Care managers' confidence in managing home-based end-of-life care: a cross-sectional study.
Care managers' confidence in managing home-based end-of-life care: a cross-sectional study.
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DOI：
10.1186/1471-2318-13-67
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发表时间：
2013-07-01
期刊：
影响因子：
4.1
通讯作者：
Suzuki M
中科院分区：
文献类型：
--
作者：
Watanabe M;Yamamoto-Mitani N;Nishigaki M;Okamoto Y;Igarashi A;Suzuki M
在日本，越来越多的情况下，护理管理人员（CM）在家中管理老年人的临终（EOL）情况。然而，许多CM报告焦虑，困难和低信心管理这样的照顾，虽然信心被认为是一个重要的决定因素的专业表现。本研究探讨了在管理家庭为基础的EOL情况及其因素的CM的信心。这项横断面研究的参与者是来自日本1,200家家庭护理机构的CM，这些机构是从国家数据库中系统抽样的。参与者被问及他们在管理家庭为基础的EOL情况的整体信心，以及他们的人口，专业和机构的特点。进行多元逻辑回归分析以检查与CM置信水平相关的因素。从458名参与者中获得有效答复（答复率为39.4%）。在受访者中，81.0%（n = 371）为女性;平均年龄49.2岁（标准差= 8.8）。他们的专业背景包括护士（28.2%），护理人员（49.8%），社会工作者（10.9%）和家庭服务员（6.1%）。大约70%的CM表示对管理家庭EOL情况有一定程度的信心。多元Logistic回归分析显示，自信与有护士执照（OR：2.71，95%CI：1.26-6.19）和有额外的工作责任以外的CM，如家庭护理护士或家庭服务员（OR：2.78，95%CI：1.06-4.74）显着相关。与那些没有或只有一次经历的人相比，有多次经历EOL情况的人更经常报告更高的置信水平：OR=2.60（95%CI 1.26-5.50），4-10例OR=7.12（3.21-16.56），11例及以上OR = 33.67（8.14-235.19）。这些结果表明，CM与直接的，动手的经验与EOL护理，或谁管理多个EOL情况下，往往是有信心在管理家庭为基础的EOL情况。鉴于作为CM工作的护士数量正在减少，需要进一步的研究来探索CM需要什么支持来增加他们的信心，特别是当CM没有护理执照和/或EOL情况的经验时。
There are increasing occasions for care managers (CMs) to manage end-of-life (EOL) situations for older persons at home, in Japan. However, many CMs report anxiety, difficulties and low confidence in managing such care, although confidence is considered a significant determinant of professional performance. This study examined the confidence of CMs at managing home-based EOL situations and its factors. Participants of this cross-sectional study were CMs from 1,200 homecare agencies in Japan, which were systematically sampled from a national database. Participants were asked about their overall confidence in managing home-based EOL situations, as well as their demographic, professional and agency characteristics. Multiple logistic regression analysis was conducted to examine the factors associated with CM confidence levels. Valid responses were obtained from 458 participants (response rate, 39.4%). Among the respondents, 81.0% (n = 371) were female; mean age 49.2 years old (standard deviation = 8.8). Their professional backgrounds included nurses (28.2%), care workers (49.8%), social workers (10.9%), and home attendants (6.1%). Approximately 70% of CMs expressed some level of confidence in managing home-based EOL situations. Multiple logistic regression analysis showed that being confident was significantly associated with having a nursing license (OR: 2.71, 95% CI: 1.26–6.19) and having an additional work responsibility other than being a CM, such as working as a homecare nurse or a home attendant (OR: 2.78, 95% CI: 1.06–4.74). Higher confidence levels were more frequently reported among those who had multiple experiences with EOL situations, compared with those who had none, or only one experience: OR=2.60 (95% CI 1.26–5.50) for those with 2-3 cases; OR=7.12 (3.21–16.56) for those with 4-10 cases; OR = 33.67 (8.14–235.19) for those with 11 cases and over. These results suggest that CMs with direct, hands-on experience with EOL care, or who have managed multiple EOL cases, tended to be confident at managing home-based EOL situations. Given that the number of nurses working as CMs is decreasing, further research is needed to explore what support CMs need to increase their confidence, especially when the CMs do not have nursing licenses and/or experience with EOL situations.
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