Preparedness for Resident Death in Long-Term Care: The Experience of Front-Line Staff.
Preparedness for Resident Death in Long-Term Care: The Experience of Front-Line Staff.
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长期护理中居民死亡的准备：一线工作人员的经验。
DOI：
10.1016/j.jpainsymman.2015.02.008
复制
发表时间：
2015
影响因子：
4.7
通讯作者：
Burack,OrahR
中科院分区：
文献类型：
--
作者：
vanRiesenbeck,Isabelle;Boerner,Kathrin;Barooah,Adrita;Burack,OrahR
尽管居民死亡在长期护理中是常见的，但很少有人关注提供大部分居民日常护理的注册护士助理(CNA)对这种经历的影响。目的确定与CNA对居民死亡的准备相关的居民、CNA和护理环境的特征，并确定情绪准备与信息准备的不同模式。方法对140名CNA进行半结构化面对面访谈，了解他们关于居民死亡的经历。CNA的特征(例如，个人临终关怀偏好)、CNA对居民状况的感知(例如，对居民状况的了解)、护理环境(例如，来自同事的支持和临终关怀的参与)与情绪和信息准备之间的关联被使用双变量和多变量分析来检验。CNAS支持EOL护理偏好，即想要所有可能的治疗，而不考虑康复的机会，他们可能报告较少的情绪准备。在年龄和任期方面，较高级别的国家金融机构报告的备灾水平较高。来自同事的更多支持和临终关怀参与也与准备的两个方面的更高水平相关，后者尤其是当临终关怀得到CNA的积极评价时。结论拥有更多关于住院状态的信息和护理团队内关于EOL相关挑战的更多交流机会，可能有助于CNA对住院死亡做更多准备，并加强他们提供良好EOL护理的能力。
ContextAlthough resident death is a common occurrence in long-term care, little attention has focused on how prepared certified nursing assistants (CNAs), who provide most of residents’ daily care, are for this experience.ObjectivesTo identify characteristics of the resident, CNA, and care context associated with CNAs’ preparedness for resident death and to determine differential patterns for emotional versus informational preparedness.MethodsOne hundred forty CNAs completed semistructured, in-person interviews concerning their experiences regarding resident death. The associations of CNA characteristics (e.g., personal end-of-life [EOL] care preferences), CNAs’ perceptions of resident status (e.g., knowledge of resident’s condition), and the caregiving context (e.g., support from coworkers and hospice involvement) with emotional and informational preparedness were examined by the use of bivariate and multivariate analyses.ResultsCNAs who reported that their resident was “aware of dying” or “in pain” expressed greater levels of both emotional and informational preparedness. CNAs who endorsed an EOL care preference of wanting all possible treatments regardless of chances for recovery were likely to report lesser emotional preparedness. More senior CNAs, both in regard to age and tenure, reported greater preparedness levels. Greater support from coworkers and hospice involvement also were associated with greater levels of both facets of preparedness, the latter in particular when hospice care was viewed positively by the CNA.ConclusionHaving more information about resident status and more exchange opportunities within the care team around EOL-related challenges may help CNAs feel more prepared for resident death and strengthen their ability to provide good EOL care.
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