriented leadership ( Harvath et al. , 2008 ; Havig et al. , 2011 ; Jennings et al. , 2011 ; Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ). In a Norwegian study, Havig et al. (2011) report that task-oriented leadership has a more significant impact on the job satisfaction of employees. Also, Jennings et al. (2011) conclude that there is little empirical evidence to relate impacts to certain leadership because leadership is multidimensional and complex: leaders use combinations of leadership behaviors and styles in practice. Olinger (2010) found no statistical significance for nursing home administrator and nursing director leadership styles on care quality.

3.3. Factors influencing leadership

Out of all articles included in this review, 22 articles describe factors that could influence leadership. The influencing factors were identified at three levels: the leader, the team(s) and the organization. Table 4 presents these factors.

Factors influencing leadership

A number of influencing factors – found in seven articles – can be related to the leader him/herself: personal characteristics of the leader ( Cummings et al. , 2008 , 2014 ; Nielsen and Cleal, 2011 ), leadership competencies ( Cummings et al. , 2008 ), educational activities ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ) and distance to practice ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). The systematic review by Cummings et al. (2008) provides particular insight into the influence of these factors on relational leadership. Cummings et al. state that the personal characteristics of effective leaders relate to openness, extraversion and management motivation. “Significant positive relationships were reported between the leaders’ motivation and their leadership behaviors.” ( Cummings et al. , 2008 , p. 244). Education of leaders, both in relation to professional knowledge and to leadership skills, is mentioned as a positive influencing factor in three articles ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ). In a Swedish case study, Hakanson et al. (2014) found that leaders identify their own shortcomings and needs for personal development by following educational activities. The specific content of the different educational activities or programs were not described in the articles. A distance to practice was found to be a constraining factor ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). As illustrated by Havig and Hollister (2018) :

They also spent less time at the ward and did not have the same knowledge about their employees’ work situation as the leaders in the high-quality wards. The result of this lack of leadership was often poor work environments, with interpersonal conflicts and frustration, which distracted the care workers and turned their focus away from their daily work duties and the residents ( Havig and Hollister, 2018 , p. 379).

Ten studies showed that team-related factors could influence leadership:

  • turnover and absence ( Cloutier et al. , 2016 ; Havig et al. , 2011 );
  • interpersonal relations ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 );
  • workload ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 );
  • willingness to be coached ( Cummings et al. , 2014 ; Havig et al. , 2011 );
  • employee well-being and satisfaction ( Cummings et al. , 2014 ; Nielsen et al. , 2008 );
  • self-efficacy ( Nielsen et al. , 2009 ; Nielsen and Munir, 2009 ); and
  • interdependent workgroups ( Havig and Hollister, 2018 ).

Two articles relate a high turnover and/or absence rate of employees to less effective leadership ( Cloutier et al. , 2016 ; Havig et al. , 2011 ). In a Western Canadian case study, Cloutier et al. (2016) report that “With greater staff mobility and change, the leadership had less knowledge of their staff to mobilize existing skill sets, use the expertise and build cohesion” ( Cloutier et al. , 2016 , p. 12). Close interpersonal relations – staff/staff, leader/staff and staff/resident – were found to be positively related to leadership ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 ). In turn, a high workload was negatively related ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 ). Also, the (un)willingness of teams to be coached was mentioned as an influencing factor ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Cummings et al. illustrate this as follows:

“Some managers reported out that some of their staff have little interest in learning new things and updating their skills and knowledge,” as per the following quote: “They just want to do their job and go home.” […] A manager, who considered coaching uninterested staff to be undesirable, reported: “Not wanting to rock the boat (don’t have time to risk losing that staff)” ( Cummings et al. , 2014 , p. 205).

Furthermore, employee well-being and satisfaction were stated as potential influencers of leadership. Although there is limited evidence of the direct relationship between leadership behavior and well-being ( Nielsen et al. , 2008 ), two articles mention that a higher level of job satisfaction corresponds to more effective leadership ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Finally, Havig and Hollister (2018) found that independent workgroups (or teams) of caregivers, which had their own meetings, reports and administrator, could have a possible influence on nursing home quality. Their analysis revealed that workgroups were fostered by three mediators, namely, psychological ownership, perceived insider status and shared mental models.

In total, 20 articles described factors that influence leadership at an organizational level. The following factors were identified in this category:

  • organizational structure ( Corazzini et al. , 2015 ; Cummings et al. , 2008 , 2014 ; Lundgren et al. , 2016 ; Rokstad et al. , 2015 );
  • the extent to which person-centered care has been implemented ( Backman et al. , 2016 , 2020 );
  • organizational culture ( Ali and Terry, 2017 ; Backman et al. , 2020 ; Corazzini et al. , 2015 ; Havig and Hollister, 2018 ; Jeon et al. , 2010 ; Nielsen et al. , 2008 ; Vesterinen et al. , 2009 );
  • the available information and information flow ( Forbes-Thompson et al. , 2007 ; Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Vesterinen et al. , 2009 );
  • previous leaders ( Vesterinen et al. , 2009 );
  • available budget and time ( Ali and Terry, 2017 ; Cummings et al. , 2014 ; Hakanson et al. , 2014 ; Nielsen et al. , 2010 ; Rokstad et al. , 2015 );
  • tasks and responsibilities ( Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Kristiansen et al. , 2016 ; Nielsen et al. , 2008 );
  • the leadership team ( Hakanson et al. , 2014 ; Vesterinen et al. , 2009 );
  • organizational dynamics and stability ( Jeon et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 );
  • support from superiors ( Jeon et al. , 2010 ; Westerberg and Tafvelin, 2014 ); and
  • openness to change and innovations ( Brodtkorb et al. , 2019 ; Jeon et al. , 2010 ; Lynch et al. , 2011 ; Nielsen et al. , 2008 ).

First, the structure of an organization was found to influence the way in which leadership is performed. In bigger organizations, for instance, there is often more distance between managers and the work floor than in smaller organizations and this creates challenges to performing direct, relational leadership ( Lundgren et al. , 2016 ; Rokstad et al. , 2015 ). As Lundgren et al. state:

Physical distance between leaders and subordinates reduces the opportunity for leaders to supervise, organize and optimize nursing assistants’ work situations, which may have negative effects in the field of home help services ( Lundgren et al. , 2016 , p. 51).

In a Finnish qualitative study, Vesterinen et al. (2009) report that organizational culture and information available for employees influence leadership:

The managers said that their leadership style was influenced by the flow of information in the organization. It was difficult to lead others toward a vision when there was a lack of information ( Vesterinen et al. , 2009 , p. 508).

Other influencing factors include tasks and responsibilities of leaders ( Hakanson et al. , 2014 ; Kristiansen et al. , 2016 ) and available budget and time. Although they emphasize that leadership depends on situations and people, Nielsen and Cleal (2011) relate a stable organization (low staff turnover, financially stable, no reorganizations) positively to (transformational) leadership.

