Hospice in the nursing home: perspectives of front line nursing home staff.
Hospice in the nursing home: perspectives of front line nursing home staff.
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疗养院临终关怀：疗养院一线工作人员的观点。
DOI：
10.1016/j.jamda.2014.07.009
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发表时间：
2014
影响因子：
7.6
通讯作者：
Miller,SusanC
中科院分区：
文献类型：
--
作者：
Unroe,KathleenT;Cagle,JohnG;Dennis,ME;Lane,KathleenA;Callahan,ChristopherM;Miller,SusanC
目的探讨安宁疗护的使用与改善安老院居民的预后有关，而安老院工作人员对安宁疗护的态度影响安宁疗护转介。摘要本研究旨在探讨持证护理员、护士及社工对疗养院安宁疗护的态度。设计、设置和参与者我们对印第安纳州52家养老院的1859名工作人员进行了调查。测量研究数据包括对6个量表问题和3个开放式定性提示的回答。此外，在疗养院照顾安宁疗护病人的受访者被问及安宁疗护的频率：(1)使他们的工作更轻松；(2)在病人出现症状或即将死亡时反应灵敏；(3)使护理协调顺畅；(4)是需要的；(5)教他们一些东西；(6)受到患者/家属的赞赏。回答分为“总是/经常”和“有时/从不”。结果1229份调查符合纳入标准。受访者中，护士占48%，护士占49%，社工占3%；83%的人表示会照顾疗养院的临终关怀病人。“总是/经常”比例最高的语句是“患者/家属感谢额外的护理”（84%）；最低的是“临终关怀使我的工作更轻松”（54%）。社工对安宁疗护的反应性及疗护协调性的正面反应较CNAs多（P= .03及P= .05）。结论绝大多数员工对养老院的临终关怀持肯定态度。大约三分之一的养老院员工认为护理协调比其他方面要低，许多定性评论强调了临终关怀不能满足病人需求的例子，这是改善的重要机会。
ObjectiveUse of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff toward hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers toward hospice care in nursing homes.Design, setting, and participantsWe conducted a survey of 1859 staff from 52 Indiana nursing homes.MeasurementsStudy data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: (1) makes their job easier; (2) is responsive when a patient has symptoms or is actively dying; (3) makes care coordination smooth; (4) is needed; (5) taught them something; and (6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never.ResultsA total of 1229 surveys met criteria for inclusion. Of the respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was ‘patient/family appreciate added care’ (84%); the lowest was ‘hospice makes my job easier’ (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (P= .03 andP= .05, respectively).ConclusionsA majority of staff responded favorably regarding hospice care in nursing homes. About one-third of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement.