Recognizing dying by staff in long-term care

This study describes how staff in long-term care facilities recognize dying in residents. From the staff interviews, a process of increasing death awareness was revealed identifiable through five cue groups. "Ambiguous Cues" begin the process in which an adverse event precipitates thinking about the end of life and culminates in "Decision Cues." "Ready-to-Go Cues" mark the resident's preparation for dying and culminate with the "Withdrawing and Saying Goodbye Cues." "The Look About Them Cues" indicate that death is imminent. A counter process of diminishing death denial was also noted and the interaction between the two processes caused staff tension. The continuum of death denial is represented at one end by the theme "We Don't Say It" and at the other by "We Don't Shut the Door," in which the staff actively ensure that all persons can say goodbye to the dying resident.