4. Discussion

As a result of analysis of the academic literature currently available, the findings of this study provide insight into leadership behaviors, their effects and factors influencing them. When looking into what kind of leadership is considered appropriate in the nursing home care context, also considering its current developments, our analysis does not provide an unambiguous answer. Our review shows that leadership in nursing home care is a complex and multidimensional undertaking, influenced by multiple internal and external factors. On the one hand, there is a tendency toward relationship-oriented and transformational leadership in particular. Our search identified 15 different sorts of leadership related to relational leadership with many reported positive effects on health-care professionals, quality of care, quality of life and person-centered care. However, a diversity of measures was used, with a variety in quality. Both quantitatively and qualitatively observed effects were considered. On the other hand, contrasting findings have also been reported, for example, both positive and negative effects on job satisfaction associated with task-oriented leadership ( Cummings et al. , 2010 ; Havig et al. , 2011 ). Also, various studies emphasized that “good” leadership cannot be achieved by applying only one type of leadership behavior. Both relationship-oriented and task-oriented leadership have resulted in positive effects, as demonstrated by the evaluation of job satisfaction in nursing homes ( Havig et al. , 2011 ). Furthermore, as a broad scope was used to comprehensively identify insights applicable in nursing home care, the studies compared in this review were carried out in different contexts (for example, nursing homes, long-term care, facility care, etc.) in different countries using different methodologies. For example, in the studies included in which a relationship between leadership and quality of care was reported, different definitions of quality of care were used and there was no differentiation between specific aspects of quality of care ( Castle and Decker, 2011 ; Havig et al. , 2011 ; Marotta, 2010 ; McKinney et al. , 2016 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Therefore, it is also difficult to interpret and compare the results of these studies. This makes it hard to draw any meaningful conclusions about the effects of certain leadership. Another complicating factor in the identification of appropriate leadership is that leadership is a product of multiple influencing factors. Our review identified 22 influencing factors at the individual, team and organizational levels. This shows that leadership in nursing home care is not only complex and multidimensional but may also be influenced by internal and external factors. As a consequence, when looking for appropriate leadership, the answer does not lie in one type of leadership.

This observation is also reflected in some of the articles included in the review. Although a relationship-oriented style was the basis for investigation in most of the studies analyzed, some of them report that certain contexts and situations demand more task-oriented behaviors. Furthermore, literature also shows that the combination of both styles may be appropriate. A balanced mix of leadership styles, for instance, a relationship-oriented focus combined with task-oriented behaviors, is also advocated in other sectors outside nursing home care. Mintzberg (2009) , for example, cites the broad variety of leadership styles in the literature and emphasizes that the application of one style may lead to management that is not in balance ( Mintzberg, 2009 ). Furthermore, in their study on leadership patterns and their effects on employee satisfaction and commitment, Gavan O’Shea et al. (2009) conclude that effective leaders use a combination of styles ( Gavan O’Shea et al. , 2009 ). This was also the conclusion reached by Aarons (2006) specifically with respect to the mental health sector ( Aarons, 2006 ).

While our analysis shows a tendency in favor of combinations of elements from different types of leadership to deal with different situations and contexts, many included studies explore relationships between relational and task-oriented leadership only in a bivariate way. As Cummings et al. (2010) conclude:

In our analyzes, we had simplified the pattern of two approaches to leadership styles and their impact on specific outcomes for nurses, the nursing environment and the nursing workforce. In reality, leadership practices, behaviors and styles and outcomes are not that clean-cut ( Cummings et al. , 2010 , p. 17).

This awareness demonstrates that a greater focus on leadership behaviors in relation to contextual factors rather than leadership styles could provide more valuable insight into appropriate leadership in nursing home care. In most of the literature reviewed, however, leadership behavior is not described or explained precisely. Fortunately, more recent literature is moving away from studying solely leadership styles and is focusing more on appropriate leadership behavior for new developments, like the implementation of Dementia Care Mapping and person-centered care ( Backman et al. , 2020 ; Lynch et al. , 2018 ; Quasdorf and Bartholomeyczik, 2019 ).

Another point worthy of reflection is that the results of our study show a broad variety of leadership terms, styles and names and a large degree of overlap between their characteristics. This is especially the case in the field of relationship-oriented leadership. It is debatable whether these different definitions of leadership really encompass different behaviors or only use different terminology.

Considering that a focus on leadership behaviors could provide more insight into effective leadership in nursing home care, it is interesting to ask what leadership behaviors will be appropriate with respect to the current developments in nursing home care. First of all, the nursing home care sector could be considered as a complex adaptive system (CAS), in which the connected elements of the system evolve and adapt continuously ( Meadows, 2008 ). The current developments, with tendencies toward decentralization, self-organization and person-centered care, are examples of this evolving and adapting system. While the nursing home care sector consists of many different entities and a high level of interactivity, nursing homes can also be considered as systems in which organizational dynamics take place ( Ashmos et al. , 2000 ). The consequence of leadership behavior is that it is important to be aware that employees are part of a complex system, both in the organization and in the health system as a whole. As complexity scientists ( Lichtenstein et al. , 2006 ) reflect: “leadership is a dynamic that transcends the capabilities of individuals alone; it is the product of interaction, tension and exchange rules governing changes in perceptions and understanding.” ( Lichtenstein et al. , 2006 , p. 2). In this complex environment, it is important to reflect continuously and analyze the suitability of leadership behaviors in different contexts and situations. Corazzini et al. (2015) elaborate on this in their study about adaptive leadership and they conclude that problems in nursing homes are mostly complex and cannot be solved by one type of leader.

Furthermore, current developments toward flat organizations, decentralization and self-direction, show a tendency toward more collective responsibility and ownership at all layers of organizations. Most papers included in this review addressed a specific organizational level. A number of studies focus on leadership in middle management ( Buljac-Samardzic and van Woerkom, 2015 ; Corazzini and Anderson, 2013 ; Hakanson et al. , 2014 ; Leutz et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 ; Oldenhof et al. , 2016 ; Vesterinen et al. , 2009 ) and only one article is specifically taking independent workgroups (teams) into account ( Havig and Hollister, 2018 ). Other articles cover board/management level and some do not focus on a specific organizational level. In the light of current developments in nursing home care, taking new organizational structures with decentralized collective responsibilities such as self-directed teams, into account, a focus on leadership across multiple layers of nursing homes would provide more detailed insights into leadership behaviors and the complex interaction between people and situations. It is striking that the current review did only identify one article that focused specifically on these issues.

4.1. Research limitations and implications

The literature review was carried out in a structured and systematic way. Six systematic reviews were used in this study, which included 255 articles in total (including several studies published before January 1, 2007). This provided a strong theoretical basis, including insights into a broader context. Because the leadership literature is extensive, only articles applicable to nursing home care were included. On the one hand, the current tendencies and insights in leadership literature are well represented in the literature applicable to nursing home care. On the other hand, the leadership literature in this sector is still relatively new. This may yield articles that take an exploratory approach. Also, the definition of “nursing home care” may differ between countries as will the services or care which are captured under this term. Furthermore, relevant insights in nursing home care are often shared in non-academic documents or grey literature. This study only focused on the academic literature. This “publication delay” could explain that literature on relatively new leadership-related tendencies such as self-organization, self-management and autonomous teams, was not available.

