Let me talk - an advance care planning programme for frail nursing home residents
Let me talk - an advance care planning programme for frail nursing home residents
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DOI：
10.1111/j.1365-2702.2010.03353.x
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发表时间：
2010-11-01
影响因子：
4.2
通讯作者：
Pang, Samantha M. C.
中科院分区：
文献类型：
--
作者：
Chan, Helen Y. L.;Pang, Samantha M. C.
目的和目标。本研究试图测试让体弱的疗养院居民参与预先护理计划 (ACP) 的合理性。背景。预先护理计划促进个人、家庭和卫生专业人员之间关于临终关怀的沟通。然而，由于其敏感性，这种做法很少及时发生。设计。这是一项为期一年的准实验研究，旨在测试让我谈谈 ACP 计划的可行性，其设计受到文献和我们早期工作的启发，针对体弱的疗养院居民。方法。每隔六个月进行三次评估，以监测计划效果。讲故事的方法让参与者将他们的过去、现在和未来串联起来，这是该计划的关键特征。结果。研究结果表明，干预组的治疗偏好稳定性显着更高（kappa = 0 中心点 53，p < 0 中心点 001）。该组中显着更多的参与者也向家人或护理人员传达了他们的治疗偏好（p = 0 中心点 012），优势比为 4 中心点 52。该计划还对减轻参与者的生存困扰产生了积极作用。结论。该计划在澄清参与者的治疗偏好并鼓励他们向重要的其他人传达自己的偏好方面有效。然而，我们还发现，让参与者的家人参与公开讨论仍然很困难。因此，有必要在社区进行广泛推广。与临床实践相关。建议将此类 ACP 项目纳入疗养院护理实践，因为它们可以在轻松的氛围中启动，并作为一个持续的过程来维持。疗养院的护士和居民之间的信任关系可以进行深入的讨论。护士还可以在指导过程、提供信息和调解家庭讨论方面发挥协调者的作用。
Aims and objectives.This study attempted to test the plausibility of engaging frail nursing home residents in advance care planning (ACP).Background.Advance care planning fosters communication among individuals, family and health professionals regarding end-of-life care. Yet, such practice seldom takes place in a timely fashion because of its sensitive nature; thus, the concerns of these residents are often left unattended.Design.This was a one-year quasi-experimental study to test the feasibility of the Let Me Talk ACP programme, with its design being inspired by literature and our earlier work, among frail nursing home residents.Method.Three assessments were conducted at six-month intervals to monitor the programme effects. The storytelling approach, which allowed participants to thread together their past, present and future, was the key feature of the programme.Results.Findings showed that the treatment preference stability was significantly higher in the intervention group (kappa = 0 center dot 53, p < 0 center dot 001). Significantly more participants in this group also communicated their treatment preferences to their family or caregivers (p = 0 center dot 012), with an odds ratio of 4 center dot 52. The programme also had a positive effect on mitigating participants' existential distress.Conclusions.The programme was found effective in clarifying participants' treatment preferences and encouraging them to communicate their preferences to significant others. However, it was also found that involving participants' family in open discussion remained difficult. Extensive promotion in the community is therefore necessary.Relevance to clinical practice.It is recommended that such ACP programmes should be integrated into nursing home care practice, as they can be initiated in a relaxed atmosphere and maintained as an ongoing process. The trusting relationship between the nurse in the homes and the residents enables in-depth discussion. The nurse is also well placed to play the facilitator role in guiding the process, providing information and mediating the family discussion.