Navigating preferences for a trouble-free transition: a grounded theory study among older residents in nursing homes

With rising demand for hospice and palliative care nursing (HPCN) in nursing homes (NHs) worldwide, understanding older residents' HPCN preferences has become increasingly crucial. Given the diversity of these preferences across cultural and institutional contexts, a context-specific understanding is essential to developing services truly meet individual needs. Existing research mainly focuses on specific end-of-life aspects and lacks integrative frameworks to explain how broader HPCN preferences are shaped. This study aims to explore how older residents form their HPCN preferences within the interplay of Chinese cultural values and institutional environments and develop a theoretical framework explicating this formation process.

Using a grounded theory approach with purposive and theoretical sampling, 20 participants were selected from 5 NHs across urban and suburban areas. Data collection involved in-depth, semi-structured face-to-face interviews conducted between October 2021 and January 2022, with concurrent analysis based on Corbin and Strauss's method.

The analysis identified two contextual conditions shaping residents' preferences for HPCN: cultural context and NH environment. These conditions created cognitive and emotional challenges, categorized into limited understanding of HPCN and psychosocial disconnection. Consequently, residents expressed four main preferences: physical and emotional comfort, supporting relationality, collaborative decision-making, and continuity of care. A bidirectional relationship emerged, wherein challenges influenced preferences, and meeting these preferences helped mitigate challenges. Ultimately, the core concept of "navigating preferences for a trouble-free transition" emerged, capturing the varied and evolving preferences of older residents seeking care that minimizes burdens on both themselves and their families.

This study developed a theory on how contextual conditions and residents' cognitive and emotional challenges shape HPCN preferences. It highlights the diversity, variability, and individuality of these preferences, underscoring the need to enhance cultural sensitivity and care environments in Chinese NHs and comparable settings.