Challenges for staff encountering older people's existential concerns: Swedish first-line managers' views. A cross-sectional study.

Aims and objectives: To describe first-line managers' (FLMs) views of the challenges faced by staff when encountering older people's existential concerns in home and residential care.

Methodological design and justification: This cross-sectional study uses a combination of qualitative and quantitative methods.

Ethical issues and approval: The study was approved by the Swedish Ethical Review Authority (ref. number 2014/652 ) and followed the guidelines of the Helsinki Declaration.

Research methods: FLMs in home and residential care were randomly selected and invited to participate. A self-administered questionnaire was distributed online to 467 managers, 136 (29%) of whom completed it.

Results: About 80% of the FLMs reported that their staff members sometimes or frequently had conversations with the older people in their care about existential concerns, including the following topics: thoughts and feelings about meaning in life; losses and longing for meaningful relations; death, fears and uncertainty and supporting meaningful everyday life. About 75% of the managers also reported that their staff sometimes or often had conversations about existential concerns with one another. Major hindrances to existential conversations were reportedly cognitive impairment and aphasia among the older people and insecurity and unwillingness among the staff. Most managers (73%) reported that their staff received support when encountering existential concerns, mostly as individual support from managers or registered nurses.

Study limitations: The main limitation of this study is its low response rate, which is common for digital surveys. Nevertheless, the sample is considered to be representative; therefore, the study holds exploratory value.

Conclusion: Regular conversations among staff, improved conversational skills and the ability to listen reflect on and perceive older people's perspective and life world are needed when encountering older people's existential concerns. FLMs play a crucial role in emphasising and planning staff support on a regular basis.