The results of this study show that a broad range of leadership behaviors is evident in nursing home care. Further investigation of behaviors that match particular contexts or situations would be relevant. The behaviors identified in this review provide insight into leadership in nursing home care, but more research is needed on how this is reflected in practice. Characteristics such as involvement and appreciation mainly focus on the result of leadership behavior, while more knowledge could be gained about how to actually achieve this. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Another relevant avenue of research is the impact of cultural aspects on leadership. Research demonstrates that leadership-related culture and values may differ across settings and countries ( Ardichvili and Kuchinke, 2002 ; Chhokar et al. , 2007 ; Hofstede, 2011 ). Examples are power distance, masculinity, uncertainty avoidance and long-term orientation ( Hofstede, 2011 ). These core values could influence leadership approaches and behaviors in practice. Our review includes studies from various, mainly Western, countries such as the USA, Canada, Australia, England and multiple Scandinavian countries. The included articles do not explicitly reflect on the cultural aspects of leadership. More insight into what the exact impact of these aspects is would be relevant. Finally, an interesting research question would be to compare how leadership behavior is perceived by the different people involved. The role of informal leadership and the dynamics in collaborating networks could also be interesting topics for further research.

5. Conclusions

In conclusion, because leadership in nursing home care is multidimensional and influenced by multiple factors, no specific type of leadership can be considered as most appropriate. Furthermore, this review showed a high level of overlap between the behaviors of the many types of leadership presented in the articles included. It is, therefore, questionable whether leadership styles are a useful vocabulary in the debate on leadership in nursing homes. Moreover, the current tendency toward flat organizations, decentralization and self-direction transforms leadership into a more collective undertaking that transcends hierarchy and encompasses behavior, context and people. Tendencies toward networks of collaborating organizations require new leadership competencies that transcend organizational boundaries and interests. Therefore, a stronger focus on leadership behaviors in relationship to specific contexts instead of the application of leadership styles could provide more insight into what is needed when and what works.

The findings of this study show that leadership is a complex and multidimensional phenomenon, which is determined by multiple internal and external factors. Employees of nursing homes have to be aware that the success of leadership is determined by the interplay between behavior and several contextual factors and the various people involved. Furthermore, the study findings suggest focusing more on leadership behaviors instead of styles. Although thinking in leadership styles could be helpful in terms of categorization and framing, a broader and more conceptual perspective on leadership could be helpful in providing more insight into the underlying mechanisms and behaviors that play a role in leadership. First, a broader perspective implies that leadership should be seen as more than merely a function for managers and team leaders ( Martin and Learmonth, 2012 ). It should be constructed as something to be enacted by all employees across an organization. Second, the broader perspective also means that one has to be aware that leadership processes take place at multiple layers in an organization, e.g. in the care setting, in professional interaction or at the board level. Third, people in organizations could benefit from more awareness of their leadership behavior and how this fits with the current context, circumstances and developments.


Funding : The research is funded by the Dutch Ministry of Health as part of the W&T Program. The Ministry of Health had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

Competing interests : The authors declare that they have no competing interests.

Availability of data and materials: The data sets used during the current study are available on request.

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  • Open access
  • Published: 28 March 2024

Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study

  • Rachel Gilbert 1 &
  • Daniela Lillekroken   ORCID: orcid.org/0000-0002-7463-8977 1  

BMC Nursing volume  23 , Article number:  216 ( 2024 ) Cite this article

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Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto’s theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.

The content analysis generated five categories that were labelled similar to Tronto’s five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses’ autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto’s theory contributes to greater reflectiveness around what may constitute ‘good’ end-of-life care.


Tronto’s care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto’s care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what ‘good’ end-of-life care should be.

Peer Review reports

In recent decades, improving end-of-life care has become a global priority [ 1 ]. The proportion of older residents dying in nursing homes is rising across the world [ 2 ], resulting in a significant need to improve the quality of end-of-life care provided to residents. Therefore, throughout the world, nursing homes are becoming increasingly important as end-of-life care facilities [ 3 ]. As the largest professional group in healthcare [ 4 ], nurses primarily engage in direct care activities [ 5 ] and patient communication [ 6 ] positioning them in close proximity to patients. This proximity affords them the opportunity to serve as information brokers and mediators in end-of-life decision-making [ 7 ]. They also develop trusting relationships with residents and their next-of-kin, relationships that may be beneficial for the assessment of residents and their next-of-kin’s needs [ 8 ]. Moreover, nurses have the opportunity to gain a unique perspective that allows them to become aware of if and when a resident is not responding to a treatment [ 9 ].

When caring for residents in their critical end-of-life stage, nurses form a direct and intense bond with the resident’s next-of-kin, hence nurses become central to end-of-life care provision and decision-making in nursing homes [ 10 ]. The degree of residents and their next-of-kin involvement in the decision-making process in practice remains a question [ 11 ]. Results from a study conducted in six European countries [ 12 ], demonstrate that, in long-term care facilities, too many care providers are often involved, resulting in difficulties in reaching a consensus in care. Although nurses believe that their involvement is beneficial to residents and families, there is a need for more empirical evidence of these benefits at the end-of-life stage. However, the question of who should be responsible for making decisions is still difficult to answer [ 13 ]. One study exploring nurse’s involvement in end-of-life decisions revealed that nurses experience ethical problems and uncertainty about the end-of-life care needs of residents [ 14 ]. Another study [ 10 ] reported patients being hesitant to discuss end-of‐life issues with their next-of-kin, resulting in nurses taking over; thus, discussing end-of-life issues became their responsibility. A study conducted in several nursing homes from the UK demonstrated that ethical issues associated with palliative care occurred most frequently during decision-making, causing greater distress among care providers [ 15 ].

Previous research has revealed that there are some conflicts over end-of-life care that consume nurses’ time and attention at the resident’s end-of-life period [ 16 ]. The findings from a meta-synthesis presenting nurses’ perspectives dealing with ethical dilemmas and ethical problems in end-of-life care revealed that nurses are deeply involved with patients as human beings and display an inner responsibility to fight for their best interests and wishes in end-of-life care [ 17 ].

Within the Norwegian context, several studies have explored nurses’ experiences with ethical dilemmas when providing end-of-life care in nursing homes. One study describing nurses’ ethical dilemmas concerning limitation of life-prolonging treatment suggested that there are several disagreements between the next-of-kin’s wishes and what the resident may want or between the wishes of the next-of-kin and what the staff consider to be right [ 18 ]. Another study revealed that nurses provide ‘more of everything’ and ‘are left to dealing with everything on their own’ during the end-of-life care process [ 19 ] (p.13) . Several studies aiming to explore end-of-life decision-making in nursing homes revealed that nurses experience challenges in protecting the patient’s autonomy regarding issues of life-prolonging treatment, hydration, nutrition and hospitalisation [ 20 , 21 , 22 ]. Other studies conducted in the same context have described that nurses perceive ethical problems as a burden and as barriers to decision-making in end-of-life care [ 8 , 23 ].

Nursing, as a practice, is fundamentally grounded in moral values. The nurse-patient relationship, central to nursing care provision, holds ethical importance and significance. It is crucial to recognise that the context within which nurses practice can both shape and be shaped by nursing’s moral values. These values collectively constitute what can be termed the ethical dimension of nursing [ 24 ]. Nursing ethos and practices are rooted in ethical values and principles; therefore, one of the position statements of the International Council of Nurses [ 25 ] refers to nurses’ role in providing care to dying patients and their families as an inherent part of the International Classification for Nursing Practice [ 26 ] (e.g., dignity, autonomy, privacy and dignified dying). Furthermore, ethical competence is recognised as an essential element of nursing practice [ 27 ], and it should be considered from the following viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection.

