Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences
Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences
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DOI：
10.1186/s12913-018-3515-x
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发表时间：
2018-09-12
影响因子：
2.8
通讯作者：
Lykkeslet, Else
中科院分区：
文献类型：
--
作者：
Midtbust, May Helen;Alnes, Rigmor Einang;Lykkeslet, Else
背景：痴呆症已成为世界范围内的一个主要公共卫生问题，原因是其患病率迅速上升，长期护理机构中与痴呆症相关的死亡人数不断增加。本研究的目的是检查卫生专业人员在为长期护理机构中的严重痴呆症患者提供姑息治疗方面的潜在障碍和促进因素的经验。方法：定性描述性研究。数据收集自4个焦点小组和20个与4个挪威养老院的医疗保健专业人员进行的个人深度访谈。按照布劳恩和克拉克的说法，这些数据是通过主题文本分析来分析的。结果：主要发现表明，卫生保健专业人员经验缺乏连续性的主要障碍，以促进姑息治疗。时间压力和效率要求的提高尤其影响到最虚弱和卧床不起的痴呆症患者。医疗保健专业人员在想要花更多的时间照顾每个病人和感到帮助每个人的压力之间感到矛盾。虽然资源稀缺，但医疗专业人员总是优先考虑临终病人，要么雇用额外的人员，要么重组任务，以方便有人留在临终病人身边。先进的护理规划被强调为提供缓和医疗的促进因素，但是护士和医生中大量使用临时工作人员以及在庇护病房和长期病房之间的重新安置威胁到规划和提供缓和医疗的连续性。结论：研究结果表明，医疗保健专业人员经历了几个结构性障碍，阻碍了长期护理机构向严重痴呆症患者提供姑息治疗。对经济理性的要求越来越高，导致护理缺乏连续性。应该实施组织变革，例如提高长期雇员的能力和比例的措施，以及预防负担沉重的临终过渡，以改善护理的连续性和质量。
Background: Dementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals' experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities.Methods: This was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke.Results: The major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care.Conclusions: The findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care.