Registered nurses’ experiences of caring for people with dementia at the end of life in nursing homes during the Covid-19 pandemic: a grounded theory study

Malinki, Tidziwe 2026. Registered nurses’ experiences of caring for people with dementia at the end of life in nursing homes during the Covid-19 pandemic: a grounded theory study. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

People living with dementia often present with complex care needs as they approach the end of life, which can necessitate nursing home admission. In the United Kingdom (UK) Registered nurses are pivotal in providing and coordinating end-of-life care for people living with dementia. However, little is known about the experiences of registered nurses of caring for people living with dementia at the end of life in nursing homes. Therefore, it is difficult to understand the challenges the nurses encounter in the delivery of end-of-life care for people living with dementia in nursing homes. This thesis aims to explore the experiences of registered nurses in providing end-of-life care for people living with dementia in nursing homes. A qualitative Straussian grounded theory (Strauss and Corbin 1998) study was conducted involving four nursing homes in South Wales. Eighteen registered nurses were recruited for this study using purposive and theoretical sampling approaches. Data was collected between February and December 2021 using semi-structured in-depth interviews. Interview transcripts, field notes and memos were analysed using constant comparative analysis. The analysis, assisted by NVIVO software, integrated open, axial, and selective codes which assisted in the development of main categories and grounded theory for this study. Three main categories were generated from the data which included the participants’ experiences of residents’ ‘end-of-life care wishes and preferences’, the ‘organisation and delivery of end-of-life care’, and ‘moral distress’. The core category of ‘interpersonal relationships’ led to the generation of the grounded theory which carries implications that extend well beyond the pandemic context. The findings of this study reveal a Relational Paradox; the quality of interpersonal relationships that existed among nurses, residents, and families, enabled good care but also caused moral distress when that care was constrained. The COVID-19 pandemic disrupted these relational foundations, severing the connections upon which quality care depended. This study, therefore, recommends structural changes that value relational continuity, invest in workforce stability, create robust systems of emotional support for staff, and ensure that the relational dimensions of care are protected even under conditions of crisis. Given, that the grounded theory in this study is new and original, it needs to be tested, developed, and refined through further research. Keywords: dementia, end-of-life care, experiences, registered nurses, nursing homes, qualitative, grounded theory, interpersonal relationships, moral distress, relational paradox.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Healthcare Sciences
Date of First Compliant Deposit:	12 October 2026
Last Modified:	13 Oct 2026 08:46
URI:	https://orca.cardiff.ac.uk/id/eprint/190120

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