Experiences of older people dying in nursing homes: a narrative systematic review of qualitative studies.

OBJECTIVES: To identify and synthesise qualitative research from 2001 investigating older people's (65+ years) experiences of dying in nursing and care homes. METHODS AND OUTCOMES: Eight electronic databases (AMED, ASSIA, CINAHL Plus, Embase, HMIC, Medline, PsychINFO and Scopus) from 2001 to July 2017 were searched. Studies were included if they were qualitative, primary research and described the experiences of dying in nursing or care homes from the perspectives of the older people themselves, their families or staff. Study quality assessment was undertaken to systematically assess methodological quality, but no studies were excluded as a result. RESULTS: 1305 articles were identified. Nine met the inclusion criteria. North American studies dominated. Most used a mixture of observations and interviews. All the included studies highlighted the physical discomfort of dying, with many older people experiencing potentially avoidable symptoms if care were to be improved. Negative psychosocial experiences such as loneliness and depression were also often described in addition to limited support with spiritual needs. CONCLUSIONS: More qualitative research giving a holistic understanding of older people's experiences of dying in residential care homes is needed. Undertaking research on this topic is challenging and requires great sensitivity, but the dearth of qualitative research from the perspectives of those most closely involved in older people's deaths hampers service improvement.

How to record a 12-lead electrocardiogram.

RATIONALE AND KEY POINTS: This article provides a step-wise, practical approach to recording a 12-lead electrocardiogram (ECG) and explores the evidence base that supports the use of this important assessment tool in clinical practice. •A 12-lead ECG is frequently used in a variety of clinical settings, including emergency care, preoperative and post-operative assessment, and primary care. It is used to assess and diagnose patients with suspected arrhythmias, hypertension, coronary heart disease or heart failure.•Correct positioning of the electrodes using anatomical landmarks is essential to ensure an accurate and high-quality ECG recording.•Skin preparation is essential, since suboptimal electrode contact or electrodes being placed where there is a significant amount of dry or dead skin cells, grease, sweat or hair, can negatively affect the quality of the ECG recording. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1.How this article might improve your practice when recording a 12-lead ECG.2.How you could use this information to educate your patients and colleagues on the appropriate technique for recording a 12-lead ECG.