The term ‘end-of-life care’ is often used interchangeably with various terms such as terminal care, hospice care, or palliative care. End-of life care is defined as care ‘to assist persons who are facing imminent or distant death to have the best quality of life possible till the end of their life regardless of their medical diagnosis, health conditions, or ages’ [ 28 ] (p.613) . From this perspective, professional autonomy is an important feature of nurses’ professionalism [ 29 ]. Professional autonomy can be defined based on two elements: independence in decision-making and the ability to use competence, which is underpinned by three themes: shared leadership, professional skills, inter- and intraprofessional collaboration and a healthy work environment [ 30 ].

As presented earlier, research studies have reported that nurses experience a range of difficulties or shortcomings during the decision-making process; therefore, autonomous practice is essential for safe and quality care [ 31 ]. Moreover, autonomous practice is particularly important for the moral dimension in end-of-life care, where nurses may need to assume more responsibility in the sense of defining and giving support to matters that are at risk of not respecting ethical principles or fulfilling their ethical, legal and professional duties towards the residents they care for.

To the best of the researchers’ knowledge, little is known about nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents; therefore, the aim of this study is to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Theoretical framework

Joan Tronto is an American political philosopher and one of the most influential care ethicists. Her theory of the ethics of care [ 32 , 33 , 34 ] has been chosen as the present study’s theoretical framework. The ethics of care is a feminist-based ethical theory, focusing on caring as a moral attitude and a sensitive and supportive response of the nurse to the situation and circumstances of a vulnerable human being who is in need of help [ 33 , 34 , 35 ]. In this sense, nurses’ caring behaviour has the character of a means—helping to reach the goal of nursing practice—which here entails providing competent end-of-life care.

Thinking about the process of care, in her early works [ 32 , 33 , 34 ], Tronto proposes four different phases of caring and four elements of care. Although the phases may be interchangeable and often overlap with each other, the elements of care are fundamental to demonstrate caring. The phases of caring involve cognitive, emotional and action strategies.

The first phase of caring is caring about , which involves the nurse’s recognition of being in need of care and includes concern, worry about someone or something. In this phase, the element of care is attentiveness, which entails the detection of the patient and/or family need.

The second phase is caring for , which implies nurses taking responsibility for the caring process. In this phase, responsibility is the element of care and requires nurses to take responsibility to meet a need that has been identified.

The third phase is care giving , which encompasses the actual physical work of providing care and requires direct engagement with care. The element of care in this phase is competence, which involves nurses having the knowledge, skills and values necessary to meet the goals of care.

The fourth phase is care receiving , which involves an evaluation of how well the care giving meets the caring needs. In this phase, responsiveness is the element of care and requires the nurse to assess whether the care provided has met the patient/next-of-kin care needs. This phase helps preserve the patient–nurse relationship, which is a distinctive aspect of the ethics of care [ 36 ].

In 2013, Tronto [ 35 ] updated the ethics of care by adding a fifth phase of caring— caring with —which is the common thread weaving among the four phases. When care is responded to through care receiving and new needs are identified, nurses return to the first phase and begin again. The care elements in this phase are trust and solidarity. Within a healthcare context, trust builds as patients and nurses realise that they can rely on each other to participate in their care and care activities. Solidarity occurs when patients, next-of-kin, nurses and others (i.e., ward leaders, institutional management) engage in these processes of care together rather than alone.

To the best of our knowledge, these five phases of caring and their elements of caring have never been interpreted within the context of end-of-life care. The ethics of care framework offers a context-specific way of understanding how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with Tronto’s five phases, which has motivated choosing her theory.

Aim of the study

The present study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The current study has a qualitative descriptive design using five individual interviews and one focus group to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Setting and participants

The setting for the study was four nursing homes located in different municipalities from the South-Eastern region of Norway. Nursing homes in Norway are usually public assisted living facilities and offer all-inclusive accommodation to dependent individuals on a temporary or permanent basis [ 37 ]. The provision of care in the Norwegian nursing homes is regulated by the ‘Regulation of Quality of Care’ [ 38 ], aiming to improve nursing home residents’ quality of life by offering quality care that meets residents’ fundamental physiological and psychosocial needs and to support their individual autonomy through the provision of daily nursing care and activities tailored to their specific needs, and, when the time comes, a dignified end-of-life care in safe milieu.

End-of-life care is usually planned and provided by nurses having a post graduate diploma in either palliative nursing or oncology nursing– often holding an expert role, hence ensuring that the provision of end-of-life care meets the quality criteria and the resident’s needs and preferences [ 39 ].

To obtain rich information to answer the research question, it was important to involve participants familiar with the topic of study and who had experience working in nursing homes and providing end-of-life care to residents; therefore, a purposive sample was chosen. In this study, a heterogeneous sampling was employed, which involved including participants from different nursing homes with varying lengths of employment and diverse experiences in providing end-of-life care to residents. This approach was chosen to gather data rich in information [ 40 ]. Furthermore, when recruiting participants, the first author was guided by Malterud et al.’s [ 41 ] pragmatic principle, suggesting that the more ‘information power’ the participants provided, the smaller the sample size needed to be, and vice versa. Therefore, the sample size was not determined by saturation but instead by the number of participants who agreed to participate. However, participants were chosen because they had particular characteristics such as experience and roles which would enable understanding how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The inclusion criteria for the participants were as follows: (i) to be a registered nurse, (ii) had a minimum work experience of two years employed at a nursing home, and (iii) had clinical experience with end-of-life/palliative care. To recruit participants, the first author sent a formal application with information about the study to four nursing homes. After approval had been given, the participants were asked and recruited by the leadership from each nursing home. The participants were then contacted by the first author by e-mail and scheduled a time for meeting and conducting the interviews.

Ten nurses from four different nursing homes were invited to participate, but only nine agreed. The participants were all women, aged between 27 and 65 and their work experience ranged from 4 to 21 years. Two participants had specialist education in palliative care, and one was currently engaged in a master’s degree in nursing science. Characteristics of the participants are presented in Table  1 :

Data collection methods

Data were collected through five semistructured individual and one focus group interviews. Both authors conducted the interviews together. The study was carried out between April and September 2022. Due to the insecurity related to the situation caused by the post-SARS-CoV-2 virus pandemic and concerns about potential new social distancing regulations imposed by the Norwegian government, four participants from the same nursing home opted for a focus group interview format. This decision was motivated by a desire to mitigate the potential negative impact that distancing regulations might have on data collection. The interviews were guided by an interview guide developed after reviewing relevant literature on end-of-life care and ethical dilemmas. The development of the interview guide consisted of five phases: (i) identifying the prerequisites for using semi-structured interviews; (ii) retrieving and using previous knowledge; (iii) formulating the preliminary semi-structured interview guide; (iv) pilot testing the interview guide; and (v) presenting the complete semistructured interview guide [ 42 ]. The interview guide was developed by both authors prior to the onset of the project and consisted of two demographic questions and eight main open-ended questions. The interview guide underwent initial testing with a colleague employed at the same nursing home as the first author. After the pilot phase in phase four, minor language revisions were made to specific questions to bolster the credibility of the interview process and ensure the collection of comprehensive and accurate data. The same interview guide was used to conduct individual interviews and focus group (Table  2 ).

The interviews were all conducted in a quiet room at a nursing home. Each interview lasted between 30 and 60 min and were digitally recorded. The individual interviews were transcribed verbatim by the first author. The focus group interview was transcribed by the second author.

