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A discourse of silence: professional carers reasoning about death and dying in nursing homes

Published online by Cambridge University Press:  11 January 2011

JANE ÖSTERLIND ,
GÖREL HANSEBO ,
JANICKE ANDERSSON ,
BRITT-MARIE TERNESTEDT  and
INGRID HELLSTRÖM
JANE ÖSTERLIND*
Affiliation:
School of Health and Medical Sciences, Örebro University, Örebro, Sweden. Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
GÖREL HANSEBO
Affiliation:
Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
JANICKE ANDERSSON
Affiliation:
Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
BRITT-MARIE TERNESTEDT
Affiliation:
Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
INGRID HELLSTRÖM
Affiliation:
Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
*
Address for correspondence: Jane Österlind, Department of Palliative Care Research, PO Box 111 89, Stockholm 100 61, Sweden. E-mail: jane.osterlind@esh.se
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Abstract

Nursing homes are a setting in which death and dying is common. How death and dying is articulated and the actions that take place in a nursing home constitute a discourse that guides the staff in their work. The aim of this study was to explore the discourse of death and dying in nursing homes from the perspective and understanding of the staff. The study draws on Foucault's discourse analysis. Data are from five focus-group discussions held with 28 staff of four different nursing homes in Sweden. The findings show that the discourse had three characteristics: (a) dying was silent and silenced, (b) emotions were pushed into the background, and (c) attentiveness to death arose after the moment of the elderly person's death. The structure of the discourse was characterised by a movement between two positions, avoiding and confronting death, the main focus being on avoidance. The articulation and practices of silence highlight a need to regard dying as a process that requires attention. One way to ensure appropriate attention could be to instil the philosophy of palliative care in nursing homes, including training and support for the staff in their work. The study demonstrates that nursing-home staff need more knowledge and support to enable them to feel that they do a good job.

Keywords

older peopledeath and dyingnursing homestafffocus-group discussionsdiscourse analysis
Type
Articles
Information
Ageing & Society , Volume 31 , Issue 4 , May 2011 , pp. 529 - 544
Copyright
Copyright © Cambridge University Press 2011

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