Hospitalization and Death Acceptance: A Meta-Ethnography of Perceptions of Hospital as a Place of Death for Nursing Home Residents.

BACKGROUND

Efforts to reduce hospital transfers from nursing homes at the end of life have received considerable attention. However, less is known about how hospitals are understood and experienced as places of death for nursing home residents.

OBJECTIVE

To synthesize qualitative evidence exploring stakeholder perceptions of hospital as a place of death for older adults living in nursing homes.

DESIGN

A meta-ethnography of qualitative evidence following the Meta-ethnography Reporting Guidelines (eMERGe). Four bibliographic databases (MEDLINE, CINAHL, PsychINFO and Scopus) were systematically searched to identify all studies published from January 2012 to March 2024.

REVIEW

METHODS

Studies were included if they reported qualitative findings on nursing home residents dying in hospital. Following quality appraisal, first- and second-order constructs were extracted and translated across studies using reciprocal and refutational analysis to develop third-order interpretations.

FINDINGS: Two overarching interpretive themes were generated: (1) Controlling Symptoms of Dying: Comfort and Discomfort; and (2) Acceptance of Death After All Efforts to Save Life Have Been Exhausted. Hospitals were perceived as both impersonal environments and medically resource-rich settings that legitimize death through medical authority.

CONCLUSIONS

Hospitals occupy a paradoxical position in end-of-life care for nursing home residents. While often viewed as clinically oriented and less personal, they are also perceived to provide symptom control and reassurance that 'everything possible' has been done. Addressing these perceptions-alongside strengthening palliative capacity within nursing homes-is essential to supporting residents' preferences and enabling high-quality end-of-life care across settings.

IMPLICATIONS FOR PRACTICE: Nurses can support more person-centred end-of-life care by strengthening palliative symptom management in nursing homes, engaging residents and families in early advance care planning, and improving communication about dying and hospital treatment. These practices may help reduce avoidable hospital transfers and support residents to die in their preferred place.