Ethical perspectives

Prior to the onset of the data collection, ethical approval and permission to conduct the study were sought from the Norwegian Agency for Shared Services in Education and Research (Sikt/Ref. number 360,657) and from each leader of the nursing home. The study was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association [ 43 ]: informed consent, consequences and confidentiality. The participants received written information about the aim of the study, how the researcher would ensure their confidentiality and, if they chose to withdraw from the study, their withdrawal would not have any negative consequences for their employment at nursing homes. Data were anonymised, and the digital records of the interviews were stored safely on a password-protected personal computer. The transcripts were stored in a locked cabinet in accordance with the existing rules and regulations for research data storage at Oslo Metropolitan University. The participants did not receive any financial or other benefits from participating in the study. Written consent was obtained prior to data collection, but verbal consent was also provided before each interview. None of the participants withdrew from the study.

Data analysis

The data were analysed by employing a qualitative deductive content analysis, as described by Kyngäs and Kaakinen [ 44 ]. Both researchers independently conducted the data analysis manually. The empirical data consisted of 63 pages (34,727 words) of transcripts from both individual and focus group interviews. The deductive content analysis was performed in three steps: (i) preparation, (ii) organisation and (iii) reporting of the results.

During the first step—preparation—each researcher, individually, read the transcripts several times to get an overview of the data and select units of analysis by searching for recurring codes and meanings and to carefully compare the similarities and differences between coded data. These codes were labelled independently by both researchers and placed into an analysis matrix.

During the next step—organisation—the researchers met and discussed and then compared and revised the labels several times until they agreed about the preliminary findings. During the interpretative process towards developing an understanding of the empirical data, the content of the labels referred to nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with the five phases of Tronto’s theory of ethics of care [ 32 , 33 ], thus assigning them to the five phases of the theory. Following this final refinement, one main category and five categories, each supported by several subcategories, were identified, as presented in Table  3 .

Reporting the results was the last step in the analysis. To enhance the understanding of the study’s findings, the findings are presented with supporting excerpts from the participants.

In qualitative studies, trustworthiness is the main parameter for appraising the rigour of the study [ 45 ]. To enhance the trustworthiness of the study, four criteria—credibility, transferability, dependability and confirmability, as described by Lincoln and Guba [ 46 ]—were applied.

To support credibility, a detailed description of the sample and the sampling process was provided. Furthermore, the interview guide and the questions that the participants were asked during the interviews are made available to the readers. Moreover, although the data were collected from five individual interviews and one focus group, triangulation of two data collection methods allowed researchers to ensure that the study is based on diverse perceptions and experiences, strengthening the credibility and impact of the study’s findings [ 47 ].

Detailed information about the sample and setting supports the assessment of the transferability of the findings. In this way, the readers can recognise and evaluate whether the findings would be applicable to similar contexts with a similar sample. Quotes from the participants’ statements are given to support the findings. Each quote ends with a number representing the code that each nurse was given before conducting the interviews (i.e., Participant in interview 1, PI1 or participant 6 in focus group interview, P6FG).

To increase dependability, the same interview guide was used to ask all participants the same questions. Dependability was also increased by the researchers reading and analysing the interviews independently and then checking the consistency of the data analysis technique with each other and discussing the analytical process until a consensus was reached.

To enhance confirmability, excerpts from the participants’ statements were included when presenting the findings, thus verifying the concordance of findings with the raw data. This demonstrates that the data were not based on preconceived notions.

Trustworthiness was also supported by member checking, meaning that the researchers sent the participants the transcripts of the interviews immediately after data collection; then, the interviews were transcribed. The participants were asked to review the transcripts and check the accuracy of the data; hence, they had the opportunity to add, remove or clarify their statements. Only one participant answered this request, stating that the transcripts were accurate, and she did not have any further comments. Despite encountering a suboptimal response from participants, the authors remain confident in the trustworthiness of the study. Rich data, derived from a combination of individual and focus group interviews, yielded diverse and nuanced responses from participants, reinforcing the credibility of the findings.

Reflexivity is the researcher’s reflection on their position during the research process [ 48 ]. Both researchers have clinical experience in providing end-of-life care to nursing home residents. Therefore, it was critical to be aware of the impact that their clinical backgrounds might have on the research process from information seeking during the analysis of data and discussion of the findings. To avoid early interpretation of the data, the researchers were aware of their preunderstanding and tried to put it on hold. Both authors engaged in discussions regarding apprehensions and reflections, actively participating in the triangulation process throughout the study to prevent potential bias during data collection, analysis, and interpretation. The theoretical framework was brought in the end of the analysis process, which helped label the emerged findings.

The analysis of the empirical data combined with an ethical reflection helped researchers to identify and understand the moral dimension of nurses’ experiences with end-of-life care provided to nursing home residents. During the analysis, an overarching category emerged– ‘The moral dimension of the provision of end-of life care’– describing nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. The participants agreed that end-of-life care is a care process that undergoes several phases, with each phase having its own ethical quality or its own element of care, here according to Tronto’s moral qualities [ 34 ]. In the following section, the findings are described using Tronto’s identified moral qualities for each of the five phases of the care process [ 32 , 33 , 34 , 35 ].

Caring about—being attentive

For the participants, being autonomous was perceived as a feature that increased their awareness of the resident’s caring needs during their last days of life. The participants agreed that the caring process involves paying attention, listening and recognising residents’ unspoken needs. Moreover, it implies nurses being able to make autonomous decisions when deciding which needs to care about at one particular moment.

The participants agreed that the core values of providing end-of-life care were to alleviate suffering, maintain dignity and provide comfort care. The participants perceived caring about as having sufficient knowledge, along with the experience and autonomy in practice, as well as providing comprehensive end-of-life care for residents. For the participants, caring about during the end-of-life process means them being present and dedicated. This implies nurses carefully observing, autonomously acting, and making decisions based on their judgements, and thus, they can decide and choose their course of action promptly based on resident’s condition or side effects. Moreover, caring about involved participants being attentive to perceiving the residents’ needs when the residents could no longer articulate themselves. The participants expressed their worries about resident’s bodily deterioration, leading them to lose their ability to express needs, as shown by the following quote:

There is not much communication when residents go into their last stage of life. Well… some of them are consciously until their death, but most are sedated; therefore, it is necessary to use your knowledge and experience to assess not only their needs for food and liquids or bodily hygiene, but also, we have to monitor their response to pain killers and other medication, and if it’s too much or too little, we need to do what’s needed to reduce or increase the medication and not let them suffer (PI3).

Some of the participants expressed that attentiveness to the residents’ care needs was a skill based on their clinical gaze developed during their careers. Other participants discussed that building a close relationship with the residents while they still could walk and talk was a precondition that helped them develop a clinical gaze, hence facilitating the nurses’ being attentive. Attentiveness allowed the participants to do what was needed when knowing the residents’ needs during the provision of end-of-life care. This may be interpreted as the moral or ethical quality of caring about during the end-of-life caring process, as demonstrated by the following statement:

We have time to know the resident before their health condition worsens… We previously knew what they wanted and how they wanted… their stay at nursing home gives us the opportunity to know their preferences and needs. Morally, we are obliged to provide the same quality of care they received when they could express themselves (PI4).

Caring for—taking responsibility

According to several participants, another phase within the end-of-life caring process was taking responsibility to care for. The participants agreed that monitoring the residents in their last days implies assuming responsibility. Assuming responsibility was perceived as an autonomous caring activity. They also discussed taking this responsibility seriously, which is a moral dimension of the end-of-life caring process and, ultimately, of the nursing profession. Usually, this responsibility was taken by a nurse, but it also involved other healthcare personnel or even next-of-kin. Among these responsibilities, the participants mentioned that the end-of-life caring process included not only caring for the resident’s physiological and psychosocial needs, but also assigning permanent healthcare personnel to continuously monitor the resident. Although the participants were aware that they share responsibilities for the caring process, ‘who does what…’, they ultimately had the overall responsibility for the whole end-of-life caring process.

Another responsibility included communication, which included listening, providing information, and supporting the residents’ next-of-kin. One of the participants expressed this as follows:

When I observe that the resident’s health worsens, I inform the next-of-kin and invite the spouse or the children to a meeting together with the responsible doctor and I, and we inform the next-of-kin what they might expect. The end-of-life care is not only about the resident and their last days, but also is to care for their next-of-kin to meet their needs and to overcome guilt feelings, anger or sadness.… (PI1).

Another way to care for patients was to deliberately increase opportunities to exercise autonomy during the caring process. For instance, the focus group participants discussed issues around advanced life support during the resident’s last days of life. Being prepared and having knowledge were the preconditions that gave them the authority to identify and make decisions about residents’ needs in here-and-now moments, hence exercising their autonomy. Some participants shared their experiences with controversies between next-of-kins’ and nurses’ assessments of what is the best care for the residents during their last days of life. Therefore, the importance of taking the initiative to discuss and clarify the resident’s needs and preferences was emphasised during the focus group interview, as shown in the following quote:

Some next-of-kins express wishes for advance life support and hospitalisation for their loved ones… and sometimes, to meet their needs, we try this, but the resident is suffering. The resident comes back to us after one or two days… To avoid this, clear guidelines, and a dialogue between the resident, their next-of-kin and us at the very beginning [when the resident enters the nursing home] is important… I think that minimalising the occurrence of difficult or conflictual situations and relieving the sufferance is care for both resident and their next-of-kin (P8FG).

Care giving—knowing what, why, how and when

During the interviews, the participants also discussed the caregiving process and provided concrete examples of what their caregiving encompassed. Spending extra time with the resident, choosing to be in the room and holding their hand to maintain physical contact was perceived as an autonomous caring act and a deliberate choice. One participant described this as follows:

For me, it is important that the dying person feels or hears that I am here with him or her… how he or she feels in these moments matters to me. I do it because I want to do it.… (PI5).

Other participants said that being autonomous when they actually provided caregiving to residents helped them make continuous assessments based on knowledge about what , how , how much , when and why to care. Knowledge and skills were decisive factors in providing competent care and making autonomous decisions during the caregiving phase; hence, competence was perceived as a moral dimension of caregiving. One of the participants said the following:

Caregiving at end-of-life is not only about giving morphine according to the doctor’s prescription… it involves all the judgements you have to make, all the skills you have… from preventing the occurrence of bedsores to knowing when to stop feeding but preventing thirst… think about all this knowledge and experience you must have to be able to make autonomous bedside judgements about when , why and so on.… (PI2).

Care giving at the end-of-life was described as all the necessary activities a nurse does to provide comfort and compassionate care to a dying resident. Among these activities, providing fundamental care and keeping residents comfortable and free of pain were seen as parts of the caregiving process. Moreover, adequate pain relief and symptom management were described as the moral dimension of care giving at this stage of end-of-life care, as one of the participants from the focus group interview said:

You cannot be passive when you see that the resident is suffering. I cannot go home and think that I should have done one or the other. It is against the nurses’ code of ethics and my personal moral and ethical principles. You have to act… I have to do what is needed… first thing first… pain relief and then personal hygiene! (P9FG)

Some of the participants mentioned some challenges they encountered during the care giving process. They said that care giving implies also standing in demanding situations. The lack of healthcare personnel with necessary knowledge or formal palliative care education or handling ethical dilemmas was seen as demanding situations that influenced the provision of care giving. Most of the participants felt that they were alone during the decision-making processes, which increased their awareness of their professional autonomy:

Sometimes, during weekends or evenings, I am the only nurse among the healthcare staff, and I have an overall responsibility for all nursing home residents. I have to prioritise who gets my attention and who needs me the most. Things can happen, regardless of whether it is Friday evening or weekend. I have to make a decision and do what is needed: to be with the dying resident and to support his or her next-of-kin in that moment. (PI5)

Care receiving—assessing caregiving

Several participants stated that, during the care-giving process, it was important to assess how the resident receive the care provided at the end-of-life stage. This was possible by monitoring the resident’s state of being but to also assess the outcomes of their care giving activities. They also reflected on their assessments and how they subsequently dealt with those assessments.

All the participants were confident in their knowledge and with their care giving at the end-of-life stage. They were aware that their care activities had consequences for the residents’ physiological and psychosocial needs. The assessment of the resident’s state of being was made by nurses listening, observing and interpreting resident’s response to care giving as signs of comfort or discomfort. One of the participants explained this as follows:

When providing personal care, if the resident presents any signs that can be interpreted as discomfort, I think that priority number one is me not causing more pain or suffering. However, I also understand that this person needs more pain killers, so I have to make sure that this person receives adequate medicine. (PI5)

Some participants also discussed the importance of assessing their care giving activities. They mentioned the importance of their assessments of the benefits of all care giving against the burden of all interventions and treatments. Their professional autonomy allowed them to make decisions about how to eschew care giving that was inappropriately and burdensome and choose the best comforting care for the resident. The participants stated that knowledge and experience were important in making such decisions, and their professional autonomy facilitated making choices of the best and less burdensome care giving. One of the participants said the following:

We have to assess whether the care giving provided meets the resident’s needs or not, whether the care comforts or perceives it as a burden and how the resident responds to this provision of care. (PI4)

During the interviews, some of the participants revealed a feeling of guilt when assessing that care giving altered the resident’s state of being, thus leading to new needs for care. They also discussed that the moral obligation and intention to relieve the suffering of the resident should override the foreseen but unintended harmful effects of care giving, including medication or other care interventions. One of the participants shared her experience as follows:

I still remember the attitude some of us had for a while ago… too much or too often morphine depresses the respiration and leads to death… I was struggling with feelings of guilt and even moral distress when I observed residents were still suffering because the medication they received had little or maybe no effect. I called the doctor and explained the situation… usually, the experienced doctors listen to us… and he [the doctor] prescribed more morphine.… (PI3).

Documentation of the response to care giving was also an issue discussed during the interviews. Some participants emphasised the importance of keeping detailed reports for a proper assessment of the care giving and medication and its outcomes. All reports were digitally written. Informal discussions between nurses and next-of-kin were also documented, especially when next-of-kin evaluated the care their loved ones received. The participants indicated that the more written information there was, the better. One participant acknowledged the following:

There is no such thing as ‘too much information’… being open about the morphine’s side effects and what to expect in the next hours or days is important for them [next-of-kin]. It helps them understand that end-of-life care is a process, not a quick fix procedure. (PI5)

Caring with—It is a teamwork process

During the interviews, most of the participants reflected upon the end-of-life caring process and its occurrence within the context of care in nursing home. The participants discussed that end-of-life care is not only about the responsibilities nurses have towards residents and their next-of-kin, but also the responsibilities of others who may influence the caring process. They perceived the caring process as an interplay between residents, next-of-kin, and themselves, along with how they relate to each other, which influences the caring process. However, as several participants asserted, this process did not occur in a vacuum: it occurred within an organisational context, which then influenced the caring process from the very beginning. One participant emphasised the importance of stable healthcare personnel within a caring organisation:

High staff turnover does not facilitate good end-of-life caregiving. Both residents and their next-of-kin need continuity and predictability in caring for and among healthcare personnel. They need somebody they know and trust… being exposed to new people every day increases their stress levels. (PI1)

Other participants discussed the importance of the leadership style and how the leader’s support influenced the culture of end-of-life care at the ward. The participants revealed that, within a caring context where their natural potential was enhanced through an enabling leadership style, they felt that they could provide competent and compassionate end-of-life care. One of the participants from the focus group stated that a positive leadership style supports nurses’ professional autonomy, thus helping them control the caring process, to have independence and to increase their ability to make clinical decisions and competent judgements regarding resident’s end-of-life care. One participant shared her experience as follows:

My leader gives me the freedom to make decisions when it comes to deciding what is best for the resident… She [the leader] enables me to be autonomous during the caring process, and this makes me aware of what and how to care.… (PI2).

The participants from the focus group interview also discussed how the nursing home’s caring culture influences care practice. They perceived the nursing home’s caring culture as positive, enabling good end-of-life care but also defective and an obstacle to care. They emphasised the importance of providing dignifying end-of-life care for residents. During the focus group interview, two of the participants engaged in a dialogue:

End-of-life care is providing care to the most vulnerable people, and it should be dignified… To do so, I have to provide care in a ‘caring room’ filled with dignity. (P7FG) Although next-of-kin and I have different perspectives of what good end-of-life care might be, we care together, we are a caring team which ensures in our own way that the resident receives competent care.… Yes, you [P7] mentioned this ‘caring room’… maybe we should open the door more often into this room and invite next-of-kin. (P6FG)

The aim of the present study was to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. In the following, we discuss these perceptions in relation to Tronto’s [ 32 , 35 ] ethics of care framework and other supporting literature. To identify the moral dimension of these perceptions, we have related them to the moral qualities corresponding to each phase of the care process, as described by Tronto [ 33 , 35 ].

In the first phase of the care process—caring about—the participants discussed the importance of being attentive to which type of care needs to be provided, which is the moral quality of the first phase of care. Similar to findings from another study [ 49 ], findings from the present study revealed that some participants perceived autonomous practice as carrying out actions based on their decisions. Caring about entails detecting the resident’s needs, hence obliging nurses to ‘do something’ [ 50 ]. This particular skill was seen as an autonomous caring activity, that is, the nurses’ deliberate choice of putting on hold their self-interest and/or agenda and ‘a capacity genuinely to understand the perspective of the other in need’ [ 35 ] (p.34) , here nursing home resident.

In Tronto’s view [ 33 ], nurses’ attentiveness contributes to building up a caring relationship with a patient. The findings from the current study reveal that nurses perceived the provision of competent and compassionate end-of-life care as a result of their clinical gaze developed through certain activities, attitudes and knowledge of the patient, and through mutual relationships between the residents, next-of-kin and them. These results are supported by findings from previous studies that emphasise the importance of the nurse’s past experiences with the resident [ 51 ] and the significance of developing a good relationship with the resident and their next-of-kin [ 8 , 23 , 52 , 53 , 54 ] to provide adequate care. Moreover, similar to findings from other studies [ 55 , 56 ], the present study reveal that, to respond to the resident’s end-of-life care needs, nurses must bring not only their professional knowledge, clinical experience and ability to work autonomously but even ethical sensitivity. These findings enforce Gastman’s [ 50 ] view on caring, in which caring should respond to the patient’s care needs. This involves nurses having empathy, capacity of judgement and the ability to see what is required in a specific situation (here, end-of-life care), which, according to Gastmans [ 50 ], is inherent in the moral dimension of nursing practice.

The second phase of care—caring for—refers to nurses taking on the burden of meeting the needs identified in the first phase, that is, caring about. There was no ambiguity, and the participants had no doubts regarding who had the responsibility for the provision of end-of-life care to nursing home residents. The nurses’ responsibility was seen as a moral dimension of care. In line with Pursio et al.’s study [ 30 ], the present findings indicate that the freedom to make patient care decisions and work independently has a positive impact on the moral dimension of end-of-life care for nursing home residents. However, nurses’ work was not only about meeting residents’ needs, but also to create a safe milieu, a communicative space together with each other and with the resident’s next-of-kin, thus sharing power and control over the care process. Similar findings are displayed in an integrative literature review [ 53 ], demonstrating that a positive culture of collaborative and reciprocal relationships, a willingness to engage and become engaged and nurses communicating with intent to share and support rather than inform all lead to facilitating decision-making in nursing homes. According to Tronto [ 35 ], to facilitate end-of-life decision-making, nurses must take the initiative to allocate responsibilities; otherwise, the nurses withdraw themselves from their responsibility. By exercising their professional autonomy to assign responsibilities, nurses strive to mitigate the power imbalance among residents, their next-of-kin, and themselves, thereby preventing the occurrence of potential power struggles in their relationships [ 34 ]. This proactive approach helps prevent the emergence of end-of-life care dilemmas that could undermine the moral dimension of end-of-life care.

The third phase of care—care giving—requires, according to Tronto [ 35 ], the moral quality of nurses’ competence, meaning nurses directly engaging with care. The findings revealed that the nurses provided end-of-life care, and to do so, they needed to have competence, which implies the nurses having the knowledge, skills and values necessary to know what, why, how and when to provide end-of-life adequately. In addition, good end-of-life care requires the competence to individualise care—to provide competent care based on the resident’s physical, psychological, cultural and spiritual needs [ 57 ] while considering the resident’s context of care. Nurses’ competence is crucial for their autonomy; however, to effectively utilize their competence, nurses must be capable of assessing care needs and responding promptly [ 30 ]. Otherwise, delays in assessing residents’ care needs could undermine the moral dimension of end-of-life care. To provide individualised competent care, it is necessary that nurses make continuous assessments. As the findings reveal, the nurses were concerned with providing competent care, that is, adequate pain management. If the care provided was incompetent and led to more pain for the resident, the nurses perceived psychological distress—a state of being that resulted in response to a variety of moral events—leading to the nurses feeling anger, frustration, guilt, powerlessness and stress [ 58 ]. According to Tronto [ 34 ] (p.17) , ‘incompetent care is not only a technical problem, but a moral one’; however, as the findings reveal, the provision of competent care also depends on the nurses’ ability to prioritise decision-making when standing alone. Although nurses’ professional autonomy enabled them to make decisions and choose the right what , how , how much , when , and why , the lack of adequately educated healthcare personnel make the decision-making process a technical problem, which could weaken the moral dimension of end-of -life care.

The fourth phase—care receiving—involves the moral quality responsiveness. This means nurses being responsive to the reaction of the nursing home residents to end-of-life care process. As the findings have revealed, nursing home residents are vulnerable to nurses’ act of care or lack of care. According to Gastmans [ 59 ], care is a reciprocal practice that occurs within the framework of a relationship between the care provider (nurse) and care receiver (resident). The reciprocity consists of nurses assessing that the care provided actually meets the resident’s needs for pain management and other physiological and spiritual needs. The nurses had to make autonomous end-of-life care decisions to meet the resident’s needs. This involved the nurse’s attention to care giving to not be perceived as power abuse, which could have negative consequences for the moral dimension of end-of-life care provision.

According to Tronto [ 33 ], vulnerability may lead to unequal relationships where power abuse may occur. Nursing home residents are in a vulnerable position because they rely on nurses’ competence and ability to alleviate suffering and assess and reassess the residents’ responsiveness to pain management. To avoid an unequal relationship between resident and nurse, nurses must assess whether the care provided is competent or incompetent. Besides assessing and documenting the care provided and its outcomes, informal discussions between the resident’s next-of-kin and nurses were also assessed as important for next-of-kin perceiving a balanced power and equal position within the relationship. However, because each end-of-life act of care may alter the resident’s state of being, responsiveness requires more attentiveness [ 34 ]. Nurses must therefore meet the resident’s new needs for care with compassion and a commitment to maintaining the highest quality of life throughout the evolving stages of the resident’s end-of-life journey.

The final phase of care—caring with—requires that solidarity and trust are the foundation of all care giving to meet caring needs [ 35 ]. The moral quality of this caring phase is solidarity. The findings from the present study suggest that the nurses felt solidarity with both the residents and their leaders. The nurses felt that they were given the support and freedom to act autonomously when making decisions regarding end-of-life care, but similar to findings from a previous study [ 22 ], they also recognised the impact that organisational factors, such as leadership and care culture, may have on the justice and equality of the care provided when they prioritise care to whom needed it the most. Similar to findings from another study [ 49 ], participants in the present study described autonomy as the ability to make independent decisions and prioritise care for those who needed it most. However, according to Tronto [ 35 ], all nurses have a responsibility to help determine how care activities and responsibilities should be allocated. Residents, their next-of-kin and other healthcare personnel may have different views on how they may perceive appropriate, compassionate and dignified end-of-life care [ 20 , 21 ].Therefore, it is important to have transparency in nurse–resident–next-of-kin relations if the element of power within the relationship should be replaced by trust. Otherwise, the nurses’ autonomy may negatively influence the moral dimension of end-of-life care provided to nursing home residents. By opening the door of the “caring room” and inviting next-of-kin to participate in the care process, nurses may contribute to a greater reflectiveness around what may constitute ‘good’ end-of-life care.

Strengths and limitations

One of the strengths of the study is the use of Joan Tronto’s theory of the ethics of care [ 32 , 34 , 35 ] and its five phases and elements of care to discuss the study’s findings. This allows a deeper understanding of how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. Another strength lies in the utilisation of two distinct methods of data collection: individual and focus group interviews. These approaches provided diverse datasets that shed light on various aspects of how nurses’ professional autonomy impacts the moral dimension of end-of-life care. Furthermore, the inclusion of participants with varying work experiences from four nursing homes enhances the richness and depth of the data generated from the interviews, further strengthening the quality of the study. Member checking ensures that the researcher’s interpretations accurately reflect the participants’ experiences and perspectives, thereby enhancing the validity of the study. This practice can be considered one of the methodological strengths of the study.

The current study has also some limitations that need to be considered. First, a limitation may be related to the size of the participant sample. The sample consisted of only nine nurses, a number that may be seen as a limitation in data collection. To challenge this limitation, the researchers posed follow-up questions during the interviews, thus offering the participants the opportunity to provide rich descriptions of their experiences with end-of-life care. Even though the sample consisted of only nine nurses, these participants reflected on and described their everyday work experiences. The participants’ rich descriptions were evaluated as possessing sufficient information power [ 41 ], thereby enhancing the overall quality of dialogues during interviews– a notable strength.

Second, the findings are limited to these nine participants and their personal work experiences in four different Norwegian nursing homes. This means that the sample is small and context dependent, which may limit the transferability and generalisability of the findings.

A third limitation pertains to the potential influence of the chosen theoretical framework on researchers’ preunderstanding during data analysis. To avoid bias, the theoretical framework was introduced at the end of the data analyses and after the coding process was conducted. The theoretical framework contributed to situating the knowledge from the empirical data into theoretical knowledge and vice versa. However, to be certain about interpretations and knowing that the qualitative nature of the study cannot completely exclude the impact of the preunderstanding on the analysis of the data, both researchers were aware of their theoretical preunderstanding and tried not to make conclusions beforehand.

The ethics of care framework provides opportunities for nurses to analyse their own caring activities during the provision of end-of-life care to nursing home residents. The exploration of the moral dimension of the provision of end-of-life care, utilising Tronto’s theory, revealed that moral qualities, such as attentiveness, responsibility, competence, responsiveness, and solidarity are influenced to a certain extent by nurses’ autonomy. What is crucial for the provision of competent end-of-life care is the nurses’ awareness of acting properly in accordance with the moral qualities to each of the phases of caring. Therefore, to provide competent end-of-life care nurses must be attentive to residents’ care needs, take on the responsibility for the care provided to ensure that residents’ needs are met, provide competent care based on knowledge, skills and values and assess how residents respond to the care provided. In other words, this is the basic nursing process in action, and this problem-solving approach is needed for the provision of competent end-of-life care.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Oslo Metropolitan University.


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We would like to express gratitude to the nurses who participated in this study, thereby contributing to the data collection. Additionally, we extend our thanks to the Oslo Metropolitan University Library for granting approval and for their support in covering the publication fee of this article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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D.L. contributed to the study conception, data collection, and analysis, and wrote the main manuscript text. R.G. was involved in data collection, analysis, reflection, and manuscript writing. D.L. was responsible for administrative work related to journal submission and was also involved in reviewing and editing the manuscript. R.G. and D.L. have read and approved the manuscript before submission.

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The Norwegian Agency for Shared Services in Education and Research approved the study protocol (Sikt/Ref. number 360657) and concluded that the study was not subject to the Norwegian Health Research Act (LOV-2008-06-20-44; https://lovdata.no/dokument/NL/lov/2008-06-20-44 ). An English version of the Norwegian Health Research Act can be found at: https://www.uib.no/en/med/81598/norwegian-health-research-act . This study does not aim to get insight into participants’ health status, sexuality, ethnicity, and political affiliation (sensitive information), therefore, no additional approval from a local ethics committee or institutional review board (IRB) was necessary to be obtained to conduct the study. This study was performed according to principles outlined in the Declaration of Helsinki, and in accordance with Oslo Metropolitan University’s guidelines and regulations. Data were kept confidential and used only for this research purpose. The researchers provided verbal and written information about the study. Informed consent was obtained from all participants prior data collection.

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Gilbert, R., Lillekroken, D. Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study. BMC Nurs 23 , 216 (2024). https://doi.org/10.1186/s12912-024-01865-5

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DOI : https://doi.org/10.1186/s12912-024-01865-5

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Abuse Occurring in Nursing Homes

  • Categories: Nursing Home

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Words: 700 |

Published: Aug 30, 2022

Words: 700 | Pages: 2 | 4 min read

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